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The goal of this clinical trial is to improve non-invasive identification of epileptogenic networks in drug-resistant epileptic patient.
The investigators aim to compare epileptogenic network identification with stereo-EEG (used as glod standard) with the identification of the same network using advanced MRI (rs-fMRI, microstructural analysis of white matter, ...). The main goals are to:
Participants will already have been selected for stereoEEG and will undergo a supplementary MRI (about 1h) with the additional MRI sequences. Follow-up MRI are scheduled for patient undergoing a second, therapeutic epileptic surgery.
Patient identified for SEEG will undergo, prior to the implantation procedure an MRI with the following sequences:
The rsfMRI will be post-processed to delineate the epileptogenic networks based on an Independant Component Analysis (ICA) methods. Once the epileptogenic network(s) has/have been identified, connexion between the different regions will be identified through post-processing of the diffusion using a MSMT-CSD algorithm. Finally, the identified tract between the different region will be quantitatively analysed using different algorithms (NODDI, DIAMOND, MF) to better grasp there integrity.
In a follow-up study, the patients that will later on benefit from a resection or disconnection (i.e. curative surgery) will also have an identical MRI 3 months after the said procedure to evaluate the evolution on the network(s) based on the same criteria.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single Arm | Experimental | Single Arm |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Advanced MRI | Device | resting-state functional MRI, diffusion with advanced post-processing (microstructure analysis), myelin mapping |
|
| Measure | Description | Time Frame |
|---|---|---|
| Network identification with MRI | Analysis of the anatomical overlap of radiological network (with MRI) and the electrophysiological network (with SEEG) using coregistration and a sublobar analysis. Overlap will be quantified in %. | At the end of phase 1 - expected to be 3 years after first inclusion |
| Prognosis of network targetting with surgery | Analysis of the impact on epileptic outcome in accordance with effect of the surgery on the network. The impact of the surgery on the network will be assessed by coregistration to determine which part of the network has been removed or disconnected. The epileptic outcome will be assessed using the Engel classification | One year after surgery (phase 2) |
| Interest of adding epileptic network radiological analysis in a standard epileptic work-up | Analyse the impact on therapeutic and/or diagnostic decision of the network radiological analysis in a standard clinical practice. This impact will be assessed by measuring the change in the type of decision (further work-up, invasive EEG, "curative" surgery, "palliative" surgery or no modification) or the modification in the extent of surgery (more/less electrodes for invasive EEG, more/less tissue targeted with surgery) | Approximately 1 year after the start of phase 3 |
| Measure | Description | Time Frame |
|---|---|---|
| Network quantification | Analysis of the strength of the network using radiological data (r², Z-score, diffusion metrics obtained via microfingerprinting such as fiber volume fraction and fiber fraction) vs electrophysiological metrics (epileptogenic index, h²) | At the end of phase 1 - expected to be 3 years after first inclusion |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Riëm El Tahry, PhD | Contact | 003227641080 | riem.eltahry@saintluc.uclouvain.be |
| Name | Affiliation | Role |
|---|---|---|
| Riëm El Tahry, PhD | Cliniques universitaires Saint-Luc- Université Catholique de Louvain | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cliniques Universitaires St-Luc | Recruiting | Brussels | 1200 | Belgium |
Data will be kept on RedCap and made available after reasonable request
12 months after completion of the study
reasonable request evaluated by the research team
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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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| Network regulation with surgery |
Analysis of the impact of the surgery on the radiological parameters of the network cited in outcome 4 (r² and Z-score for rsfMRI, number of tracts for tractography and strenght of tract with fiber fraction and fiber volume fraction for microfingerprinting) |
| One year after surgery (phase 2) |