Pioneering research

Pioneering epilepsy research

Our world leading research programmes continue to be at the cutting edge, breaking new ground and bringing new hope for people with the condition. We are working towards the goal of developing personalised treatments for every individual with epilepsy.

The Department of Clinical and Experimental Epilepsy comprises research groups at the National Society for Epilepsy, the Institute of Neurology UCL, and the National Hospital for Neurology and Neurosurgery.
The department aims to:

• understand the brain abnormalities that underlie epilepsy
• advance the treatment of people with epilepsy
• investigate the characteristics of epilepsy in communities
• look at the healthcare needs of people with epilepsy and their carers, and how to best provide that care

Review of current research

Brain imaging

• We are using MR imaging to visualize the white matter connections of the brain and how these are affected by epilepsy and by its surgical treatment.
• We are trying to increase the yield of MR imaging of the brain’s structure, to identify subtle abnormalities that may give rise to epilepsy.
• We are trying to increase the yield of MR imaging of the brain’s structure, to identify subtle abnormalities that may give rise to epilepsy.
• We have correlated quantitative MR parameters from preoperative in vivo 1.5T MR images with quantitative postoperative histopathological parameters. We have found a negative correlation between NeuN field fraction (proportion of tissue occupied by nerve cells immuno¬positive for the neuronal marker NeuN) and MRI T2 signal in the neocortex. No such studies existed previously.
• We are working on increasing our ability to find brain regions responsible for the epileptic activity and increase understanding of the mechanisms that give rise to this activity using multi-modal imaging techniques, and in particular simultaneous EEG-functional MRI.
• We are developing a new method to measure the volume of the hippocampus and its neighbour, the amygdala.
• We are using PET tracers labelled with radio-isotopes to identify patients who will be refractory to certain anti-epileptic medication.
• We are using PET tracers labelled with radio-isotopes to investigate the chemical abnormalities which are involved in epilepsy and epileptic seizures and where these are located in the brain.
• We are using magnetoencephalography (MEG) to identify the locations of epileptic foci and important cognitive functions such as memory and language. This will aid planning of surgical treatment for epilepsy and may predict the effects of surgery on brain function.
• We have developed analytical and conceptual approaches to using MEG to study the role of the hippocampus in actively maintaining information in working memory. 

> Find out more about our brain imaging research activities

Neurogenetics

• We are striving to identify the genetic contribution to the common different  forms of epilepsy, and to understand how genetic variation between individuals affects the response to antiepileptic drugs, both in terms of efficacy and adverse effects.

> Find out more about our neurogenetics research activities

• Clinical pharmacology

• We are working towards a better understanding of anti-epileptic drug treatment and when each drug should be used.

> Find out more about our clinical pharmacology activities

Cognitive neuroscience

• We are carrying out research on memory.   
  
  > Find out more about our cognitive neuroscience activities

Neuropsychiatry and neuropsychology

• We are interested in determining the psychiatric morbidity after epilepsy surgery and predicting factors.
• We are continuing our research in patients who have developed psychosis following temporal lobe surgery at the NHNN.
• We have continued to explore the factors that govern the nature and extent of cognitive changes following surgery and apply our findings to improve the clinical value of the neuropsychological assessment in the pre and post surgical evaluation of patients with epilepsy.
• We examined the access to surgery and postoperative outcome in people with learning difficulties.
• We assessed whether memory training can offset the decline in memory that occurs as a consequence of temporal lobe surgery and whether such training is better given before rather than after the operation. 
• We are working to see how we can better help people with non-epileptic seizures.

> Find out more about our neuropsychiatry and neuropsychology research activities

Clinical epileptology

• We have developed a miniaturized wearable device for detecting cessation of breathing and dangerous abnormalities of heart rhythm, and are now poised to carry out the first clinical trials of this device.
• We are examining the outcome of all those who have had epilepsy surgery at NHNN to determine whether it is possible to improve outcomes.

> Find out more about our clinical epileptology research activities

Clinical neurophysiology

• We have been carrying out a case control study of people who have been admitted to the video-EEG telemetry unit and later died from SUDEP to identify cardiac parameters both between and during seizures that my be used to predict risk of SUDEP.
• We are studying the alterations in autonomic function in epilepsy.
• Events that occur at night can be very difficult to diagnose due to a poor collateral history and so these patients are often referred for video-EEG telemetry. Studies are underway to see if we can improve the diagnostic yield by identifying clinical features that are strongly predictive of specific diagnoses. 

> Find out more about our clinical neurophysiology research activities

Epilepsy nursing

• We are auditing the efficacy (power to produce a desired effect) of Buccal Midazolam in outpatients at both Chalfont and NHNN who are switching to this from Rectal Diazepam or other rescue medications for serial seizures and pre-status epilepticus.
• We surveyed users of the epilepsy clinic telephone advice line at NHNN to find out what they thought of the service which currently receives around 2500 calls each year.
• We will be assessing whether SMS text messages can help to improve adherence to anti-epileptic drugs in patients.

> Find out more about our epilepsy nursing research activities

Neuropathology

• We have continued our research into the neuropathology of epilepsy, focussing on temporal lobe epilepsy associated with hippocampal sclerosis, focal cortical dysplasia and specific pathways, such as cdk5 and its substrates.

> Find out more about our neuropathology research activities

Epidemiology and health service research

• We are studying the prognosis of people with epilepsy in the general population.
• We hypothesize that there might be a causal relationship between Neurocysticercosis (NCC) and Hippocampal sclerosis (HS).
• We are planning a pilot study in which we will be measuring antibodies in patients with epilepsy from a malaria endemic area of Kenya in order to determine if there are immunological factors that may play a role in the pathogenesis of epilepsy in these patients.
• We have carried out studies into the mortality in epilepsy with a particular emphasis on reports of suicide and drowning.
• We are carrying out a clinic-based study in a cohort of patients with chronic epilepsy attending a tertiary referral centre to establish accurately the patterns of seizure occurrence and to categorise them using the results of previous investigations and classification of epilepsy.
• We are investigating the risk of premature mortality in people with epilepsy in rural areas of resource-poor countries.
• We are carrying out a prospective study of the impact of new anti-epileptic medication in chronic epilepsy.
• We are carrying out research into the seasonality in the outcome of epilepsy surgery and the potential role of vitamin D.

> Find out more about epidemiology and health service research activities

Global health

• Our commitment to advance the understanding of epilepsy worldwide and to improve service delivery is part of the NSE’s global pledge and will hopefully help fulfil the aim of WHO’s Global Campaign against Epilepsy to bring epilepsy out of the shadows.
• We have completed large-scale projects assessing the delivery of care for people with epilepsy in the context of primary care in rural areas of both China and Brazil.
• We have started a study of the epidemiology and treatment gap of epilepsy in the Republic of Georgia.
• We are assessing health delivery and health seeking strategies for epilepsy in the Roma community of Bulgaria.
• We are carrying out a large project to characterise epilepsy in different regions of Africa.

> Find out more about our global health research activities

Experimental epilepsy and fundamental neuroscience

• All experimental epilepsy research is carried out at the UCL Institute of Neurology and not at the NSE’s Chalfont Centre and is not supported by NSE funds.

> Find out more about research activities around experimental epilepsy and fundamental neuroscience