Piper, Rory J.;
(2024)
Network-guided surgery for children with epilepsy.
Doctoral thesis (Ph.D), UCL (University College London).
Abstract
Epilepsy is a disorder of brain networks. The connectivity of the brain may be analysed by considering the brain as a graph with nodes (brain regions) and edges (a measure of connectivity between nodes). There is a growing body of research to identify critical nodes within dynamic epileptogenic networks with the aim to target therapies that halt the onset and propagation of seizures. This PhD thesis applies a networks approach to epilepsy surgery and focuses on two particular propagation points or nodes (piriform cortex (PC) and thalamus) within epileptogenic networks and reports three studies at different steps of the clinical translational pathway. Study #1 was a retrospective study investigating the association between the extent of resection of the PC and post-operative seizure freedom in children who underwent anterior temporal lobe resection for temporal lobe epilepsy (TLE). This is the first study demonstrating that, in children with TLE and hippocampal atrophy, more extensive temporal PC resection is associated with a greater chance of seizure freedom. Study #2 was a prospective ultra-high-field (7-Tesla) MRI study investigating the functional connectivity of the PC and thalamus in children and adults with TLE. This study did not find functional connectivity differences in either mesial temporal lobe structures or thalamic subregions in the full TLE cohort compared to controls. Reduced functional connectivity of amygdala and increased functional connectivity of ventral -anterior nucleus of the thalamus were found in patients with hippocampal atrophy compared to those without. Study #3 reports on the outcomes for the first participant recruited to the Pilot Study of the Children’s Adaptive Deep brain stimulation for Epilepsy Trial (CADET), a consecutive series of prospective, multicentre, interventional clinical trials of deep brain stimulation of the centromedian nucleus of the thalamus in treating children with Lennox-Gastaut Syndrome.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Network-guided surgery for children with epilepsy |
| Language: | English |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10195083 |
Archive Staff Only
 |
View Item |
