Automated lesion detection in drug resistant epilepsy:
A project to automate lesion detection in drug resistant therapy may lead to improved treatment for people with epilepsy. Approximately one-third of epilepsy patients suffer from seizures that do not respond to drug treatments, making surgery the only effective treatment for these individuals. More than 90% of patients enjoy an improved quality of life, seizure-free, once the brain lesion is removed. Although removing the lesion rarely poses a problem, finding it does as many times the lesion is tiny and undetectable. Led by Dr. Andrea Bernasconi, the Neuroimaging of Epilepsy laboratory at the Montreal Neurological Institute and Hospital – The Neuro, McGill University, has developed a unique set of tools that supply a solution based on computer modeling. This will automatically detect and delineate cortical dysplasia -a malformation of brain cells present in 70% of severe cases of epilepsy – on an MRI scan and reproduce the biological character of the lesion. “Surgery when the MRI fails to reveal obvious cortical dysplasia is one of the greatest challenges around the world,” says Dr. Bernasconi who has been working on a solution for the past eight years. “Our technology is a bit like satellite imagery. Once the computer zooms in you see all the detail.”
A project to predict seizures in epilepsy led by Dr. Jean Gotman at The Neuro may allow epileptic sufferers to manage and possibly prevent seizure. “Epileptic seizures are rarely the big event many people imagine, says Dr. Gotman. “It’s more likely a disassociation with your surroundings, maybe a small blackout. One important problem lies in not knowing when it will happen.” Accurate prediction could give patients the time to prevent harm: stop a car, put down a baby or sit down. The team at The Neuro is pursuing two new paths of investigation. The first follows the team’s previous work on High Frequency Oscillations (HFOs), tiny oscillations at 100-500Hz which are very hard to detect. The Neuro team was recognized in 2006 for developing research on HFOs newly discovered at University of California, Los Angles. The second research program uses new sensors to measure local concentrations of oxygen and pH – a new set of variables under study in patients with epilepsy. Experimental evidence and clinical observations have pointed to an increase in oxygen consumption in the seconds or minutes leading to a seizure.
* Epilepsy is a physical condition characterized by sudden, brief changes in how the brain works. It is a symptom of a neurological disorder – that affects the brain and shows itself in the form of seizures
* Approximately 1-2% of the Canadian population has epilepsy. This includes people who take anticonvulsant drugs or who have had a seizure within the past 5 years.
* Each day in Canada, an average of 42 people learn that they have epilepsy.
* A seizure may appear as a brief stare, an unusual movement of the body, a change in awareness, or a convulsion. A seizure may last a few seconds or a few minutes.
* Epilepsy may result from a variety of causes. These include:
– Head injury that causes scarring to the brain tissue
– High fever and prolonged convulsions during early childhood
– Trauma at birth
– The result of a stroke or tumor
* In almost one third of patients, seizures cannot be controlled despite the best possible medications. In these patients, surgical resection of the brain area causing seizures is presently the only effective treatment in controlling seizures and improving quality of life.
· The Neuro has been at the forefront of epilepsy treatment and research for three quarters of a century.
· Dr. Wilder Penfield and his team developed the “Montreal Procedure,” a surgical approach that explores the brains of epilepsy patients while they are awake and under local anesthetic in order to find the precise tissue causing the seizures and to minimize the risks of surgery.
· 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.
· Today, scientists at The Neuro study the genetic factors of epilepsy and epileptic syndromes, use EEG to monitor the electrical manifestations of epileptic seizures, and also treat the psychiatric aspects of epilepsy.
· Brain imaging techniques developed at The Neuro have greatly contributed to the understanding of causes and consequences of epilepsy. Importantly, they have facilitated epilepsy surgery by unveiling brain lesions that are not seen by standard radiological methods.
· The Neuro’s Epilepsy Clinic sees about 1500 patients per year and provides both in-patient and out-patient evaluation and treatments.
· The Neuro’s Epilepsy Program has a multi-disciplinary team that includes epileptologists, neurosurgeons, nurses, neuropsychologists, neuropsychiatrists, social workers, EEG technologists, nurse clinicians and case managers.
· The Epilepsy team works closely with our community partner Epilepsy Montreal Metropolitain in providing monthly support group meetings at The Neuro.
The Montreal Neurological Institute and Hospital -The Neuro- is a unique academic medical centre dedicated to neuroscience. The Neuro is a research and teaching institute of McGill University and forms the basis for the Neuroscience Mission of the McGill University Health Centre. Founded in 1934 by the renowned 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 www.mni.mcgill.ca.
March 27, 2012