Can doctors see into the future?
At least when it comes to epileptic seizures.
In a groundbreaking project from the University of TX Health Science Center at Houston, scientists say they can now predict seizures more than 30 minutes before they occur among patients with temporal lobe epilepsy.
The team, led by Sandipan Pati, MD, associate professor in the Department of Neurology with McGovern Medical School at UTHealth Houston, has developed the possibility of a new therapy using electrodes that could also stop seizures before they even start.
In a media release, Pati, senior author of the study and a member of the Texas Institute for Restorative Neurotechnologies at UTHealth Houston Neurosciences, said,
“The ability to predict seizures before they occur is a major step forward in the field of epilepsy research. “These findings are significant because they suggest that we may be able to develop more effective therapies for epilepsy, which could greatly improve the quality of life for patients who suffer from this condition.”
Temporal lobe epilepsy is the most common seizure disorder. In fact, estimates show that it affects about 50 million people globally. The brain has two temporal lobes, one on each side of the head behind the temples. Mesial temporal lobe epilepsy, which accounts for around 80% of all temporal lobe seizures, involves seizures beginning in or around a part of the brain called the hippocampus. It is responsible for controlling memory and learning. Neocortical or lateral temporal lobe epilepsy involves seizures starting in the outer region of the temporal lobe.
As far as treatments go, surgery is usually pretty standard, but when a patient’s seizures affect more extensive areas of the brain, surgically removing part of the brain isn’t an option. So instead, neuromodulation therapy could be an alternative solution for many patients with these seizures, according to Pati.
Previous research concentrating on continuous electroencephalography (EEG) suggested seizures in people with focal-onset epilepsies often occur during heightened risk periods, typified by pathologic brain activities referred to as “pro-ictal states.” EEG-based detection of pro-ictal states is vital to the success of adaptive neuromodulation because early detection allows for the use of electrodes to the patient’s seizure onset zone and thalamus.
Pati’s team evaluated 15 patients diagnosed with temporal lobe epilepsy. They underwent limbic thalamic recordings and routine intracranial EEG for seizure localization. They ended up analyzing 1,800 patient hours of continuous EEG.
The researchers successfully detected pro-ictal states in patients with temporal lobe epilepsy at least 35 minutes before seizure onset. What’s more, in 13 of the 15 participants, the team predicted pro-ictal states at least 45 minutes before seizure onset. In the other two patients, they predicted seizures up to 35 minutes before they presented.
Scientists still have to confirm this theory through clinical trials. However, Dr. Pati believes that modulation of these brain regions during pro-ictal periods may be an effective therapeutic approach to treating temporal lobe epilepsy. These findings could also lead to the development of drugs that prevent seizures altogether.
“This study was made possible by the collaboration of a team of experts in neurology, neurosurgery, and neuroscience,” Pati concludes. “It highlights the importance of interdisciplinary research in advancing our understanding of brain disorders.”
The study is published in NEJM Evidence,