Grant: Project Grant

Epilepsy can strike anyone at any time. It is therefore time to offer more effective treatment options for the 70.000 Canadians suffering from drug-resistant seizures. Surgery is the only hope to cure focal epilepsy. However, only 500-1000 epilepsy surgeries are performed each year across Canada. Reasons for this immense gap include the complexity and availability of pre-surgical evaluation. It requires a 1-2 week hospitalization for seizure recording. Developing a shorter 24-hr evaluation that does not require capturing seizures, avoiding seizure-related complications, and that can outperform the current approach (only 50% of patients are postsurgically seizure-free) would be a game changer: It will significantly increase its accessibility, reduce costs drastically, and improve surgical outcomes. This project aims for a time efficient, accurate, and minimally invasive presurgical evaluation. (i) Intracranial electroencephalography (iEEG) is the ideal technique to establish seizure-independent markers, as it is the most direct tool to define the epileptogenic zone. We will develop for patients requiring iEEG new seizure-independent markers to identify the epileptogenic zone within 24 hrs, thus making recording of seizures unnecessary resulting in shorter hospitalization. (ii) Intracranial EEG has major limitations: it is invasive, costly, and has limited coverage of the brain. A translational approach to non-invasive techniques is necessary. We will develop non-invasive markers based on the combination of 256-channel EEG (in clinical routine 19 channels are used) and multimodal magnetic resonance imaging to identify the epileptogenic zone within 24 hrs. Our new approaches will be compared to localization accuracy and surgical outcome obtained with the standard 1-2 week evaluation including prolonged EEG monitoring. This research is timely and will be of benefit for the many patients with focal epilepsy who need epilepsy surgery to cure their seizures.