Clinical trials are research studies that test how well new medical approaches work in people. Each study answers scientific questions and tries to find better ways to prevent, screen for, diagnose, or treat a disease. People who take part in clinical trials have an opportunity to contribute to knowledge of, and progress against a disease. They also receive up-to-date care from experts. Below is an up-to-date list of the clinical trials the Epilepsy Program is offering:
A pilot study to evaluate MR-guided laser ablation of focal lesions in patients with medically refractory epilepsy
Epilepsy is a disorder which occurs at a high rate among the general population. Studies in industrialized populations estimate that between 1%-3% have some form of epilepsy. Approximately one-third of all patients with epilepsy do not respond to available antiepileptic treatment, which leads to a significant reduction in their quality of life. Options for patients with refractory seizures include resective surgery following a carniotomy. This can be associated with significant risk and often complete resections are not possible because of the proximity of the epileptic foci to areas of brain that control major functions. Previous studies have demonstrated potential for thermal ablation (tissue destruction through heating) techniques as an alternative surgical procedure for epilepsy in patients that did not respond well to medication. In these prior studies small probes were placed into the region of the brain suspected as being responsible for causing or promoting seizures and used for heat volumes of tissue to lethal temperatures. While good results have been reported with such techniques they are not widely practiced because the physician can not tell how much tissue is being heated and therefore may unintentionally heat and damage normal tissue. The Visualase Thermal Therapy System is an FDA-cleared device used for thermal destruction of soft tissue in neurosurgery under guidance from a magnetic resonance imaging (MRI) system. The device combines a laser and computer workstation for that allows a surgeon to perform a type of therapy called Laser Interstitial Thermal Therapy (LITT) which heats tissue using lasers while watching the temperatures and areas treated using information from the MRI. LITT uses laser light to heat and destroy the affected tissue by delivering light through small fiber-optic probes placed directly into the area intended for heating. During the heating process, MRI images are obtained and data from them are used to display temperatures around the probe to make sure the targeted tissue receives enough heating and that normal tissues around the target are not treated. LITT is less invasive than an open surgical procedure. There are no radiation-related side effects, or limits on the number of times it can be repeated. Also, since the procedure is performed in the MRI, doctors can find out right away how much tissue was treated by using special imaging sequences, which may also show any areas of the target that were insufficiently heated.
Diagnostic utility of diffusion tensor imaging in individuals with intractable epilepsy
Epilepsy is a condition in which an individual experiences recurrent abnormal electrical discharges in the brain that manifest as paroxysmal behavior patterns (i.e., seizures). In centers that specialize in the diagnosis and treatment of epilepsy, a diagnostic work-up routinely includes acquiring a detailed medical and psychiatric history, physical and neurological examinations, prolonged video-EEG monitoring, standard structural MRI and other neuroradiologic techniques, neuropsychological testing, and intra-carotid sodium amytal testing. The major purposes of the work-up are to determine whether epileptic seizures exist, the correct classification of epileptic seizure type, where in the brain the epileptogenic region is located, and what is the most effective treatment.
EEG and the Default Mode Network
Our present research investigates the causal inter-relationships between the default mode network of the brain (DMN) and two major eloquent brain areas – Broca’s expressive speech area and Wernicke’s receptive speech area that are activated in goal-directed behavior. The objective of the research is (1) To identify the timing of activation – which areas of the brain lead and which follow in (a) DMN – eloquent cortex activation, and (b) eloquent cortex – DMN activation (the default state) using functional magnetic resonance (fMRI), diffusion imaging and electroencephalography (EEG). (2) To continue to characterize the abnormal patterns of activation of the brain with EEG and fMRI that we have discovered in patients with complex partial seizures (CPS), the most prevalent form of epilepsy in the United States. Our fMRI studies have found the activation of a much larger number of areas of the brain in patients with CPS than in patients without seizures. We believe that the pattern of activation that we have found in patients with CPS has diagnostic significance and that it can also be used to monitor the efficacy of anticonvulsant medication and provide a prognosis of the efficacy of surgical removal of epileptic cortex.
For more information, please contact:
Sha Rogers, LVN
Research Coordinator
Methodist Neurological Institute
6560 Fannin, Suite 802
Houston, TX 77030
713-441-3970 phone
713-790-2270 fax
LLRogers@tmhs.org
