Pioneering research

Pioneering epilepsy research

World class research to benefit everybody with epilepsy

We are recognised as a centre for excellence by the World Health Organisation (WHO) and work in partnership with the National Hospital for Neurology & Neurosurgery and the Institute of Neurology. With expertise in brain imaging, genetics, pharmacology, epidemiology and psychology we are always at the forefront of medical research into epilepsy.

We have an extensive research programme to:

• clarify the underlying causes of epilepsy
• advance the treatment and rehabilitation of individuals with epilepsy
• identify and investigate the healthcare needs of, and services for, people with epilepsy and their carers

Our new genetics research looks into why some people are more likely to develop epilepsy than others, and whether a person's genetic make-up can help to identify the best medication for them.

Areas of research include:

• Brain imaging
• Neurogenetics
• Neuropsychology
• Clinical epileptology
• Epilepsy nursing
• Experimental epilepsy
• Clinical pharmacology

• Global health

Brain imaging

Brain imaging using MRI is a major focus of our work. 

• An important study was recently published that showed how imaging the areas of brain involved in language and memory gave results that could predict the impact of epilepsy surgery on these functions and this is beginning to replace more invasive techniques.  We have taken the important step of translating the imaging of language within the brain from research to a clinical tool which is now in regular use at the Chalfont Centre for Epilepsy.  Once we are satisfied that this is entirely robust our next move in this translation will be to show other Centres how this can be put in place and give useful results. We are pushing this area of work forward further with finding ways to examine other aspects of brain function in both cognition and emotion to determine the effects of epilepsy and epilepsy treatments in both groups, and in individual subjects.
• An area that we plan to develop in the next year is pharmacological functional imaging whereby the functional imaging is used to evaluate the effects of medications on brain function.  It is our aspiration that this will allow prediction of the effects of medication on cognition and mood and hence to be able to minimise and avoid adverse effects from medications that may be used. 
• Imaging epileptic activity within the brain using MRI is an area in which we have been one of the world leaders and are pursuing this further with ways to better pin down where seizures are arising, and the pathways of the brain that are involved in the spread of seizures and using this to design surgical treatments. 
• The mapping of critical nerve pathways in the brain has been implemented at Chalfont and led to an important publication and media interest and these data are now being used to design safer neurosurgery at the National Hospital.
• In collaboration with GE Healthcare we are testing a brain tracer to try to identify areas of the brain that give rise to seizures.  The initial studies are in those with severe established epilepsy.  This will be important for identifying the source of seizures if other imaging is unclear.  Further it is hoped that this tracer maybe able to identify abnormalities in individuals who have had a brain injury, such as from trauma, infection or stroke and will identify those in whom the onset of epilepsy is likely or not likely, and that this could then influence the course of treatment that would be advised.

• We are making important steps in the use of PET imaging to visualise the entry or drugs into the brain and to test whether in those individuals in whom medications do not control seizures the problem may be that the drugs are not entering into the brain from the blood.  If this turns out to be so, this would open a whole new avenue of potential treatments.

Neurogenetics

• Our genetic work continues to make steady progress.  This is a long term and laborious venture that requires great attention to detail and the collection of very large amounts of data from many individual subjects.  We lead a multinational consortium to augment numbers and are now at the stage that important findings are beginning to emerge. We have already identified some rare genetic causes of epilepsy, and our combined studies over several years are changing the direction of epilepsy genetics research. We are also using genetics to understand and eventually predict how medications might work for individual patients, or cause them side effects. Genetics will continue to be a major focus over at least the next five years.

Neuropsychology

• The psychological aspects of epilepsy are crucial to understanding how epilepsy affects individuals and how these consequences may be minimised.  We are now reaping the benefits of many years of assiduous data collection to determine the long term effects of epilepsy, ageing, medication and surgery on brain function and how individuals function in society and employment.
• Medical devices are important and have possibility to give rise to major advances in diagnostics and treatment.  We are closely involved in diagnostic and therapeutic wireless devices to monitor vital life functions and the EEG, and their evaluation.

Clinical epileptology

• Sudden death in epilepsy is thought to be the result of cardiac or respiratory arrest. We have developed a miniaturized wearable device for detecting cessation of breathing and dangerous abnormalities of heart rhythm, and are carrying out the first clinical trials of the device. With Dr Esther Rodriguez (Electronic Engineering, Imperial College) we have developed a miniaturized wearable apnoea detection device (WADD) that detects the acoustic signal of breathing and cardiac activity and have tested this in healthy volunteers. The microchip in the device identifies apnoea and serious tachycardias and bradycardias. The device has been patented and approved by MHRA for clinical investigations, and received the new IT award at the Institution of Engineering Technology Awards in 2009.

Epilepsy nursing

• Projects led by Epilepsy Specialist Nurses to evaluate of the efficacy of buccal midazolam as a rescue medication for individuals with prolonged and clusters of seizures and to evaluate the possibility of SMS text messages to remind individuals to take medications at the correct times are underway.  This is really important as, for many individuals with well controlled epilepsy, seizures occur when there has been a lapse in the accurate taking of medication. 

Experimental epilepsy

• The Experimental Epilepsy and Fundamental Neuroscience Group at the UCL Institute of Neurology continued to make good progress in understanding the abnormalities on individual nerve cells and the chemicals that communicate between nerve cells that are fundamental to the normal functioning of the brain and also that become deranged when seizures occur.  The parallel study of basic science and clinical work is mutually informative and cross fertilising.  An area to develop further is the study of individual nerve cells and the transmission of signals between nerve cells in specimens of brain that are removed during the surgical treatment of epilepsy.

Clinical pharmacology

• It is always important to evaluate critically potential and recently developed anti epileptic drugs in clinic.The regulatory environment for doing clinical trials in the UK has been difficult for pharmaceutical companies and investigators in recent years with many bureaucratic hurdles and institutions charging highly for studies to be done.  This has lead to pharma companies carrying out investigations in countries other than the UK.  It has been more recently appreciated, however, that this economy has been at the cost of quality. 

• In the coming years we anticipate that clinical trials will be focused again on the UK and it is important that we maintain the capability to be able to participate in these fully. A key part of this will be the equipping of the Therapeutic Drug Monitoring Laboratory with Mass Spectrometry equipment.

Global health

• We are very aware of the need to have a global context.  This is facilitated by Professor Sander’s links in many other countries particularly The Netherlands, Brazil, Georgia, Bulgaria China and several African countries and the development of closer links with our Dutch counterparts at SEIN and the Free University in Amsterdam.