Optimising cognitive outcomes in epilepsy surgery
Research type
Research Study
Full title
A unified inferential framework for optimising cognitive outcomes in epilepsy surgery
IRAS ID
167797
Contact name
Beate Diehl
Contact email
Sponsor organisation
UCLH
Clinicaltrials.gov Identifier
UCL Data Protection Registration Number, Z6364106/2015/12/28
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Epilepsy is a very common serious chronic neurological condition, affecting 450 000 people in the UK alone. About 30% of patients have seizures that do not respond to medical treatment, leading to cognitive decline, poor quality of life and significantly increased mortality. Such “drug resistant” patients may benefit from surgical removal of the area of the brain causing the seizures. However, identification of the boundaries of the potential resection area can be difficult, and routinely requires information from a number of clinical investigations including structural and functional brain imaging, electrophysiological recordings and neuropsychological testing. In some patients this is not enough and temporary intracranial electrodes are surgically inserted into the brain to localise epileptic brain activity with high fidelity and resolution. Just as important, however is to determine the function of nearby normal brain areas, so functionally critical areas are not resected. The gold standard method for this is to use Direct Cortical Stimulation (DCS), where brief electrical stimulation of an intracranial electrode temporarily disrupts local brain function. The behavioural effects of this disruption are determined by monitoring patient movements and speech during stimulation. One can infer that if stimulation of a certain brain area, for example, causes weakness of the contralateral hand, then resection of that area is likely to do the same. However, currently we have no clinical behavioural tests for monitoring the effects of stimulation on complex limb movements, long term planning, social interaction, weighing up financial risks, etc. — and yet these functions are critical to normal daily life. The purpose of this research project is to establish a pilot framework for testing such higher cognitive abilities in patients being considered for surgery for epilepsy so as to enable the delineation of areas of the brain that are safe to remove without causing cognitive disability. Since no such established framework currently exists the need we wish to satisfy is a very urgent one.
REC name
London - West London & GTAC Research Ethics Committee
REC reference
16/LO/0618
Date of REC Opinion
4 May 2016
REC opinion
Favourable Opinion