Contribution of Genetics, Non-invasive Methods and Neuropsychology in Focal Cryptogenic Epilepsies

NCT ID: NCT05015868

Last Updated: 2025-05-01

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 5 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-07-15
• Study Completion Date: 2024-12-31

Brief Summary

Patients with cryptogenic focal epilepsy (unknown cause) represent about the 30% of the entire population of epilepsy patients. Among them, about 30% are drug-resistant. The implementation of of high-field magnetic resonance imaging resolution, the new Next Generation Sequencing techniques,and innovative non-invasive neurophysiological methods (Electroencephalogram-Functional magnetic resonance imaging and High Density-Electroencephalogram) could provide a superior identification of the epileptogenic zone and therefore an increased access to epilepsy surgery.

Despite this, patients with cryptogenic epilepsy require more frequently invasive methods of presurgical study and they have more unfavorable results than patients with lesions detectable on magnetic resonance imaging. Within this context, the study is aimed at integrating the neurophysiological, radiological, neuropsychological and genetic aspects of patients with focal cryptogenic epilepsy in order to evaluate their surgical eligibility,sparing invasive methods.

Detailed Description

The investigators foresee study duration of 36 months and the enrollment of about 20-25 patients, affected by cryptogenic epilepsy with onset during pediatric age (0-18 years), not only to identify the cause of epilepsy and the epileptogenic zone, but also to define in a non-invasive manner, the patient's possible eligibility for surgical therapy.

Innovative neurophysiological methods, such as combined Electroencephalogram-Functional magnetic resonance imaging recording and high resolution electroencephalogram, in addition to 7 Tesla brain magnetic resonance imaging (available through the Imago7 non-profit foundation), neuropsychological studies and genetic tests through Next generation sequencing allow an advanced pre-surgical study free from the risks and discomforts caused by invasive methods. The systematic use of these diagnostic approaches will implement the knowledge and skills of the teams and it will stimulate their use in the clinical daily practise, especially for pediatric patients.

In addition to that, the investigators would like to analyse descriptive indications relating to the diagnostic sensitivity of the combined Electroencephalogram-Functional magnetic resonance imaging recording, High Density-electroencephalogram and 7 Tesla magnetic resonance imaging in the identification of the epileptogenic zone, in patients with cryptogenic focal epilepsy.

Conditions

Epilepsies, Partial; Epilepsy Intractable

Study Design

• Allocation Method: NA
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: NONE

Study Groups

IDENTIFICATION OF THE CAUSE OF THE EPILEPSY AND OF THE EPILEPTOGENIC ZONE (sequential approach)

Step1: standard of care.

• acquisition and updating of Electroencephalogram polygraphic data of wakefulness and sleep and neuroradiological data
• complete neuropsychological assessment
• genetic tests through Next generation sequencing epilepsies panel, or exome

Step 2: experimental

• combined Electroencephalogram-Functional brain magnetic resonance imaging registration.

Step 3: experimental

In the event that neither the cause nor the epileptogenic area has been identified, we will evaluate the execution of further tests, such as:

• execution of High Density-Electroencephalogram recording at "IRCCS Medea di Conegliano" (TV, Italy) (approximately 3 patients / year) for a further electrophysiological definition;
• 7 Tesla brain magnetic resonance imaging performed at "IRCCS Stella Maris in Calambrone"(PI, Italy) (approximately 3 patients / year expected), to obtain greater spatial resolution and better neuroradiological definition.

Group Type: EXPERIMENTAL

Standard of care

Intervention Type: DIAGNOSTIC_TEST

Enrollment of patients afferent to our Center with cryptogenic drug-resistant epilepsy with onset in pediatric age, subject to informed consent;

• acquisition and updating of Electroencephalogram polygraphic data of wakefulness and sleep and neuroradiological data (previous negative brain magnetic resonance imaging);
• execution of a complete neuropsychological assessment for the classification of cognitive aspects and evaluation of executive functions;
• execution of genetic tests through Next generation sequencing epilepsies panel or exome sequencing

Functional magnetic resonance imaging-Electroencephalogram combined analysis

Intervention Type: DIAGNOSTIC_TEST

A functional brain magnetic resonance imaging is executed analysing blood oxygenation level dependent signal.

During the functional recording, a contemporary electroencephalogram is registered in order to analyse the space-time relationship between the epileptic discharges and the bold abnormalities.

High density- electroencephalogram or 7 Tesla magnetic resonance imaging

Intervention Type: DIAGNOSTIC_TEST

In the event that neither the cause nor the epileptogenic area has been identified, we will evaluate the execution of further tests, such as:

• execution of High Density-electroencephalogram recording at "IRCCS Medea di Conegliano" (TV, Italy) (approximately 3 patients / year) for a further electrophysiological definition;
• 7 Tesla brain magnetic resonance imaging performed at "IRCCS Stella Maris in Calambrone" (PI, italy) (approximately 3 patients / year expected), to obtain greater spatial resolution and better neuroradiological definition.

Interventions

Standard of care

Enrollment of patients afferent to our Center with cryptogenic drug-resistant epilepsy with onset in pediatric age, subject to informed consent;

• acquisition and updating of Electroencephalogram polygraphic data of wakefulness and sleep and neuroradiological data (previous negative brain magnetic resonance imaging);
• execution of a complete neuropsychological assessment for the classification of cognitive aspects and evaluation of executive functions;
• execution of genetic tests through Next generation sequencing epilepsies panel or exome sequencing

Intervention Type: DIAGNOSTIC_TEST

Functional magnetic resonance imaging-Electroencephalogram combined analysis

A functional brain magnetic resonance imaging is executed analysing blood oxygenation level dependent signal.

During the functional recording, a contemporary electroencephalogram is registered in order to analyse the space-time relationship between the epileptic discharges and the bold abnormalities.

Intervention Type: DIAGNOSTIC_TEST

High density- electroencephalogram or 7 Tesla magnetic resonance imaging

In the event that neither the cause nor the epileptogenic area has been identified, we will evaluate the execution of further tests, such as:

• execution of High Density-electroencephalogram recording at "IRCCS Medea di Conegliano" (TV, Italy) (approximately 3 patients / year) for a further electrophysiological definition;
• 7 Tesla brain magnetic resonance imaging performed at "IRCCS Stella Maris in Calambrone" (PI, italy) (approximately 3 patients / year expected), to obtain greater spatial resolution and better neuroradiological definition.

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

• focal epilepsy, onset during pediatric age (<18 y)
• drug resistance
• unknown cause
• Brain magnetic resonance imaging negative

Exclusion Criteria

• epilepsy with good therapeutic control
• focal symptomatic epilepsy
• age limits onset (> 18 y)

• Minimum Eligible Age: 1 Month
• Maximum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

IRCCS Eugenio Medea

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Stefania Zambrano, MD

Role: PRINCIPAL_INVESTIGATOR

Scientific Institute IRCCS Eugenio Medea

Locations

Scientific Institute IRCCS Eugenio Medea

Bosisio Parini, lecco, Italy

Countries

Italy

Other Identifiers

879

Identifier Type: -

Identifier Source: org_study_id