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What did the project achieve?
“Our results suggest that sophisticated new brain scans could be a useful tool to improve the diagnosis of a certain type of epilepsy,” says Dr David Carmichael of the UCL Great Ormond Street Institute of Child Health. “By non-invasively identifying specific abnormalities in the brain, these scans could help doctors to decide whether or not a child is likely to benefit from surgery.”
Children with a specific type of epilepsy called focal cortical dysplasia (FCD) have disorganised nerve cells in an area of their brain, which puts them at a much higher risk of seizures. Brain surgery can be life-changing for some children who carry on having seizures despite trying medication. But this is a major operation and has risks.
“It’s important to know as much possible about a child’s type of FCD and the areas of their brain that are affected, to help doctors predict which children are likely to benefit,” says Dr Carmichael.
This research involved using new, advanced MRI scanning techniques to look in detail at the changes in the affected areas of the brains of children with FCD and comparing these to brain scans from healthy children.
“We found changes in brain scans from children with FCD that aren’t seen using existing techniques and we also identified a pattern of changes that appear to be specific to the type of FCD,” says Dr Carmichael. “With this knowledge, we can create images that are better tuned to look at a child’s specific brain abnormalities which we hope will lead to improved predictions for their chance of successful surgery.”
Recently, the researchers compared their scans to data from a highly advanced UK national scanning facility, using a machine that is 10,000 times more powerful than a traditional microscope.
“This showed that the changes in some of our scans related to changes in iron and calcium alterations in affected tissues,” says Dr Carmichael.
The team is also working on computer programmes that can automatically detect brain changes without the need for human interpretation. Their promising results have also led to new projects to continue this work using a newer more powerful brain-scanning machine that can provide even better images.
This research was completed on
Around 60,000 children and teenagers under 18 in the UK have epilepsy.1 Sadly, up to one third of these young people carry on having seizures despite trying medication, meaning life can be difficult and unpredictable.2-5 Brain surgery can totally transform some of these children’s lives by freeing them from seizures altogether, but important questions must be answered before children undergo such a major operation. Dr David Carmichael from the Institute of Child Health in London is investigating whether sophisticated new brain scans could provide answers, so more children can benefit from surgery.
How are children’s lives affected now?
“Seizures can be scary, for children and their families” says Dr Carmichael. “They can cause physical injury and even death, and make day-to-day life difficult. Activities that other children might take for granted, like riding a bike, can be dangerous if there is a chance of having a seizure. Epilepsy can also interrupt learning and disrupt development.”
Brain surgery can offer hope of a better life if children carry on having seizures despite trying medication. Estimates suggest over 400 children with epilepsy could benefit from brain surgery every year in the UK.6 Surgery can stop children’s seizures and limit the disability that epilepsy can cause.
“Unfortunately, we cannot offer surgery to all of the children who might benefit from it, as we can’t always pinpoint exactly which part of the brain is causing a child’s problems,” explains Dr Carmichael. “Also, it’s not always possible to tell children and their families exactly how successful surgery is likely to be.”
How could this research help?
Dr Carmichael and his team are hoping to improve brain scanning of children with epilepsy.
“We are focusing on a type of epilepsy called focal cortical dysplasia, which affects around half of the children who visit our centre to find out whether or not they can have surgery,” explains Dr Carmichael.
“We are investigating whether a new type of MRI scanning might improve both our ability to predict a child’s chances of benefiting from surgery and our ability to pinpoint the abnormal area in a child’s brain that is causing their problems,” continues Dr Carmichael. “This information is vital for families when making the difficult decision about whether or not to go ahead with surgery and for surgeons when carrying out operations.”
The new scans are also designed to work even if children move around a bit during the scanning process – an important advantage when young children are having a scan.
References
1. Epilepsy Society. Epilepsy in childhood. http://www.epilepsysociety.org.uk/epilepsy-childhood#.Uqm_r9HuPVI. Website accessed 16 December 2013.
2. Epilepsy Action. NHS England. A guide for Paediatricians: Children’s Epilepsy Surgery Service (CESS). Guidelines for children’s epilepsy brain surgery referrals in England. https://www.epilepsy.org.uk/sites/epilepsy/files/professionals/cess-prac... Website accessed 18 December 2013.
3. Epilepsy Society. Antiepileptic drugs for children. http://www.epilepsysociety.org.uk/anti-epileptic-drugs-children#.UqnFONH... Website accessed 16 December 2013.
4. Epilepsy Society. Treatment. http://www.epilepsysociety.org.uk/treatment#.Uq7wE9HuPVI Website accessed 16 December 2013.
5. Epilepsy Society. Anti-epileptic drugs for adults. http://www.epilepsysociety.org.uk/anti-epileptic-drugs-adults#.Uq7wd9HuPVI Website accessed 16 December 2013.
6. E09/S/e. 2013/14 NHS Standard contract for children’s epilepsy surgery service (CESS). Section B Part 1 – Service specifications. http://www.england.nhs.uk/wp-content/uploads/2013/06/e09-child-epilepsy-... Website accessed 16 December 2013.
| Project Leader | Dr D W Carmichael MSci PhD MInstP |
| Project Team | Dr N Weiskopf PhDProfessor Helen Cross FRCPCH FRCPDr K Shmueli PhDDr T Jacques PhD MRCP FRCPathDr C A Clark BSc MSc PhDDr W K Chong MD MRCP FRCRDr T Baldeweg MD |
| Project Location | Department of Imaging and Biophysics, Department of Radiology, Department of Neurosciences and Developmental Cognitive Neuroscience Unit UCL Institute of Child Health and Great Ormond Street Hospital for Children |
| Project Location Other | Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, Department of Medical Physics and Bioengineering, University College LondonNeural Development Unit, Birth Defects Research Centre and Department of Histopathology, UCL Institute of Child Health, London |
| Project duration | 30 months |
| Date awarded | 1 November 2013 |
| Project start date | 9 March 2015 |
| Project end date | 28 February 2019 |
| Grant amount | £164,035 |
| Grant code | GN2214 |
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