Functional imaging has potential for tracking changes in cognition during the onset and evolution of epilepsy. Although the concept of imaging such changes over time is an exciting new direction, feasibility remains an open question. The current article outlines a case example in which functional magnetic resonance imaging (fMRI) and event-related potentials (ERPs) were used to monitor memory changes before and after selective temporal lobe resection. From this example, three key methodologic challenges for new-onset epilepsy are identified and discussed. The first challenge relates to the interpretation of results in regions near epileptogenic tissue. We argue that this is best addressed by collecting information from multiple modalities to test for convergent evidence. The second challenge relates to optimizing the methods for sensitivity to detecting changes. In this case, enhanced imaging methods and a region-of-interest approach provide necessary focus. The third and final challenge relates to the practical difficulties of conducting research in new-onset epilepsy cases. We suggest that greater integration of imaging research within the clinical setting is needed.
The example given (monitoring changes after temporal lobe resection ) is something quite distinct from new onset epilepsy, but the authors are presenting it as a starting point for what questions to ask and what problems might arise. “feasibility remains an open question” is a major understatement. How does one track an individual before onset of epilepsy or very soon after onset (the third challenge)? And, what regions should be tracked? It gets to be a very hairy problem. But I appreciate the proposal.