Drug Resistant Epilepsy
Conditions
Keywords
epilepsy, network, non-invasive investigation
Brief summary
The goal of this clinical trial is to improve non-invasive identification of epileptogenic networks in drug-resistant epileptic patient. The investigators aim to compare epileptogenic network identification with stereo-EEG (used as glod standard) with the identification of the same network using advanced MRI (rs-fMRI, microstructural analysis of white matter, ...). The main goals are to: 1. Compare the accuracy of network identification. 2. Analyse the effect of the MRI sequences on candidates selection and target identification. Participants will already have been selected for stereoEEG and will undergo a supplementary MRI (about 1h) with the additional MRI sequences. Follow-up MRI are scheduled for patient undergoing a second, therapeutic epileptic surgery.
Detailed description
Patient identified for SEEG will undergo, prior to the implantation procedure an MRI with the following sequences: * 3D T1 * rsfMRI * multishell diffusion The rsfMRI will be post-processed to delineate the epileptogenic networks based on an Independant Component Analysis (ICA) methods. Once the epileptogenic network(s) has/have been identified, connexion between the different regions will be identified through post-processing of the diffusion using a MSMT-CSD algorithm. Finally, the identified tract between the different region will be quantitatively analysed using different algorithms (NODDI, DIAMOND, MF) to better grasp there integrity. In a follow-up study, the patients that will later on benefit from a resection or disconnection (i.e. curative surgery) will also have an identical MRI 3 months after the said procedure to evaluate the evolution on the network(s) based on the same criteria.
Interventions
DEVICEAdvanced MRI
resting-state functional MRI, diffusion with advanced post-processing (microstructure analysis), myelin mapping
Sponsors
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
3 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient suffering from drug-resistant epilepsy * Patient already selected for SEEG implantation as part of their epileptic networks
Exclusion criteria
* Patient excluded from SEEG (pregnant women, children too young for the procedure, patient unable to undergo the procedure) * Contra-indication for MRI
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Network identification with MRI | At the end of phase 1 - expected to be 3 years after first inclusion | Analysis of the anatomical overlap of radiological network (with MRI) and the electrophysiological network (with SEEG) using coregistration and a sublobar analysis. Overlap will be quantified in %. |
| Prognosis of network targetting with surgery | One year after surgery (phase 2) | Analysis of the impact on epileptic outcome in accordance with effect of the surgery on the network. The impact of the surgery on the network will be assessed by coregistration to determine which part of the network has been removed or disconnected. The epileptic outcome will be assessed using the Engel classification |
| Interest of adding epileptic network radiological analysis in a standard epileptic work-up | Approximately 1 year after the start of phase 3 | Analyse the impact on therapeutic and/or diagnostic decision of the network radiological analysis in a standard clinical practice. This impact will be assessed by measuring the change in the type of decision (further work-up, invasive EEG, "curative" surgery, "palliative" surgery or no modification) or the modification in the extent of surgery (more/less electrodes for invasive EEG, more/less tissue targeted with surgery) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Network quantification | At the end of phase 1 - expected to be 3 years after first inclusion | Analysis of the strength of the network using radiological data (r², Z-score, diffusion metrics obtained via microfingerprinting such as fiber volume fraction and fiber fraction) vs electrophysiological metrics (epileptogenic index, h²) |
| Network regulation with surgery | One year after surgery (phase 2) | Analysis of the impact of the surgery on the radiological parameters of the network cited in outcome 4 (r² and Z-score for rsfMRI, number of tracts for tractography and strenght of tract with fiber fraction and fiber volume fraction for microfingerprinting) |
Countries
Belgium
Contacts
CONTACTRiëm El Tahry, PhD
PRINCIPAL_INVESTIGATORRiëm El Tahry, PhD
Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Outcome results
None listed