The Impact of Epilepsy Surgery on Dream Content

February 18, 2020 updated by: David Steven, London Health Sciences Centre
Prospective observational study on epilepsy patients undergoing partial brain resection surgery (i.e. anterior temporal lobectomy) to assess the change in dream content before and 3 months and 1 year after surgery using anonymized dream-recall questionnaires. A control group of epilepsy patients undergoing diagnostic depth electrodes placement will complete the same questionnaires pre- and postoperatively to asses the factor 'general anesthesia' as a potential confounder.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

STUDY RATIONALE Dream research, unlike sleep research, has not greatly developed anymore as there are few dream research laboratories only and not much systematic dream research is done outside the laboratory either(1) although validated methods of collecting and analyzing dream reports on the basis of the coding system developed by Calvin S. Hall and Robert Van de Castle are readily available.(2) According to Domhoff et al.,(3) the main features of the default dream network include the medial prefrontal cortex, the medial temporal lobe, the bilateral inferior parietal lobule/temporoparietal junction, and the posterior cingulate cortex, with the medial pre- frontal cortex and the posterior cingulate cortex serving as major hubs. The dorsal medial subsystem including the dorsomedial prefrontal cortex, the temporoparietal junction/anterior inferior parietal lobule, the lateral temporal cortex, and temporopolar cortex (the anterior pole of the temporal lobe) is activated by instructions to think about the present situation or a present mental state (''present self'').(3) The medial temporal subsystem including the ventral medial prefrontal cortex, posterior inferior parietal lobule, retrosplenial cortex, parahippocampal cortex, and hippocampal formation is activated by thinking about personal situations and decisions in the future (''future self'').(3) A lot of what is known about the neuronal function of dreaming comes from lesion studies that are well-summarized by Solms.(4) To the best knowledge, investigators are the first to prospectively investigate the change of dream content in patients electively undergoing surgical resection of brain tissue (i.e. the anterior temporal lobe for temporal lobe epilepsy).

The merits of the current study are the following:

  • To better understand the dream network (academic significance)
  • To better consult epilepsy patients with respect to the impact of surgery on dreaming (practical significance)

PURPOSES AND OBJECTIVES

Purpose:

- To assess the change in dream content in patients following epilepsy surgery compared to a control group of patients undergoing general anesthesia.

Hypothesis:

- Dream content is markedly changed in patients before and after epilepsy surgery.

Objective:

- To quantify dream content in patients before and after epilepsy surgery using the MOST RECENT DREAM questionnaire and compare these results to patients undergoing general anesthesia (control group).

STUDY DESIGN AND METHODOLOGY Setting/Design: Prospective observational study on epilepsy patients undergoing elective surgical resection of brain tissue (study group: Epilepsy surgery=ESx) or depth electrode insertion in general anesthesia (control group=DE).

Methodology: Patient baseline characteristics are Age (minimum age: 16 years); Date of birth (DOB); Sex; Handedness: RH/LH; Education (years); Occupation according to the International Standard Classification of Occupation(5); Seizure history (years); Seizure frequency ENGEL classification; Antiepileptic drugs; Other medication (antidepressants, dopaminergic agonists and antagonists, etc.); Pathology (Ammon's horn sclerosis y/n); Side (right/left); Any previous cranial surgery; Other relevant medical history (dementia, depression and other psychiatric disorders, Parkinson's, etc.) Questionnaire: MOST RECENT DREAM (STANDARD INSTRUMENT (2)

STUDY PROCEDURES AND SPECIFIC TESTINGS In this observational study, the MOST RECENT DREAM questionnaire, a standard validated instrument(2) represents the only study specific testing outside of standard care. The questionnaire is handed out to patients to record the most recent dreams five times pre- and post-operatively. The length of each dream summary lies in between 50 and 300 words. Study participation and the questionnaires will not affect standard patient care in any way and carries no additional risks.

STUDY GROUP:

Visit 1 (pre-op outpatient clinics or epilepsy monitoring unit) - Study information - Informed consent - Hand-out anonymized MOST RECENT DREAM (5x), return by mail before surgery.

Visit 2 (post-op outpatient clinics at ~1 month) - Hand-out anonymized MOST RECENT DREAM (5x) to be completed and returned by mail at 3 months postoperatively - Outcome according to the Engel classification Long-term FU at 12 month - Mail anonymized MOST RECENT DREAM (5x), return by mail.

