Thalamic Recordings in Children Undergoing SEEG (TRICS)

NHS Foundation Trust

Status: Enrolling

Conditions: Focal Epilepsy

Treatments: Procedure: Additional electrodes into bilateral anterior, centromedian and pulvinar thalamic nuclei

Study type: Interventional

Funder types: Other

Identifiers

NCT06453759

23BI31

Details and patient eligibility

About

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.

Enrollment: 30 estimated patients

Sex: All

Ages: 2 to 20 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. All children undergoing SEEG as part of their pre-surgical evaluation at GOSH
2. Participants/parents/legal guardian provide informed consent for inclusion

Exclusion criteria

1) Lack of informed consent

Trial design

Primary purpose: Basic Science

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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30 participants in 1 patient group

Thalamic SEEG

Experimental group

Description:

The centromedian, anterior and pulvinar nuclei on each side will be chosen as target for new electrodes.

Treatment:

Procedure: Additional electrodes into bilateral anterior, centromedian and pulvinar thalamic nuclei