Epilepsy is a disorder of the nervous system resulting from abnormal activity of nerve cells in the brain. The condition is characterized by seizures and affects approximately 150,000 individuals in the United States annually. In fact, it is estimated that 1 in 26 people in the U.S. will receive an epilepsy diagnosis during their lifetime. Among neurological disorders, epilepsy ranks as the fourth most prevalent, following migraines, stroke, and Alzheimer’s.

A team of researchers at the UCL Queen Square Institute of Neurology has made a significant breakthrough in understanding epilepsy. They have identified a network of connections in the brain that are linked to seizures in people with the condition.

This discovery, published in the journal Brain, could have far-reaching implications for the design of neurological operations for patients with epilepsy that cannot be controlled through medication.

By disconnecting certain pathways in the frontal lobe, the researchers believe that patients may be able to enjoy long-lasting freedom from seizures.

This could represent a major step forward in the treatment of epilepsy, which affects millions of people around the world.

Epilepsy affects a large number of people worldwide, with 500,000 individuals in the UK and 50 million people globally suffering from the condition. Unfortunately, one in three patients are unable to manage their epilepsy through medication alone.

While neurosurgery can be curative for some patients, only 30% of individuals who receive surgery to their frontal lobes remain seizure-free in the long-term.

In order to improve treatment outcomes, the researchers conducted an analysis of MRI scans from 47 patients who had undergone surgery for epilepsy years earlier.

The analysis of the MRI scans revealed that patients experienced longer-term seizure freedom when certain nerve pathways in the brain linking the frontal lobe to deep brain structures, such as the thalamus and striatum, were disconnected.

These structures are responsible for various functions, such as relaying sensory and motor signals, motor control, emotion, and reward.

After three years, 88% of patients remained seizure-free, and 80% were still seizure-free after five years, which is a substantial improvement compared to the typical outcomes of epilepsy-treating neurosurgery (30%) in the frontal lobe.

Additionally, the researchers found that cutting these connections did not result in any negative effects on language or executive functions.

Lead author and neurosurgeon, Mr Davide Giampiccolo (UCL Queen Square Institute of Neurology and Cleveland Clinic London), said:

“Neurosurgery can be very effective for people with epilepsy that is not controlled with medication,” remarks lead author Mr. Davide Giampiccolo.

“However, in some patients, seizures recur years after surgery and, until now, it has not been clear why this happens.”

They think that “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.”

According to the lead author, this breakthrough discovery will enable the redesign of neurosurgical operations and the personalization of procedures for each patient.

This will ensure that the right connections are disconnected, which could result in a significant improvement in the long-term results of epilepsy surgery.

The researchers are hopeful that this development will help to reduce the recurrence of seizures in patients with epilepsy, providing greater long-term relief and improved quality of life.

Tom Shillito, the Health Improvement and Research Manager at Epilepsy Action, has highlighted the significant impact of uncontrolled epilepsy on various aspects of life, including education and employment.

“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 free from seizures in the long-term following brain surgery, the decision to undergo this invasive operation can be an incredibly difficult one to make.”

Shillito has expressed excitement about the new findings, which offer improved results in providing long-term relief from seizures, particularly for individuals with drug-resistant epilepsy.

He hopes that this development will help to empower even more people with epilepsy to make informed decisions about their future treatment and gain greater seizure freedom.

Source: 10.1093/brain/awad085

Image Credit: Getty