Predicting and reducing language deficits from temporal lobe epilepsy surgery

Lead investigator: Dr Sjoerd Vos, Department of Medical Physics and Biomedical Engineering, University College London

Co-investigators: Prof John Duncan, UCL, Dr Peter Taylor, Newcastle University, Dr Pamela Thompson, UCL,  Dr Sallie Baxendale, UCL

Project grant: £163,573, 3 years

“Our project aims to improve treatment options in those people who do not benefit from epilepsy medication. In the right cases, surgery can be curative, and we hope to improve quality of life after surgery. This is my first grant and I hope it helps me work towards my future goals of improving people’s lives after epilepsy surgery.” Dr Sjoerd Vos, University College London

Background

About 30-40% of people with epilepsy continue to have seizures despite anti-epileptic drug (AED) therapy. In those individuals where a single brain region is responsible for the seizure and AED therapy does not help, surgery can be a successful and cost-effective treatment that can improve quality of life. The most commonly performed surgery in epilepsy is anterior temporal lobe resection. This procedure has a significant risk of language deficits if the surgery is on the side of the brain responsible for language and speech. It is expected that the language difficulties arise from damage to the fibre bundles connecting the language areas. These fibres, or neural highways, lie deeper in the brain and might be unknowingly damaged during surgery.

Study

In patients who have had epilepsy surgery, Dr Vos and colleagues will analyse MRI scans and language test data they have been collecting over the last ten years. They will analyse the MRI data taken before surgery, using diffusion MRI and fibre tractography to create a map of the fibre connections. Combining this with an MRI scan post surgery, the researchers will determine if surgery damaged any of these connections. From the cognitive tests routinely done on these patients both before and after surgery, Dr Vos and colleagues already know where language skills have declined. Combining all this data, their aim is to discover which fibre connections are essential in language use, in order to preserve these during surgery.

In the second part of this project, the research team will identify these essential fibre connections, relay the information to the surgeon before surgery and then monitor the location of these bundles on screen during the surgery itself, thus helping to avoid damage to these vital connections.

Significance

The researchers aim to reduce the possible deficits in language capabilities as a result of epilepsy surgery, thus improving patients’ post-surgery quality of life. They also hope that this research will reassure people who are afraid of possible language decline to choose surgery as an alternative treatment to their intractable epilepsy.

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