CONTROL GROUP (Diagnostic depth electrodes):

Visit 1 (pre-op outpatient clinics/epilepsy monitoring unit) Study information - Informed consent - Hand-out anonymized MOST RECENT DREAM (5x), return before surgery.

Visit 2 (post-op epilepsy monitoring unit) Hand-out anonymized MOST RECENT DREAM (5x) to be completed and returned by mail at 1 month postoperatively.

DATA ANALYSIS Major indicators for main content categories in the Hall/Van de Castle system(2) are compared before and after the index procedure and results will be presented graphically similar to Bentes et al.(6). Data analysis is done using EXCEL spreadsheets available from http://www.dreamresearch.net/ and analysis performed as explained at http://www2.ucsc.edu/dreams/Info/statistics.html

Study Type

Observational

Enrollment (Actual)

20

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • London, Ontario, Canada, N6A 5A5
        • London Health Sciences Center, University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years and older (ADULT, OLDER_ADULT, CHILD)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Epilepsy patients undergoing elective surgical resection of brain tissue (study group: Epilepsy surgery=ESx) or depth electrode insertion in general anesthesia (control group=DE).

Description

Inclusion Criteria:

  • All epilepsy patients (minimum age: 16 years) undergoing elective surgical resection of brain tissue (study group) or depth electrode insertion in general anesthesia (control group) that give written consent after thorough study information.
  • Patients must be able to understand the study concept and willing/able to document their most recent dream in written.

Exclusion Criteria:

  • Inability to document their most recent dream in written (language barrier, illiteracy, low intelligence, mental disabilities). Age <16 years.
  • Relevant co-morbidities such as dementia, depression and other psychiatric disorders, Parkinson's disease.
  • Previous cranial surgery in a relevant cortical area of the default dream network.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
ESx
Epilepsy patients undergoing elective surgical resection of brain tissue; study group: epilepsy surgery=ESx.
Procedure: Epilepsy surgery
Epilepsy surgery is a procedure that removes an area of the brain where seizures originate.
DE
Epilepsy patients undergoing elective depth electrodes insertion in general anesthesia; control group: depth electrodes=DE.
Procedure: Depth electrodes insertion
Depth electrodes are inserted for monitoring/mapping the subsurface levels of the brain for the surgical treatment of epilepsy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage Change of Dream Features Occurrence (i.e. dream content; MOST RECENT DREAM questionnaire) - both groups (ESx & control group)
Time Frame: 3 months

Percentage change of the following dream features occurrences according to the Hall/Van de Castle system are considered:

  • Characters
  • Social Interactions
  • Aggression
  • Friendliness
  • Sexuality
  • Activities (walking, talking, seeing, thinking, etc.)
  • Success and Failure
  • Misfortune and Good Fortune
  • Emotions
  • Settings
  • Objects
  • Descriptive Elements (modifiers, time, negatives)

The relative abundance of the dream content listed above will be expressed in percentage and postoperative changes compared to the preoperative baseline.

Relative differences between the indicators will be determined and statistically tested for significance. The one indicator that turns out to be statistically different from the rest will be considered the primary outcome measure. For an example, compare Bentes et al. 2011.
3 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Dream Content (MOST RECENT DREAM questionnaire) - ESx group
Time Frame: 12 months
Major indicators for main content categories according to the Hall/Van de Castle system.
12 months

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Seizure frequency (ESx only)
Time Frame: 3 and 12 months
According to the ENGEL classification
3 and 12 months
Anti epileptic drugs (AED) usage (ESx only)
Time Frame: 3 and 12 months
Number of different AED
3 and 12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

London Health Sciences Centre

Investigators

  • Principal Investigator: David A Steven, M.D., London Health Science Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

March 1, 2016

Primary Completion (ACTUAL)

June 30, 2018

Study Completion (ACTUAL)

June 30, 2018

Study Registration Dates

First Submitted

April 2, 2016

First Submitted That Met QC Criteria

April 6, 2016

First Posted (ESTIMATE)

April 7, 2016

Study Record Updates

Last Update Posted (ACTUAL)

February 20, 2020

Last Update Submitted That Met QC Criteria

February 18, 2020

Last Verified

February 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 107654 (Other Identifier: FDA IND#)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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