Professor John Duncan

Optimising epilepsy surgery

Our programme is focused on using brain imaging to enable and to optimise individualised curative surgical treatment of focal epilepsy that is not controlled with medication. We aim to improve the rates of cure of epilepsy and to reduce the adverse effects of surgery. We work closely with consultant neurosurgeons at NHNN Andrew McEvoy and Anna Miserocchi, and Professor of Neuropsychology, Sallie Baxendale.

We developed the EpiNav software platform for 3D multimodal neuroimaging for computer-assisted placement of intracranial electrodes, tumour biopsies and delivery of focal therapy, and planning resections carried out with interventional MRI, in collaboration with Rachel Spark and Seb Ourselin of Kings College London. We are now working to make this package user-friendly and quick to use for clinicians without specialist training or high-power computing.

Legend: Image-guided electrodes to identify the site of onset of seizures and the motor cortex.

There has been a dramatic improvement in the ability to visualise small grey matter structures and white matter tracts in the brain in vivo. We have perfected the acquisition and processing of these data and have produced a detailed 2-dimensional and 3-dimensional atlas of these structures that facilitates a step change in the accuracy of neuroimaging for research and clinical care.

Legend: The components of the hippocampus.

We demonstrated that transection of the tracts joining the frontal cortex with striatum and thalamus underpins long-term seizure freedom after frontal lobe resections.

Legend: Frontal lobe resection transecting anterior thalamic radiation.

We clarified the functional anatomy of verbal memory and the influence of temporal lobe epilepsy with atrophy of medial and dorsolateral pre-frontal cortex (PFC), superior and middle temporal gyri, anterior and posterior cingulate cortex, left ventrolateral PFC and parietal-temporal-occipital junction and the left dentate gyrus.

We have shown the importance of sparing the inferior fronto-occipital fasciculus in temporal lobe surgery to preserve word-finding abilities and to spare the posterior 45% of the hippocampus and attached fornix to mitigate adverse effects on memory.

Legend: MRI-guided epilepsy surgery. Identifying parts in red and magenta to be removed, and those in green and blue to be preserved.

Many neuroimaging research studies need large numbers of datasets. In collaboration with Peter Taylor and the CNNP Lab, Newcastle University, we have created IDEAS (Imaging Data for Epilepsy And Surgery). This contains fully anonymised preoperative and post-operative MRI and clinical meta data on 453 individuals hosted on OpenNeuro. It is the first Open Source resource for research into focal epilepsy. These data also contributed to the MELD programme to identify covert cerebral abnormalities giving rise to focal epilepsy.

Imaging Database for IDEAS

The great majority of individuals with epilepsy live in resource poor countries, without access to MRI. In collaboration with UCL Hawkes Institute, we have started a study to validate images acquired in individuals with focal lesions causing epilepsy, using MRI acquired with the 0.064T Hyperfine Swoop mobile MRI scanner, with image enhancement software.

Selected Recent Publications

Binding L, Taylor P, O'Keeffe AG, Giampiccolo D, Fleury M, Xiao F, Caciagli L, de Tisi J, Winston GP, Miserocchi A, McEvoy A, Duncan JS, Vos SB. The impact of temporal lobe epilepsy surgery on picture naming and its relationship to network metric change. Neuroimage Clin. 2023 May 27;38:103444.
Giampiccolo D, Binding LP, Caciagli L, Rodionov R, Foulon C, de Tisi J, Granados A, Finn R, Dasgupta D, Xiao F, Diehl B, Torzillo E, Van Dijk J, Taylor PN, Koepp M, McEvoy AW, Baxendale S, Chowdhury F, Duncan JS, Miserocchi A. Thalamostriatal disconnection underpins long-term seizure freedom in frontal lobe epilepsy surgery. Brain. 2023;146:2377-2388.
Trimmel K, Vos SB, Binding L, Caciagli L, Xiao F, van Graan LA, Koepp MJ, Thompson PJ, Duncan JS. Naming fMRI-guided white matter language tract volumes influence naming decline after temporal lobe resection. J Neurol. 2024 Apr 7. doi: 10.1007/s00415-024-12315-2.
Taylor PN, Wang Y, Simpson C, Janiukstyte V, Horsley J, Leiberg K, Little B, Clifford H, Adler S, Vos SB, Winston GP, McEvoy AW, Miserocchi A, de Tisi J, Duncan JS. The Imaging Database for Epilepsy And Surgery (IDEAS). Epilepsia. 2024 Dec 5. doi: 10.1111/epi.18192.
Duncan JS, Giampiccolo D. MRI Neuroanatomy: cortex, nuclei and connections. Major reference work. Springer 2025. in production.