Neocortical Epilepsies - Do They Progress?

Study Overview
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Brief Summary
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This study will use MRI and PET scan to compare the brain imaging results between epilepsy patients and normal healthy controls, also to study changes in 3 years.

Detailed Description
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We would like to continue analyzing the structural and metabolic differences between two epilepsy groups (JME and FLE) and the control to understand the imaging presentations of epilepsy patients

Official Title
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Neocortical Epilepsies - Do They Progress?

Conditions
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Epilepsy

Intervention / Treatment
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* Device: Arm 1: Juvenile Myoclonic Epilepsy
* Device: Arm 2: Frontal Lobe Epilepsy
* Device: Arm 3: Normal Controls


Participation Criteria
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Eligibility Criteria
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Controls (20 Subjects): Inclusion criteria: Ages 18-65, based on the usual ages of patients seen in the adult neurology services who are not likely to suffer from the exclusions (see below). Exclusion criteria: History of seizures, faints, or any unexplained blackouts. Use of neuroleptic medications or sedating doses of antianxiety or antidepressant drugs. They should not have a clear family history of epilepsy (first degree relatives). History of any substance abuse within the past 5 years. History of progressive medical or neurologic disease (Parkinson's, severe congestive heart failure). Controlled hypertension, diabetes (by oral medications or diet), asthma, etc will not be excluded. History of stroke without complete recovery of neurologic function. Pregnancy With any metallic implants, including surgical clips (hemostatic clips), pacemakers, neuro-stimulation devices, prosthetic heart valves, or other ferromagnetic material. Inability to understand the consent. (standard form attached) Inability to speak fluent English. Note: the neuropsychological tests are standardized for English speakers. They are not all available in multiple languages. Since the scoring and norms are established for English speakers, simply translating them would still not make the testing norms and scoring applicable. Juvenile Myoclonic Epilepsy (JME; 20 Subjects): Inclusion Criteria: Ages 18-65, based on the usual ages of patients seen in the adult neurology services who are not likely to suffer from the exclusions (see below), plus History of myoclonic plus tonic-clonic or clonic-tonic-clonic seizures with or without absence seizures. EEG consistent with primary generalized epilepsy (>/= 3 c/s generalized, frontal maximum, poly spike and wave; normal alpha) Exclusion Criteria History of significant head injury (> 30 min loss of consciousness) Use of neuroleptic drugs or sedative doses of antianxiety or antidepressant drugs History of any substance abuse within the past 5 years Presence of epileptogenic brain lesion on MRI (tumor, stroke, cortical congenital dysplasia, etc; excluding normal variants, mild subcortical white matter ischemic change, venous angiomas). EEG with focal epileptiform potentials or polymorphic slowing History of progressive medical or neurologic disease (Parkinson's, severe congestive heart failure). Controlled hypertension, diabetes (by oral medications or diet), asthma, etc will not be excluded. History of stroke without complete recovery of neurologic function. Pregnancy With any metallic implants, including surgical clips (hemostatic clips), pacemakers, neuro-stimulation devices, prosthetic heart valves, or other ferromagnetic material. Inability to speak fluent English Frontal Lobe Epilepsy (FLE; 20 Subjects): Inclusion Criteria Ages 18-65, based on the usual ages of patients seen in the adult neurology services who are not likely to suffer from the exclusions (see below), plus: Seizure semiology (behavior) consistent with FLE Interictal EEG spikes consistent with FLE or Ictal video-EEG consistent with FLE Frontal lobe lesion of MRI Frontal hypometabolism on FDG-PET Exclusion Criteria: Presence of seizure semiology, ictal EEG, interictal EEG, MRI or PET findings that are not consistent with a frontal lobe epilepsy focus. Use of neuroleptic drugs or sedative doses of antianxiety or antidepressant drugs History of any substance abuse within the past 5 years History of progressive medical or neurologic disease (Parkinson's, severe congestive heart failure). Controlled hypertension, diabetes (by oral medications or diet), asthma, etc will not be excluded. History of stroke without complete recovery of neurologic function. Pregnancy With any metallic implants, including surgical clips (hemostatic clips), pacemakers, neuro-stimulation devices, prosthetic heart valves, or other ferromagnetic material. Absence of either a radial or ulnar arterial pulse Inability to speak fluent English

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Three different Groups in this study: Juvenile Myoclonic Epilepsy, Frontal Lobe Epilepsy, Normal Controls
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm 1: Juvenile Myoclonic Epilepsy<br>Juvenile Myoclonic Epilepsy group of subjects will participate for imaging assessment | Device: Arm 1: Juvenile Myoclonic Epilepsy<br>* Positron emission tomography (PET) fluorodeoxyglucose (FDG) (10 mCi) and MRI<br>|
| Experimental: Arm 2: Frontal Lobe Epilepsy<br>Frontal Lobe Epilepsy group of subjects will participate for imaging assessment | Device: Arm 2: Frontal Lobe Epilepsy<br>* Positron emission tomography (PET) fluorodeoxyglucose (FDG) (10 mCi) and MRI<br>|
| Experimental: Arm 3: Normal Controls<br>Normal Controls, eligible subjects don't have Juvenile Myoclonic Epilepsy or Frontal Lobe Epilepsy will be placed in this group | Device: Arm 3: Normal Controls<br>* Positron emission tomography (PET) fluorodeoxyglucose (FDG) (10 mCi) and MRI<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional Connectivity | We will analyze the structural and metabolic differences between two epilepsy groups (JME and FLE) and understand the imaging presentations of epilepsy patients. We will process imaging requisition for Arm 1 and Arm 2 patients and the controls to examine if any differences in their brain image. The hypothesis is the functional connectivity between brainstem structures and cortical/subcortical regions may reflect in their imaging data. We would like to know if these imaging factors are related to epilepsy (JME and FLE) patients. | During Imaging Session |