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| ID | Type | Description | Link |
|---|---|---|---|
| 2018-A02452-53 | Other Identifier | ANSM |
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Drug-resistant partial epilepsies are disabling diseases for which surgical treatment may be indicated. The determination of the area to be operated (or 'epileptogenic zone') is based on a bundle of clinical arguments and neuroimaging, having a direct impact on surgical success.
Epileptic patients have electrical abnormalities that can be detected with surface electrophysiological examinations such as surface EEG or MagnetoEncephalography (MEG). The intracerebral source of these abnormalities can be localized in the brain using source modeling techniques from MEG signals or EEG signals if a sufficient number of electrodes is used (> 100, so-called high EEG technique Resolution = EEG HR). EEG HR and MEG are two infrequent state-of-the-art techniques.
The independent contribution of EEG HR and MEG for the localization of the epileptogenic zone has been shown in several studies. However, several modeling studies have shown that MEG and EEG HR have a different detection capacity and spatial resolution depending on the cortical generators studied. Modeling studies suggest that MEG has better localization accuracy than EEG for most cortical sources.
No direct comparison of the locating value of MEG and EEG HR for the localization of the epileptogenic zone has been performed to date in a large-scale clinical study.
In this prospective study, 100 patients with partial epilepsy who are candidates for epilepsy surgery, and for some of them with intracranial EEG recording, will benefit from two advanced electrophysiological examinations including magnetoencephalographic recording (MEG). ) interictal electrophysiological abnormalities and high-resolution EEG recording (128 electrodes) in addition to the usual examinations performed as part of the pre-surgical assessment, prior to cortectomy and / or intracranial EEG recording.
Based on recent work conducted in humans, we postulate:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| cohort | Experimental | MEG - EEG HR |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MEG - EEG HR | Procedure | MEG : Magnetoencephalography is the study of the magnetic fields produced by the electrical activity of the brain. MEG signals are obtained while the patient is placed in a device specific to this technique. The latter comprises a recording chamber, recording sensors which are placed in a cryostat and an electronic measuring system. The magnetic fields are measured while the subject is placed in a shielded magnetic chamber protecting it from variations in the ambient magnetic field (displacement of metal masses, sector ...). EEG HR: High Resolution EEG is defined as the recording of cerebral electrical activity with 128 electroencephalographic electrodes and with high temporal resolution usually followed by the use of source localization tools. The HR EEG is therefore derived from standard EEG techniques, but requires a higher number of electrodes and the use of source localization tools. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients for whom there will be a spatial congruence between the operated area and the area modeled in EEG HR and MEG, among the population of patients operated and cured | We will consider that it is congruent when the most likely source model will be located in the resected focus determined by the postoperative MRI. The clinical outcome of the patients will be assessed 1 year after the intervention according to the Engel classification. Patients with an Engel Grade 1 score will be considered cured. | Month 12 after Surgery |
| Measure | Description | Time Frame |
|---|---|---|
| To compare the ability of EEG HR and MEG to localize the epileptogenic zone by considering the epileptogenic zone as the brain area involved in the beginning of the crisis in patients requiring intracranial EEG recording | Proportion of patients for whom there will be a spatial congruence between the epileptogenic zone defined by intracranial EEG recording and the modeled zone in EEG HR and MEG, among the population of operated and cured patients. The clinical outcome of the patients will be assessed 1 year after the intervention according to the Engel classification. Patients with an Engel Grade 1 score will be considered cured. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Julien JUNG, Dr | Contact | 04 72 35 79 00 | julien.jung@chu-lyon.fr | |
| Camille GIRAUDON | Contact | 04 26 73 94 38 | +33 | camille.giraudon@chu-lyon.fr |
| Name | Affiliation | Role |
|---|---|---|
| Julien JUNG, Dr | Hospices Civils de Lyon | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospices Civils de Lyon | Recruiting | Bron | 69500 | France |
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| ID | Term |
|---|---|
| D000069279 | Drug Resistant Epilepsy |
| D004827 | Epilepsy |
| ID | Term |
|---|---|
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| Month 12 after Surgery |
| To evaluate the spatial congruence between the zones modeled by the MEG and the EEG HR and the resected brain zone in the group of the patients not cured | Proportion of patients for whom there will be a spatial congruence between the operated area and the modeled area in EEG HR and MEG in the group of operated and unhealed patients. | Month 12 after Surgery |
| Study the complementarity of EEG HR and MEG for the localization of the epileptogenic zone | proportion of patients for whom there will be a spatial congruence between the operated area and the modeled area GET HR with a priori MEG and without bias MEG and the proportion of patients for whom there will be a spatial congruence between the operated area and the zone modeled in MEG with a priori EEG HR and without a priori EEG HR, among the population of patients operated and cured. | Month 12 after Surgery |
| To study the localization value of MEG intercritical network analysis for the detection of the epileptogenic zone via graph theory | Proportion of patients for whom there will be a spatial congruence between the operated area and the MEG model zone having the highest centrality value (hub) within the interictal network, among the population of patients operated and cured | Month 12 after Surgery |