Improving seizure freedom after epilepsy surgery

A network of connections in the brain could be the key to improving frontal lobe epilepsy surgery, according to new research from the UCL Queen Square Institute of Neurology.

The research, published in the journal Brain, suggests that disconnecting certain pathways in the frontal lobe could lead to longer-lasting seizure freedom after brain surgery.

Some people with epilepsy can have brain surgery to try to stop their seizures when epilepsy medicines don’t work. But in people with frontal lobe epilepsy, only around a third (30%) remain seizure free in the long term after surgery.

The networks of connections that the researchers identified link the frontal lobe to brain structures deep in the brain, including the thalamus and striatum. These control things like sensory and motor signals, motor control and emotion.

In their research, 47 people with damage in the frontal lobe of their brain had these networks disconnected. The results showed nearly nine in 10 people stayed seizure free three years after the surgery, and between seven and eight in 10 were seizure free after five years.

The research found that this surgery also did not have negative effects on language or on executive functions like planning, self-control and focus. However, other functions, such as mood or emotions, still need to be studied.

Redesigning neurosurgery

Neurosurgeon at UCL and lead author of the study, Mr Davide Giampiccolo, said: “In some patients, seizures recur years after neurosurgery 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.

“This will allow us to redesign neurosurgical operations and personalise the operations for each patient, ensuring the right connections are cut.

“We hope this will lead to a great improvement in the long-term results of epilepsy surgery.”

Tom Shillito, health improvement and research manager at Epilepsy Action, said: “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 treatment.”

The researchers said that the results need to be confirmed by a larger study.