Predicting the response to a first anti-epileptic drug

The most common type of epilepsy is idiopathic (meaning of unknown cause) generalised epilepsy or IGE. When IGE is first diagnosed, most people will be treated with an anti-epileptic drug (AED), but only half will find their seizures stop completely in the following year. There are currently no tests to tell neurologists whether a person will respond to AED treatment, and this would be extremely useful.

Professor Mark Richardson at King’s College London, and collaborators at University College London, have studied groups of people with IGE using EEG. They have used their findings to develop new methods, which have provided clues about how brain regions are connected in IGE. Importantly, these methods have revealed that the brain is connected differently in people whose seizures have stopped in response to initial AED treatment, compared to those whose seizures are continuing.

The team now wants to see if it can take this further, and actually predict who will respond to drugs (when the treatment is being started for the first time), based on how the brain is connected. At this stage they don’t have enough data to design a definitive study, but they have been awarded £29,172, over 24 months, to conduct an initial pilot study.

During the project (entitled Seeking brain network markers which predict response to first antiepileptic drug in new-onset treatment-naive Idiopathic Generalised Epilepsy) the group will use two methods (EEG and fMRI) to find out as much information as possible about brain networks (in healthy brains and newly diagnosed IGE), and decide whether there are likely to be any brain network ‘markers’ that are a) easy to locate and b) can accurately predict treatment response. If the answer is yes, the researchers will then work out which tests and analysis methods will be best to identify these markers.

If successful, this grant could ultimately lead to a new test that predicts whether a person will respond to initial AED treatment. This will help to avoid unnecessary trials of aggressive AEDs, and help to reduce delays before other (potentially more successful) therapies are explored.

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