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Projekt Druckansicht

Spontane und elektrisch induzierte Veränderungen der kortitikalen Exzitabilität epileptischer Netzwerke nach Radiofreuqenzthermokoagulation

Fachliche Zuordnung Klinische Neurologie; Neurochirurgie und Neuroradiologie
Kognitive, systemische und Verhaltensneurobiologie
Förderung Förderung von 2018 bis 2022
Projektkennung Deutsche Forschungsgemeinschaft (DFG) - Projektnummer 406906271
 
Erstellungsjahr 2023

Zusammenfassung der Projektergebnisse

Epilepsy effects around 1 out of 100 people worldwide. Around 30% of these pensions continue to have seizures despite adequate antiepileptic treatment. Some of these patients are eligible for epilepsy surgery. Epilepsy surgery aims to remove brain area set generalized epileptic seizures to render the patient permanently seizure-free. Currently this is the only method of cure for patients with epilepsy. The main challenge is that physicians face when planning epilepsy surgery is to properly identify the regions which are responsible for generating seizures. Overall, the success of epilepsy surgery is 70%. We really aim to better prognosticate which patients will be seizure-free and which will fail to become seizure-free. For this we use electrodes placed intracranially in the brain to find the seizure focus. There have been development of new biomarkers called highfrequency oscillations [HFO] that might help to identify areas that are likely to generate seizures. In this project we aimed to understand to which extend HFO's can do this and we used a unique method to understand epileptic networks and how these can be manipulated. One minimally invasive method to destroy epileptic tissue is called radiofrequency thermal ablation (RFTC). During this a project patients underwent RFTC is given via an intracranially implanted electrode and destroys the tissue around the electrode. After this intervention the electrodes remain in place and physicians can see whether the seizures stopped from this brain region. If successful, some patients do not undergo resected epilepsy surgery. The specific aim of this project was to look at HFO and how they are altered by RFTC ablation. Additionally, we wanted to understand the extent of the effect of RFTC on not only the region where it was applied but the wider epilepsy network. We could show that patients are more likely to be seizure-free if the RFTC does not only change epileptic markers in the region where it was applied but also in regions which are functionally connected and further away in the brain. That means that if we have an application of RFTC in the temporal lobe and this leads to a reduction of epileptic activity in the frontal lobe and the patient would be more likely to be seizure-free then if it only affected the activity in the local restricted region. Overall, our study results suggest that RFTC can have an effect beyond the very focal lesion and that HFO can show us when this happens. Our findings are also in line with the increasing understanding that epilepsy rarely is a very focal disease but often involves widespread brain networks. These findings are highly clinically relevant for two reasons. First, they show that very focal intervention in the brain can have a much larger network effect. Thus, a small intervention can stop seizures even if epilepsy involves larger brain. This is in keeping with a trend for having less invasive and smaller epilepsy surgeries. If we are able to understand the epileptic network and to which extent, we have to manipulate it, this would allow for much more targeted epilepsy surgery interventions in the future. Our study provided important information for these approaches. Second, we have also shown that our biomarker, the HFO, can help to measure network effects after RFCT intervention. For the future we aim to improve out methods further to allow clinical prospective trials that will allow assessing HFO network analysis with even more precision and clinical relevance.

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