Neuroimaging Predictors of Treatment Failure in Adult New-onset Epilepsy
Neuroimaging Predictors of Treatment Failure in Adult New-onset Epilepsy
Epilepsy, defined as recurrent, unprovoked seizures, is a common condition, affecting 0.5-1%
 of the general population. People with uncontrolled epilepsy suffer poor health and increased
 mortality due to their condition. They frequently experience social stigma and are
 socioeconomically disadvantaged. It is therefore imperative to help them gain control of
 their seizures as quickly as possible. A wide range of antiepileptic drugs (AEDs) has become
 available to treat people with epilepsy. However, despite maximal therapy, approximately
 20-40% show pharmacoresistance (PR) and thus continue to have seizures.

 We do not understand why a significant proportion of people with epilepsy have PR. For any
 given patient presenting with a first unprovoked seizure, we are unable to predict PR at the
 time of presentation. At least 2 different AEDs must be tried at maximum doses for a year
 before we can diagnose PR. At this point, surgical therapies become an increasingly urgent
 consideration.

 Retrospective magnetic resonance imaging (MRI) studies in the chronic stages of epilepsy have
 shown that patients with PR are more likely to have focal structural lesions in the brain,
 and in particular to have signs of damage to the hippocampi. For example, there are
 retrospective data suggesting that a decreased hippocampal N-acetylaspartate (NAA)/creatine
 ratio (measured by magnetic resonance spectroscopy [MRS]) and hippocampal atrophy (determined
 by hippocampal volumetry) correlate with PR. However, it is not clear whether these findings
 reflect the underlying pathophysiology of PR, or simply reflect the effects of chronic
 seizures and chronic drug treatment on the brain.

 The First Seizure Clinic at the Halifax Infirmary represents a unique opportunity for
 prospective, longitudinal studies of patients who present with a first seizure or with newly
 diagnosed epilepsy. In these patients, advanced neuroimaging techniques at presentation might
 show changes that truly reflect the underlying pathophysiology of PR, rather than changes
 that develop as a consequence of prolonged seizures and drug treatment. Neuroimaging
 follow-up might help us to understand the pathophysiologic changes that accompany the
 evolution of PR. Ultimately, it is our hope to combine neuroimaging features and clinical
 features of patients with PR in a predictive model that would help us to predict PR at
 presentation.
Inclusion Criteria:

 -  Age 17 years

 -  Newly diagnosed epilepsy or history of first unprovoked, witnessed seizure

 Exclusion Criteria:

 -  Lack of consent provoked seizure due to obvious

 -  Acute lesion on CT (e.g. stroke, hemorrhage

 -  Provoked seizure due to obvious, chronic lesion on CT (e.g. vascular malformation,
 tumour)

 -  Progressive brain disease (e.g. neoplastic, infectious, demyelinating diseases)

 -  History of epilepsy longer than 1 year at presentation to FSC

 -  History of AED treatment for more than 4 weeks

 -  Contraindication to MRI