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Improving brain imaging for surgery

Epilepsy affects around one per cent of the population (600,000 people in the UK). Despite over 20 medications to treat epilepsy, a third of people with epilepsy continue to have seizures. Surgical treatment of epilepsy in which the abnormal part of the brain is removed is an effective technique to cure or improve seizures suitable for some people with epilepsy.

The National Hospital for Neurology and Neurosurgery, with the Epilepsy Society and UCL Queen Square Institute of Neurology, is the largest centre in the UK undertaking epilepsy surgery (100 operations a year) and has an internationally known research programme to improve the identification of patients for surgery and understand and improve the outcomes.

Brain scans

In order for a person to be suitable for surgery, it is necessary to confirm that seizures are arising from one part of the brain and that it is safe to remove this part. This requires many tests including MRI brain scans. Despite advances in technology, around 30 per cent of people with seizures arising from one part of the brain have completely normal MRI scans. Further investigation with other types of scan is expensive, may involve radiation exposure and is not available in most places, unlike MRI. If imaging cannot identify the source of seizures, recording wires may be placed directly onto the brain surface. This is available in only a few places, is invasive, very expensive and carries some risk.

We are assessing several new MRI techniques to determine which are helpful in identifying the source of seizures in people with severe epilepsy and normal standard scans. We work with the UCL Centre for Medical Image Computing to develop new ways to analyse the scans by computer to detect subtle abnormalities not seen by the human eye.

Epilepsy surgery

These developments will enable a larger proportion of people with epilepsy to undergo surgery and be cured or their epilepsy significantly improved. MRI may replace some more expensive and less readily available scans. This will simplify and shorten the investigation pathway so surgery can take place more quickly. Since MRI is widely available at all epilepsy surgery centres, the new techniques can be introduced elsewhere to improve assessment and treatment for people with epilepsy.