Thalamic Recordings in Children Undergoing SEEG (TRICS)
Stereoelectroencephalography (SEEG) forms a key part of the pre-surgical evaluation in children who may be candidates for epilepsy surgery. It can help delineate the location of the putative epileptogenic zone, guiding further treatments including resective, disconnective and ablative epilepsy surgery techniques. However, less than 35% of children undergoing SEEG end up becoming seizure free following further treatment.
Open and closed loop stimulation of thalamic nuclei via deep brain stimulation (DBS) and responsive neurostimulation (RNS) are emerging treatment options for epilepsy. Thalamic target nuclei vary between studies and there are currently no gold standard personalised methods for choosing a target. This stems from the limited systematic neurophysiological recordings from thalamic nuclei; investigators currently do not understand the ictal and interictal thalamic signatures of involvement in epilepsy and do not understand how functional connectivity can be altered within and between patients.
In this prospective study, the investigators aim to recruit 30 patients undergoing SEEG as part of their pre-surgical evaluation for drug resistant epilepsy at Great Ormond Street Hospital over a period of 3 years. Once recruited, the investigators will target 3 nuclei bilaterally in each patient - the anterior, centromedian and pulvinar nuclei - using additional SEEG electrodes. Following clinical recording, the investigators will conduct two stimulation experiments, the first using single pulse electrical stimulation to measure effective connectivity between the thalamus and cortical regions and the second to study the effects of simulated DBS currents on cortical local field potential signatures.
This study will lay the foundation for a personalised approach to thalamic neuromodulation for drug-resistant epilepsy by identifying neurophysiological biomarkers of thalamic involvement in epilepsy, paving the way for closed loop neuromodulation strategies that aim to optimise response using these biomarkers.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Aswin Chari, PhD
- Phone Number: 07726780817
- Email: aswin.chari.18@ucl.ac.uk
Study Contact Backup
- Name: Martin Tisdall, MD
- Email: martin.tisdall@gosh.nhs.uk
Study Locations
-
-
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London, United Kingdom, WC1N 3JH
- Recruiting
- Great Ormond Street Hospital for Children
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Contact:
- Aswin Chari, PhD
- Phone Number: 07726780817
- Email: aswin.chari.18@ucl.ac.uk
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- All children undergoing SEEG as part of their pre-surgical evaluation at GOSH
- Participants/parents/legal guardian provide informed consent for inclusion
Exclusion Criteria:
1) Lack of informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Thalamic SEEG
The centromedian, anterior and pulvinar nuclei on each side will be chosen as target for new electrodes.
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The centromedian, anterior and pulvinar nuclei on each side will be chosen as target for new electrodes; up to 6 additional electrodes may be added but, where possible, existing electrode trajectories will be extended to facilitate recording. At the beginning of the recording process, usually within the first 24-48 hours of implantation, we will conduct 2 study-specific stimulation experiments:
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Ictal thalamic involvement
Time Frame: Hospital discharge (maximum one month from SEEG implantation)
|
Experienced neurophysiologists will assess, during ictal activity, whether each of the nuclei are involved in the seizure and, if so, the latency between first cortical contact onset and thalamic nucleus onset.
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Hospital discharge (maximum one month from SEEG implantation)
|
|
Epileptogenicity index
Time Frame: Hospital discharge (maximum one month from SEEG implantation)
|
We will quantify ictal involvement by measuring the epileptogenicity index in each nucleus.
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Hospital discharge (maximum one month from SEEG implantation)
|
|
Interictal power distribution
Time Frame: Hospital discharge (maximum one month from SEEG implantation)
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To assess interictal signatures, we will assess power at different frequencies in the nuclei using the 'fitting oscillations & one over f' (FOOOF) method.
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Hospital discharge (maximum one month from SEEG implantation)
|
|
Single pulse electrical stimulation (SPES):
Time Frame: Hospital discharge (maximum one month from SEEG implantation)
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We will systematically conduct SPES from all cortical and thalamic contacts and record responses in all other contacts.
This measures the effective connectivity.
|
Hospital discharge (maximum one month from SEEG implantation)
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Incidence of bleeding
Time Frame: Hospital discharge (maximum one month from SEEG implantation)
|
Radiological evidence of bleeding or clinically new neurological symptoms during SEEG implantation
|
Hospital discharge (maximum one month from SEEG implantation)
|
Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 23BI31
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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