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£1.75m to advance epilepsy surgery

Researchers have been awarded £1.75m to help pinpoint the area of the brain that needs to be removed to cure epilepsy.

A team led by BRC-supported Professor John Duncan and Professor Sebastien Ourselin has further developed their EpiNavTM software to automatically compute patient-specific electrode trajectories into the brain, to identify the source of epilepsy and determine whether this may be cured with surgery. The researchers anticipate EpiNavTM will greatly improve the accuracy of, and speed up, the process; increasing the number of patients appropriate for epilepsy surgery and may enable the possibility of surgery in circumstances that were previously considered too risky.

Successful neurosurgery for epilepsy depends on removing the parts of the brain where the cause of epilepsy arises, without damaging areas responsible for vital functions such as language, motor control, sensation and vision. At present MRI and other imaging data are generally viewed separately and in 2D slices, so the 3D relationships between normal and abnormal structures in the brain and the functional anatomy are not well demonstrated.  Consequently, there can be difficulties in planning intracranial investigations and surgery.

The EpiNavTM technology, combines information from an array of imaging technologies, including MRI of brain structure, blood vessels, fMRI of vital functions, and PET provide an integrated 3D image of multiple brain structures and functions. EpiNavTM has enabled neurosurgeons to plan the best operative approach for inserting electrodes that record the electrical activity of the brain and to plan surgical re-sections. 

Professor Duncan, from the National Hospital for Neurology and Neurosurgery, said: “We evaluate approximately 200 patients a year for surgery and half don’t proceed because it is not been possible to pin down sufficiently where the seizures are coming from or the risks of surgery are perceived to be too high. The immediate benefit of using EpiNavTM will be increased accessibility for patients because the risk/benefit ratio improves – those previously considered unsuitable for surgery can now be offered this as a potential solution”.

The researchers will go on to develop EpiNavTM so that the placement of electrodes can be guided by a robot, the electrical signals of epileptic seizures viewed in 3D and surgical resections can be precisely planned to maximise the chances of a good outcome.

The EpiNavTM prototype was created in 2012, supported by The Health Innovation Challenge Fund, a parallel funding partnership between the Wellcome Trust and the Department of Health to stimulate the creation of innovative healthcare products, technologies and interventions and to facilitate their development for the benefit of patients in the NHS and beyond.