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Brain connections associated with seizure freedom following epilepsy surgery for children

Project title 
Brain connections associated with seizure freedom following epilepsy surgery for children: an ultra-high-resolution brain imaging study

Supervisors names
Torsten Baldeweg
Martin Tisdall

Project outline
Background: Epilepsy is a common neurological condition that is prevalent in approximately 1 in 100 children in the UK. Children with epilepsy are predisposed to have epileptic seizure – which are the symptoms of abnormal and excessive electrical activity in the brain. Approximately 30% of children with epilepsy will not gain seizure freedom by taking medications alone and there a significant need to develop and translate novel therapies in order to achieve seizure freedom for and improve the quality of lives for children with drug-resistant epilepsy (1). Temporal lobe epilepsy is the most common form of focal-onset seizures – where seizures arise from the temporal lobe (‘epileptogenic zone’) before spreading further through the brain. Temporal lobe epilepsy may be treated with a brain surgery called temporal lobe resection, which aims to remove the temporal lobe and the ‘epileptogenic zone’. Children receiving temporal lobe resection have a 70% chance of becoming seizure-free after surgery – but it remains elusive as to the reasons and predictors for children being one of the 30% who continue to have seizures after surgery (2).

Aims/Objectives: The aim of this PhD project will be to investigate the neuroimaging biomarkers associated with seizure freedom for children with temporal lobe epilepsy undergoing resective epilepsy surgery. The key translational goal is to develop non-invasive neuroimaging strategies to identify children who will and will not benefit from invasive temporal lobe resection.

Methods: The PhD student will join the active project called the ‘7-Tesla Temporal Lobe Epilepsy Study’, which is an observational prospective neuroimaging study investigating alterations in brain connectivity in children and young adults with temporal lobe epilepsy. Each participant in the study will have a 7-Tesla MRI scan – an ultra-high-field novel neuroimaging method that allows unprecedented detailed imaging of the living brain (3). The student project will use multi-modal data acquired in 40 patients with epilepsy and 30 healthy participants. Data will include structural MRI (to analyse anatomical and volumetric features), diffusion MRI (to analyse white matter tract connectivity), functional MRI and simultaneous electroencephalography (EEG) (to analyse brain activity and connectivity) (4). 

Timeline: The timeline of the 7-TLE Project is advantageous to the prospective PhD student since the 7-TLE project is already recruiting patients and one-year follow-up data will become available in the first year of the PhD. The student will spend the first year learning the principles of MRI, 7-Tesla MRI and image analysis. The student will spend the latter two years conducting brain connectivity analyses with particular interest to relationships with postoperative outcome.
 

References: [1] Cross et al. Lancet. Child Adolesc. Heal. 2022;6(7):484–494. [2] Eriksson et al. Epilepsia. 2023 Jun 2. doi: 10.1111/epi.17670. [3] van Lanen et al. NeuroImage. Clin. 2021;30. [4] Tavakol et al. Epilepsia 2019;60(4):593–604.

Contact
Prof Torsten Baldeweg, t.baldeweg@ucl.ac.uk