What did the project achieve?
“We have now completed our assessment of a new child-friendly brain-scanning approach to help children with epilepsy – the largest study of its kind in children,” says Dr David Carmichael of the UCL Great Ormond Street Institute of Child Health.
Epilepsy affects around one in every 200 children and young people under 18 in the UK.1 Although many children benefit from taking drugs to help control their seizures, unfortunately, they don’t work for everyone.
So doctors may consider other treatments – including surgery to remove the part of the brain that triggers seizures. This can dramatically improve their quality of life, but it isn’t risk-free – and so it is only recommended if the doctors are confident the child will benefit.
Brain scans, which are used to direct surgery, don’t always provide doctors with enough information to support surgical treatment. And some children will find them a difficult experience and they find it hard to stay still inside the scanner, limiting the number or types of scan that doctors can get.
Dr Carmichael’s team set out to develop a better and more child-friendly way to map the brains of children with epilepsy who do not benefit from drug treatment, by combining two sophisticated scanning technologies.
“Our results suggest that our combined approach will be a useful tool for identifying more children who might benefit from life-changing surgery,” says Dr Carmichael. “We also found that allowing children to wear headphones and watch cartoons helps children to stay still during the scan – importantly, without affecting data quality.”
“We are currently building a case for this test to become a clinical service at Great Ormond Street Hospital, which we would then make available to other children’s epilepsy surgery centres across the UK,” he adds.
- Epilepsy society: https://www.epilepsysociety.org.uk/epilepsy-childhood#.WoMqnujFJPY [website accessed 13th February 2018)
This research was completed on
Around 60,000 children and teenagers under 18 in the UK have epilepsy.1 Sadly, around one in four find existing drugs do not control their seizures.2 Brain surgery can dramatically improve life for some of these children, 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.
What is the problem and who does it affect?
Around 15,000 of the under 18s in the UK are living with epilepsy that is difficult to control, facing up to life disrupted by seizures.1,2
Seizures can be scary and unpredictable. 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 offers hope of a better life, as Dr David Carmichael explains: “Surgery may be an option for some children with uncontrolled epilepsy, estimated at 400 per year in the UK.2 It can transform a child’s life – stopping them from having seizures and limiting the disability that epilepsy can cause.”
Surgery works by removing the part of the brain that triggers a child’s seizures. It is a major undertaking, which brings serious risks if not done properly. “It is vital that essential areas of the brain, such as those that control talking and walking, remain undamaged,” explains Dr Carmichael, “but existing pre-surgical tests to identify these areas are often difficult to carry out or inconclusive in children, meaning we cannot offer surgery to everyone who may benefit.”
What is the project trying to achieve?
“We aim to develop a better, more child-friendly way of mapping the brains of children with epilepsy, using a pioneering brain-imaging technique called EEG-fMRI.” says Dr Carmichael. “We hope this can help to identify which children are most likely to benefit from surgery, so that the children, their families and their doctors are more informed when making the life-changing decision about whether to go ahead with surgery. It could give surgeons vital additional information about the functional architecture of the child’s brain, so they can ensure operations are as safe and effective as possible.”
Forty children with epilepsy and 20 children without epilepsy are taking part in the study. Dr Carmichael hopes to find out how well the new technique works if children are allowed to wear headphones and watch cartoons inside the brain scanner, making it an easier experience for each child. He is also investigating the benefits of using fMRI alone, as this is more widely available.
What are the researchers’ credentials?
The project team has a wealth of experience, being based at UK’s leading centre for surgery for children with epilepsy, where 200 children are evaluated each year. The project leader, Dr David Carmichael has received two prestigious personal awards for his work using EEG and fMRI – CNT young investigator of the year and BCISMRM Sir Peter Mansfield Prize.
The team is collaborating with researchers in Geneva, UCL Institute of Neurology (who have also received previous support from AMR) and the developmental cognitive neuroscience unit at the UCL Institute for Child Health.
- Epilepsy Society. http://www.epilepsysociety.org.uk/AboutEpilepsy/Epilepsyandyou/Childrena...
Accessed June 2012.
- Berg AT, Mathern GW, Bronen RA, Fulbright RK, DiMario F, Testa FM, Levy SR. Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy. Brain. 2009;132:2785-97.
|Dr D Carmichael
|Professor J H CrossDr C ClarkDr J ClaydenDr R Pressler
|Imaging and Biosciences Unit and Neurosciences Unit, Institute of Child Health, University College London
|Project Location Other
|Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London
|22 August 2011
|Project start date
|9 May 2012
|Project end date
|8 February 2016