A study conducted at Addenbrooke’s Hospital, has shown for the first time in adults how ultra-powerful MRI scanning could help more people with focal epilepsy to get potentially curative surgery.
Once I’d had the surgery, it was very obviously the right decision.
Amanda Bradbury, an epilepsy patient that benefitted from surgical treatment guided by existing scanning methods
Focal epilepsy is a condition caused by lesions in the brain that lead to seizures. It affects around 360,000 people in the UK. A third of these struggle to control their symptoms with medication.
Having epilepsy that doesn’t respond to anti-seizure medications can have a huge impact on patients’ lives, often affecting their independence and their ability to maintain a job. We know we can cure many of these patients, but that requires us to be able to pinpoint exactly where in the brain is the root of their seizures.
Thanks to this new technique, more epilepsy patients will be eligible for life-changing surgery.
Dr Thomas Cope, consultant neurologist at CUH and clinical lecturer in the Department of Clinical Neuroscience, University of Cambridge
In cases where medication is ineffective, lesions can be removed through surgery. To guide the surgeons, magnetic resonance imaging (MRI) scans are used to pinpoint the lesions.
In some patients, the lesions are too small to be seen reliably using standard MRI scans.
The level of detail that can be seen in MRI images depends on the magnetic field generated by the scanner, measured in Tesla (T). Many NHS hospitals use 1.5T scanners, and a 3T scanner is currently in use at Cambridge University Hospitals NHS Foundation Trust (CUH).
Ultra-powerful 7T MRI scanners are available and produce highly detailed images. They are not currently widely used for brain imaging because they have a weakness which means they produce images with signal blackspots in key areas of the brain.
However, results published today in Epilepsia by researchers from CUH, the University of Cambridge’s Wolfson Brain Imaging Centre, and the Université Paris-Saclay, reveal a ‘triangulation’ technique that addresses these blackspots.
Known as parallel transmit MRI, this approach can detect lesions too small to be seen using weaker MRI scanners, allowing more patients to be offered surgery to cure their condition.
In a similar way to how single wifi routers leave areas where you will struggle to get a signal, so these scanners would tend to leave blackspots on brain scans where it was hard to make out the relevant tissue.
By using multiple transmitters positioned around the patients’ head – like having a wifi mesh around your home – we can get much clearer images with fewer blackspots. This is very important for the epilepsy scans because we need to see very precisely which part of the brain is misbehaving.
Chris Rodgers, Professor of Biomedical Imaging at the University of Cambridge
In the study 31 patients were scanned with the new approach. Over half of the images (57%) were clearer than with existing methods, while the rest were of equal quality. As a result, 18 patients are managing their epilepsy differently, including nine who are now able to have potentially curative surgery.
The study also investigated the patient experience of the new scan, which showed it was just as comfortable as standard MRI.
The research team at CUH are continuing trials using 7T MRI and hope more patients will benefit as a result of taking part.
The research was supported by the Cambridge University Hospitals Academic Fund and the Medical Research Council, with support from the NIHR Cambridge Biomedical Research Centre.
Amanda's Story
Amanda Bradbury, age 29, underwent surgery for her epilepsy based on images generated through existing MRI scanning methods. More people like Amanda could benefit from the same surgery thanks to the enhanced scanning methods developed as part of this research.
Amanda began studying interior design at university but, even though it was a course she loved, she struggled to concentrate and experienced increasing anxiety, which led to her dropping out.
What she didn’t know at the time was that she had focal epilepsy and her feelings were the result of seizures caused by small lesions in the part of her brain linked to emotions, called the amygdala.
One of the things that would happen before a seizure is I'd get an intense feeling of fear, which I now realise was seizure-related.
Amanda
Amanda’s symptoms started with distortions in her vision known as auras. As things progressed she found it hard to focus, follow conversations and was forgetting things. She started feeling anxious and struggled to speak or swallow.
I started leaving the house a lot less because of nerves, because it can affect your memory when you have a seizure. I'd be too nervous to talk, because I would get confused. I just got more and more unsure about what was going on.
This happened over several years and it was only when she moved in with her sister that it became obvious how much Amanda’s symptoms were limiting her life.
Encouraged by her sister, she sought medical help. Doctors at Addenbrooke’s Hospital diagnosed her with focal epilepsy. Most surprisingly, although Amanda was only aware of symptoms a few times each week, tests showed she was having several seizures every day.
Amanda tried three different medications but with limited success, so she was offered a 3T MRI scan and was able to undergo surgery to remove the lesions in her amygdala.
Soon after the surgery Amanda started to feel less tired and anxious. It was only once the seizures had stopped that Amanda and those close to her could fully see how many things it had stopped her from doing.
Amanda is now working in office administration but is keen to return to her passion for interior design as a hobby.
Having initially struggled with her diagnosis, Amanda is also eager to share her experience of living with epilepsy to help others. Knowing she wasn’t alone and being part of a community made a big difference, she says.
Once I’d had the surgery, despite all the healing, it was very obviously the right decision. Suddenly I realised I'm able to do loads of other things. Things felt a lot more possible, like suddenly I'm able to do so many more things.