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Researchers from the University of London confirm that there is indeed a network of connections located in the brain linked to seizures in people with epilepsy. The fact of identifying it formally could make it possible to correct it, by surgery.
In France, an estimated 600,000 people are affected by epileptic seizures, and 50 million worldwide. Although there are treatments, one in three people fail to fully control their seizures. And only 30% of patients going through the neurosurgery stage truly say goodbye to long-term seizures. But a new study conducted in London has revealed a set of connections linking the frontal lobe to deep brain structures that “just” need to be disconnected to avoid seizures.
Nerve pathways identified in epilepsy
The team analyzed the MRIs of 47 epileptic patients who had undergone frontal lobe surgery years earlier. They found that patients were freed from seizures when the nerve pathways in the brain that connect the frontal lobe to deep brain structures (the thalamus and striatum, which are responsible for relaying sensory and motor signals, motor control, emotion and reward) were disconnected.
- 88% of patients had been seizure-free after three years;
- 80% had not known one at five years old.
This was also confirmed in a subgroup of 29 patients who underwent complete resection, suggesting that these pathways may play an essential role in the development of new epileptic networks. By disconnecting certain pathways in the frontal lobe, patients might therefore be able to enjoy a sustained freedom from seizures.
Important point to clarify: in addition to preventing the recurrence of future seizures, the researchers found that cutting the connections had no negative effect on language or executive functions.
A controlled disconnection to free patients from their epilepsy
For the team behind the study, the finding is significant, and would rethink and improve neurological operations for patients whose epilepsy cannot be controlled with medication.
The main author and neurosurgeon, Mr. Davide Giampiccolo sees in this discovery a great hope:
“We now think it may be linked to connections in the brain that form a network that causes epileptic seizures. If correct, disconnecting this network from the frontal lobe with surgery could prevent seizures from occurring. reproduce years later, making sure the right connections are cut”.
For Tom Shillito, head of health improvement and research at Epilepsy Action, this discovery could also offer a simpler option for those affected: “Neurosurgery can be a really effective treatment for the many people facing the challenges of uncontrolled epilepsy… However, with only a small number of people remaining seizure-free long-term after brain surgery, the decision to undergoing this invasive operation can be incredibly difficult to take.” If this technique can effectively free people from their epilepsy, it does indeed represent a great hope of resuming a normal life.
Limits to overcome to pursue research
However, the research is far from over and deserves further investigation, as the study itself reveals:
- All 47 patients involved in the study suffered from epilepsy due to frontal lobe damage. But epilepsy due to lesions in other regions of the brain may have a different impact on brain reorganization;
- The effect of this surgery on language and executive functions has been examined, but the impact on other brain functions such as mood or emotion remains to be tested;
- Finally, the study involved only 47 patients. Confirmation of the results is needed in a larger cohort.