Grant: CIHR Fellowship

Epilepsy is a disorder in which people have seizures, and is the second most common brain condition in the world. Most people with epilepsy can stop having seizures if given the right drug. However, up to 4 out of every 10 patients treated with drugs will continue to have seizures. These patients use 8 times as many health care resources as those whose epilepsy is well controlled. Surgery can be a very effective option for many of these patients; it can be successful at making patients seizure-free and improving their quality of life. Patients with an abnormality on magnetic resonance imaging (MRI) scans of their head or on analysis of the tissue following the operation are 3 times more likely to become seizure-free after surgery. Unfortunately, not everyone has an abnormality on MRI to guide surgery. This form of epilepsy, when an MRI abnormality is not found, is called 'non-lesional' epilepsy. Non-lesional epilepsy is a major health issue for patients and a substantial challenge for the health care system. It is hoped that other forms of imaging, like positron emission tomography (FDG-PET) and single photon emission computed tomography (SPECT) may be able to identify abnormalities that are not seen on MRI. If an abnormality is detected, these patients may have better seizure control following an operation because of the identification of a surgical target. We therefore aim to first determine how common 'non-lesional' epilepsy is in centres that perform epilepsy surgery and determine whether the characteristics of these patients differ from those that have an MRI abnormality. We then plan to evaluate different approaches to the diagnosis and management of 'non-lesional' epilepsy to identify the most cost-effective strategy that is associated with greatest chance of seizure-freedom and the highest patient quality of life. This project will encourage effective use of health care resources and promote patient-centred care for people affected by epilepsy.