A network of connections has been found in the brain, linked to seizures in people with epilepsy.
A team of researchers from UCL Queen Square Institute of Neurology believe their findings will help to redesign neurological operations for patients whose epilepsy cannot be controlled by medication.
They analysed MRI scans of 47 patients who had received surgery to their frontal lobes for epilepsy, years earlier, finding that patients had longer term seizure freedom when nerve pathways in the brain that link the thalamus and striatum were disconnected.
All participants in the study, which is published in the latest edition of Brain, had epilepsy due to lesions in the frontal lobe. Although the team examined the effect of this surgery on language and executive functions, the impact on other brain functions such as mood or emotion was not tested.
Compared to the typical outcomes for epilepsy-treating neurosurgery (30%) in the frontal lobe, 88% of patients seizure free after three years and 80% seizure free at five years.
Alongside preventing the recurrence of future seizures, cutting the connections did not have any negative effects on language or executive functions.
Lead author and neurosurgeon Mr Davide Giampiccolo said: “Neurosurgery can be very effective for people with epilepsy that is not controlled with medication. However, in some patients, seizures recur years after surgery and, until now, it has not been clear why this happens.
“We now think this might be related to connections in the brain that form a network that gives rise to epileptic seizures. If this is correct, disconnecting this frontal lobe network with surgery could prevent seizures recurring years later.”
He said this will enable them to redesign neurosurgical operations and personalise the operations for each patient, ensuring that the right connections are cut.
Tom Shillito, health improvement and research manager at Epilepsy Action, welcomed the findings, saying: “It is exciting that these new findings have seen improved results in giving people long-term freedom from seizures and this is a promising development for people with drug-resistant epilepsy. We hope this can help to empower even more people with epilepsy to make more informed and confident decisions about their future treatment.”
Giampiccolo D, Binding LP, Caciagli L et al. Thalamostriatal disconnection underpins long-term seizure freedom in frontal lobe epilepsy surgery. Brain April 2023; doi: 10.1093/brain/awad085
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