March 26 is Purple Day for Epilepsy, a day to support epilepsy awareness worldwide
The Neuro has been a world leader in epilepsy treatment and research for more than 60 years. Indeed, the “Montreal Procedure” developed by The Neuro’s founder, Dr. Wilder Penfield, and his colleagues has become the standard operating procedure for the surgical treatment of epilepsy. The Neuro was also a pioneering institute in exploiting electroencephalography (EEG) and magnetic resonance imaging (MRI) to study and treat epilepsy.
Each year, The Neuro’s Epilepsy Clinic provides in-patient and out-patient services for about 1,500 patients. A multi-disciplinary team of epileptologists, neurosurgeons, nurses, neuropsychologists, neuropsychiatrists, social workers, EEG technologists, nurse clinicians and case managers makes up The Neuro’s comprehensive epilepsy program.
What is epilepsy?
Epilepsy is a neurological disorder characterized by a sudden, brief change in the brain, expressed as a seizure. According to Epilepsy Canada, approximately one per cent of Canadians have epilepsy. Thirty per cent of new Canadian cases are children. In about half of child cases, seizures eventually disappear.
Epilepsy is a result of different causes: malformations during brain development, a head injury that causes scarring to the brain tissue, high fever and prolonged convulsions during early childhood, trauma at birth, a stroke or tumour. Listen to one patient's story of how he developed epilepsy in this video.
One out of three patients cannot control seizures solely by using available medications. For these patients, surgical removal of the brain tissue causing seizures is the only known effective treatment for controlling seizures and improving quality of life.
Seizures can be triggered by outside events such as strobe lights, or by a person’s state of health—fatigue, illness, hunger, or emotional stress.
Innovation in epilepsy research: a Neuro tradition
Earlier this year, one of the world’s most distinguished epileptologists, Dr. Frederick Andermann, announced his retirement from The Neuro after a career spanning more than 40 years. Among Dr. Andermann’s distinctions was the 2003 Prix du Québec (Wilder Penfield), Quebec’s highest honour for scientific research.
The torch is passed to the next generation of epilepsy researchers. The Neuro’s epilepsy program recently welcomed a new principal investigator to its ranks, Dr. Boris Bernhardt, winner of the 2017 Michael Prize, a major international award “for the best scientific and clinical research promoting the further development in epileptology.” The Michael Award was previously bestowed on two other researchers at The Neuro: Dr. Pierre Gloor (1979) and Dr. Massimo Avoli (1995). Dr. Bernhardt’s work continues in The Neuro’s tradition of epilepsy innovation.
Dr. Bernhardt has begun developing a new method that can more accurately predict post-epilepsy surgery side effects in children. At present, following epilepsy surgery, about one patient in three suffers from either cognitive side effects or a recurrence of seizures. So far, physicians cannot accurately predict the extent or nature of an outcome prior to surgery.
Dr. Bernhardt hopes to increase prediction accuracy by combining data from preoperative markers of the patient’s anatomy with data from models that simulate the consequences of surgery. The data will be gathered before and after the surgical operation to see whether any changes occurred in the patient’s brain, as well as to map any alterations in areas of the brain that did not undergo surgery.
For the purposes of Dr. Bernhardt’s research, magnetic resonance imaging and neurocognitive data will be gathered from patients shortly before surgery and then one year later. Patients will also undergo functional magnetic resonance imaging while patients perform language and memory tasks, to map brain regions critical for these functions and to evaluate whether the resection of these regions relates to post-operative cognitive decline.
Dr. Bernhardt expects his research to yield effective models that will increase outcome predictions. His research could improve physicians’ ability to make the best clinical decisions for thousands of Canadian children who expect to undergo epilepsy surgery.
The Neuro’s Epilepsy Specialists:
Eva Andermann – a clinician/researcher who has focussed on the genetic factors that underlie epilepsy and its syndromes. She also provides genetic counselling to epilepsy patients’ families.
Andrea Bernasconi – a clinician and epileptologist specializing in neuroimaging of epilepsy. He uses advanced magnetic resonance imaging (MRI) techniques to create models of epileptogenic lesions. His specialized MRI analyses can identify neuronal migration disorders that conventional imaging often cannot detect.
Neda Ladbon-Bernasconi – a researcher using advanced MRI techniques to study the biological basis of epilepsy. Her work has helped to understand various epilepsy syndromes, particularly those related to the limbic system, which is linked to basic human emotions and memory. Dr. Ladbon-Bernasconi is the co-founder of the Neuroimaging of Epilepsy Laboratory (NOEL).
Boris Bernhardt - a researcher looking at brain structure in order to make large-scale descriptions of abnormal brain networks in epilepsy patients. Dr. Bernhardt’s research is of use to neurosurgeons who handle epilepsy surgery, but he is most interested in studying the links between brain structure and cognition. He seeks to know whether brain models based on epilepsy cases can be used to predict cognitive impairments or psychiatric abnormalities.
Francois Dubeau – a neurologist treating patients with epileptic syndromes that are difficult to manage. He works in collaboration with clinicians and researchers using non-invasive as well as invasive EEG methods to locate the sources of epileptic activity. He also looks to explain how brain lesions play a role in generating epileptic seizures. His laboratory is particularly interested in studying and defining new and more reliable biological markers of the epileptogenic zone, an area where epileptic activity is generated and requires surgical removal to make patients seizure free. In recent years, Dr. Dubeau and his colleague, Dr. Jean Gotman, have confirmed the value of fast oscillations as biomarkers of the epileptogenic zone in epileptic patients. They have also demonstrated the value of EEG/fMRI in defining this zone non-invasively. They hope to see this method used in clinical work in the near future.
Jean Gotman – a researcher using a novel combination of functional imaging techniques and electroencephalography to study brain regions where patients’ epileptic attacks are occurring. His work has improved our understanding of epileptogenesis and our ability to locate epileptogenic regions. Dr. Gotman has also developed widely used software for epilepsy patient monitoring.
Jeffrey Hall – a specialist in the neurosurgical treatment of epilepsy with a particular interest in complex cases. Dr. Hall is on the leading edge of exploring epileptic foci through the robotic insertion of MRI-compatible intracranial electrodes. This technique is helping patients to control seizures and allowing researchers to better understand basic neurophysiological mechanisms underlying seizure disorders.
Eliane Kobayashi – a neurologist applying functional neuroimaging to study epileptic foci and epilepsy networks.
The Montreal Neurological Institute and Hospital -- The Neuro, is a unique academic medical centre dedicated to neuroscience. A research and teaching institute of McGill University, The Neuro forms the basis for the Neuroscience Mission of the McGill University Health Centre. Founded in 1934 by Dr. Wilder Penfield, The Neuro is recognized internationally for integrating research, compassionate patient care and advanced training, all key to advances in science and medicine. Neuro researchers are world leaders in cellular and molecular neuroscience, brain imaging, cognitive neuroscience and the study and treatment of epilepsy, multiple sclerosis and neuromuscular disorders. For more information, please visit www.theneuro.com