Epilepsy: improving brain scanning to offer chance of surgery to more people
First published on 3 October 2014
Updated on 3 October 2014
What did the project achieve?
“We aim to make life better for people with severe epilepsy,” says Professor Louis Lemieux of University College London. “We are improving brain scanning techniques. We hope this will mean more people have the option of surgery and their chances of being cured are increased.”
More than 500,000 people have epilepsy in the UK.1 Over 60,000 are children and young people.2
People with epilepsy experience seizures, which can be scary and disruptive, and can cause injury. Epilepsy is linked to depression, memory problems and even death. During childhood, it can interrupt learning.
Successful surgery can stop seizures altogether, totally transforming people’s lives. It is considered if people carry on having seizures despite trying medication. Around 30% of people with epilepsy find medication doesn’t work for them.
Sadly, surgery cannot be offered to everyone, because it’s not always possible to pinpoint exactly where seizures are starting in the brain.
“Our new technique combines EEG recordings with MRI scans,” explains Professor Lemieux. “We’ve found that it dramatically increases the sensitivity of brain scans, providing a revolutionary way to identify the source of epileptic activity within the brain. This project has allowed us to measure the real impact of the new imaging technique on the clinical process, providing rare data in the field of epilepsy. We’ve secured more funding, so we can assess the technique’s benefits in a larger group of patients.”
This research was completed on 30 July 2013
Estimates suggest around 450,000 people have epilepsy in the UK.1-2 Around 30% continue to have seizures despite drug treatment.2 For some, successful surgery can cure their epilepsy, offering a life free from seizures. But a significant minority cannot be considered for surgery, because of limitations in brain scanning techniques. Researchers have developed a new technique, which provides extra information by combining EEG recordings with MRI scanning. They are investigating the extent to which it enables doctors to offer the life-changing chance of surgery to more people.
What's the problem and who does it affect?
Living in fear
Each year in the UK, an estimated 30,000 people are diagnosed with epilepsy.2 Anyone can develop epilepsy at any time. Causes include head injuries, strokes or infection of the brain, though sometimes the cause remains unknown.
Around 30% of people with epilepsy continue to have seizures despite trying all suitable drug treatments.2 For some, surgery offers the chance of a cure.
Despite undergoing extensive, time-consuming and expensive tests, around one in four of the people who are considered for surgery cannot go through with it, because it’s not possible to pinpoint the area in their brain in which seizures start.3 Some of the tests involve placing electrodes inside the brain, carrying a risk of infection.
People with chronic, untreatable epilepsy suffer recurrent seizures, which are extremely disruptive and can result in injury, depression, social isolation, memory deterioration and even death. They are more likely to be unemployed and are not allowed to drive.
Even though someone who suffers one seizure a week will spend six days a week unaffected, seizures are unpredictable, coming at any time. Many people live in constant fear of when their next seizure will strike.
What is the project trying to achieve?
An improved brain scanning technique
Over the last 13 years, researchers have developed a new type of brain scanning technique, which combines EEG recordings from electrodes placed on the scalp with a type of MRI scan called functional MRI (fMRI). Preliminary studies performed on selected patients in the laboratory show the combined technique’s promise in offering new hope to some people with epilepsy.4
It is now time to put the combined technique to the test in a hospital setting. Around 120 people with drug-resistant epilepsy who wish to be considered for surgery are taking part in this study. The researchers aim to establish which people are most likely to benefit from the new brain scans and how much the scans help when planning surgery and predicting the outcome of surgery. They are assessing the extent to which the combined technique can increase the number of people who can be considered for surgery.
What are the researchers' credentials?
|Project Leader||Professor L Lemieux PhD|
|Location||Department of Clinical and Experimental Epilepsy, Department of Neuroradiology and Department of Neurosurgery, Institute of Neurology, UCL, London|
|Grant awarded||18 July 2008|
|Start date||27 April 2009|
|End date||30 July 2013|
|Grant code||AP1163, GN1728|
We do not provide medical advice. If you would like more information about a condition or would like to talk to someone about your health, contact NHS Choices or speak to your GP. Please see our useful links page for some links to health information, organisations we are working with and other useful organisations. We hope you will find these useful. We are not responsible for the content of any of these sites.
Action Medical Research has supported this research team’s work on advanced methods of brain scanning for many years. The project leader, Professor Louis Lemieux, is a world expert on combining data from different imaging instruments, such as EEG, MEG and functional MRI. Over the last 8 years, he has given more than 50 invited talks at international conferences on the topic of advanced imaging in epilepsy.
All members of the project team have excellent track records. Their earlier studies into the use of EEG-fMRI to assess epilepsy place them at the forefront of this area of research. Indeed, they made many of the main technical developments that turned this technique into a possibility. They have applied the technique to the largest number of adult patients in Europe and have published more than 40 original articles, reviews and book chapters on the topic.
The epilepsy surgery programme at the team’s centre is second to none in Europe in terms of its access to the most advanced MRI facilities.
Who stands to benefit from this research and how?
Life-changing chance of surgery
Researchers believe the new, combined brain scanning technique has the potential to improve the care of people with epilepsy, by increasing the number of people who can be considered for surgery and improving the outcome of surgery. Their starting hypothesis is that the combined technique will have a tangible impact on the care of roughly 20% of cases that are considered for surgery. The results of this project will show whether their estimates are right.
Surgery is normally deemed to be successful if it reduces the number of seizures a person suffers, or eliminates their seizures altogether. Many people find they are totally cured after years of living with disabling seizures. This can be truly life changing.
People can feel they have been set free to live life to the full – to find employment or further their education, to get on with everyday activities such as cooking and bathing without worrying about seizures, to go out with friends and family, and enjoy whatever sort of recreational activities take their fancy. Some people say it’s almost as if life has begun again.
- NICE Epilepsy guidelines 2004.
- Duncan JS, Sander JW, Sisodiya SM, Walker MC. Adult epilepsy. Lancet 2006; 367(9516):1087-100.
- Rugg-Gunn FJ, Boulby PA, Symms MR, Barker GJ, Duncan JS. Imaging the neocortex in epilepsy with double inversion recovery imaging. Neuroimage 2006; 31(1):39-50.
- Salek-Haddadi A, Diehl B, Hamandi K, Merschhemke M, Liston A, Friston K, Duncan JS, Fish DR, Lemieux L. Hemodynamic correlates of epileptiform discharges: An EEG-fMRI study of 63 patients with focal epilepsy. Brain Research 2006; 1088:148-166.