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NEW IN CLINICAL EPILEPSY:

Detecting drug resistant epilepsy early

A study in the journal Epilepsia highlights major potential risks in patients with epilepsy that fails to respond to initial antiepileptic drug treatment. Persistent uncontrolled seizures, the study warns, are a health-threatening condition with significant medical, social, and economic consequences. Uncontrolled seizures can lead to psychiatric problems and cognitive impairment. As a result, patients with uncontrolled seizures carry a burden of healthcare costs, restricted social and employment opportunities, possible physical injuries, even risk of death. Despite the introduction of many second-generation antiepileptic drugs over the past two decades, as many as four out of ten patients with epilepsy will be unable to stop seizure activity solely by using drugs. Two key steps are recommended: the first step is to avoid repetitive ineffective anti-epileptic drug trials. The second step is to consider epilepsy surgery without undue delay. As many as 90 % of patients who undergo epilepsy surgery see a significant improvement in their life. The study concludes that achieving complete freedom from seizures is necessary for minimizing disability, morbidity, and mortality.  Contributing to the study was Dr. Piero Perucca, a research fellow working at the Neuro’s Epilepsy Unit under Dr. Jean Gotman and Dr. Francois Dubeau, as well as researchers at Columbia University and at Geisinger Health System, Pennsylvania.

Identifying epileptic discharges without EEG

Electroencephalography (EEG) has been used in conjunction with functional Magnetic Resonance Imaging (fMRI) to locate epilepsy-causing centres in the brain. But this method has drawbacks. Firstly, EEG readings of the scalp cannot easily detect activity within deep brain structures. Secondly, using the EEG in the imaging scanner is not only complex but gives rise to artifacts. A way to localize a specific type of epilepsy centre in the brain without using EEG was recently published in the journal Neuroimage. This study presents a new framework for identifying the blood oxygenation level-dependent (BOLD) manifestations of epileptic seizure events without relying on EEG. BOLD shows changes in the level of oxygen in the blood, changes that could indicate seizure activity. The new method involves analyzing each data point (voxel) from the epileptic event, and gathering the registered voxels according to their proximity in time and space. The study concludes that in some epilepsy discharges, it might be possible to detect their BOLD manifestations without having to record with EEG. This results in a much simpler procedure and has the potential of detecting epileptic activity even in deep brain regions too far from the skull to result in an EEG discharge. The study was undertaken by Dr. Jean Gotman, Dr. R. Lopes and Dr. F. Fahoum at the Neuro, and by Dr. J.M. Lina at Ecole de Technologie Superieure.

Techniques in epilepsy surgery: The MNI approach

An important contribution to epilepsy treatment has just been published---‘Techniques in Epilepsy Surgery, The MNI Approach, by the dean of contemporary Canadian epilepsy surgeons, Dr. Andre Olivier,  Neurosurgeon in Chief at the Neuro, in conjunction with Dr. Warren W. Boling, University of Melbourne, and Dr. Taner Tanriverdi, Istanbul University. The fruit of Dr. Olivier’s lifelong dedication to his epilepsy patients, the book describes the Neuro’s cutting-edge methods of approaching epilepsy surgery, brain anatomy and treatment diagnosis.

EPILEPSY FACTS:

• Epilepsy is neurological disorder characterized by sudden, brief changes in the brain that are expressed as seizures.
• A seizure can appear as a brief stare, an unusual movement of the body, a change in awareness, or a convulsion, lasting a few seconds or a few minutes.
• Epilepsy affects 1 – 2% of Canadians. This includes people who take anticonvulsant drugs or who have had a seizure within the past five years. • Everyday an average of 42 people learn that they have epilepsy.
• Epilepsy is a result of different causes:malformations during brain development, a head injury that causes scarring to the brain tissue, high fever and prolonged convulsions during early childhood, trauma at birth, a stroke or tumour.
• One out of three patients cannot control seizures solely by using available medications. For these patients, surgical removal of the brain tissue causing seizures is the only known effective treatment for controlling seizures and improving quality of life.

THE NEURO AND EPILEPSY:

The founder of the Neuro, Dr. Wilder Penfield, and his colleagues developed a surgical treatment for epilepsy in the 1950s known as the "Montreal Procedure" that is now a worldwide standard. During surgery, Dr. Penfield’s patients remained awake so that he could precisely detect the location of their seizure activity by conversing with them. By destroying or removing the tissue causing the disturbance within the brain, he could end their epileptic seizures. The Neuro gained international renown as a centre of advanced epilepsy research and treatment thanks to the work of Dr. Penfield and such colleagues as the surgeon, Theodore Rasmussen, and the pioneer in electroencephalography (EEG), Herbert Jasper.
Their illustrious example has inspired groundbreaking epilepsy research and treatment at the Neuro for more than 70 years:

• Scientists and clinicians at the Neuro pioneered the use of EEG to measure brain activity, and have developed new ways to diagnose and control epilepsy.
• Scientists at the Neuro study the genetic factors of epilepsy and epileptic syndromes, as well as treat psychiatric aspects of epilepsy.
• Brain imaging techniques developed at the Neuro have greatly contributed to the understanding of causes and consequences of epilepsy. These techniques have facilitated epilepsy surgery by unveiling brain lesions not seen by standard radiological methods.
• The Neuro’s Epilepsy Clinic provides both in-patient and out-patient evaluation and treatments for about 1,500 patients a year.
• The Neuro’s Epilepsy Program has a multi-disciplinary team of epileptologists, neurosurgeons, nurses, neuropsychologists, neuropsychiatrists, social workers, EEG technologists, nurse clinicians and case managers.
• The Epilepsy team works closely with its community partner, Epilepsy Montreal Metropolitain, in providing support to patients.

About the Montreal Neurological Institute and Hospital – the Neuro: The Montreal Neurological Institute and Hospital -The Neuro, is a unique academic medical centre dedicated to neuroscience. A research and teaching institute of McGill University , The Neuro forms the basis for the Neuroscience Mission of the McGill University Health Centre. Founded in 1934 by Dr. Wilder Penfield, The Neuro is recognized internationally for integrating research, compassionate patient care and advanced training, all key to advances in science and medicine. Neuro researchers are world leaders in cellular and molecular neuroscience, brain imaging, cognitive neuroscience and the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders. For more information, please visit