Kenneth D. Laxer, MD
Pacific Epilepsy Program, 2100 Webster St., #115
San Francisco, California 94115
Phone: (415) 600-7880
Introduction
Kenneth D. Laxer, MD is Professor of Clinical Neurology and Neurosurgery, University of California San Francisco, and the Medical Director for the California Pacific Epilepsy Program. He received his B.S. in Control Systems Engineering, University of California, Los Angeles and his MD from the University of California, Irvine. He did his neurology and clinical neurophysiology training at the Montreal Neurological Institute, McGill University and a fellowship in cerebellar physiology at the Neurological Sciences Institute, Portland Oregon. His research interests include the development of new neuroimaging techniques, specifically Magnetic Resonance Spectroscopy and the development of new anticonvulsants.
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NIH Neuroimaging in Epilepsy
Patients with epilepsy undergo a number of neuroimaging studies, including magnetic resonance imaging scans, positron emission tomography, magnetic resonance spectroscopy and magnetic source imaging. However, these techniques have not been systematically applied to epilepsy patients. We wish to evaluate the usefulness of these new imaging techniques to see if they provide new information that will help us in the treatment of our epileptic patients.
The surgical outcome for medically refractory epilepsy is improved when there is concordance between Video/EEG telemetry and neuroimaging data. The greater the number of tests implicating a region as the epileptogenic focus, the greater the probability that the patient will be seizure free postoperatively. This proposal will test the hypothesis that for patients with localizing VETs, newly developed, high resolution imaging techniques, including MRSI, diffusion and perfusion imaging will provide greater concordance with VET than a standard MRI.
Several studies have demonstrated the importance of concordance between neuroimaging and the seizure localization by VET. The presence of a lesion on MRI is associated with a significant increase in the percentage of patients with extratemporal epilepsy that become seizure free (67% vs. 44%).
Since the creation of the Epilepsy Center at UCSF, there has been a progressive decline in the number of patients requiring implanted electrodes as MRI scanning improved. In reviewing our surgical population, there is a clear correlation between MRI/VET concordance and positive seizure surgery outcome. In patients with temporal lobe complex partial seizures in whom the MRI demonstrated increased hippocampal T2 signal or evidence of hippocampal atrophy ipsilateral to the VET localization, 95% became seizure free.
The significance of these studies is that the use of newly developed MRI and MRSI techniques may lead to improved epilepsy surgery outcome and reduce unnecessary surgery. As explained above, neurosurgical outcome is greatly improved when concordance of neuroimaging exists. The goal of this research project is to develop the combination of diagnostic measures that best predict surgical outcome. To achieve this goal, VET and three of the imaging modalities employed in this study (PET, MRI, MRSI) will be used to provide classification information. We will develop decision rules to determine which measures (EEG, VET) or combination of measures best predict surgical outcome.
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Dr. Laxer’s CV
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Publications
Click to see List of publications by Kenneth D. Laxer, M.D. in PubMed.
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Links
Center for imaging of Neurodegenerative Diseases (CIND)
Epilepsy Clinical Trial on NeuroPace
NIH Encephalitis Study
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