The Epilepsy Research Group

Kristina Malmgren, Professor
Principal investigator for Clinical and Translational studies related to Eplepsy Surgery
Tel: 46 31 342 2763
Fax: 46 31 342 2467
E-mail: kristina.malmgren@neuro.gu.se

Elinor Ben-Menachem, Adjunct Professor
Principal investigator for the Epilepsy Therapy and Educational Development Program
Tel: 46 31 342 2483
Fax: 46 31 342 2467
E-mail: elinor.ben-menachem@neuro.gu.se  
 

Background

Epilepsy is a common chronic neurological disorders characterized by recurrent unprovoked seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain. About 50 million people worldwide and 60 000 people in Sweden have epilepsy. The main treatment is pharmacological, but 20-30% continue to have seizures that are not adequately controlled with antiepileptic medication. Other treatment options for these patients include vagal nerve stimulation, ketogenic diet and in carefully selected patients resective brain surgery. Our research spans from treatment outcome studies to translational studies of mechanisms involved in epileptogenesis.
The Epilepsy Research Group has a multidisciplinary competence including neurology, neurosurgery, clinical neurophysiology, neuropsychology, clinical genetics and basic science.
 

Our main projects

Is surgical treatment for epilepsy worthwhile for the patients at long-term?

In carefully selected patients with drug resistant focal epilepsy, resective brain surgery is a valuable treatment option. The short-term efficacy and safety of epilepsy surgery has been documented in many observational studies, while the long-term effects are less well documented. In this national, longitudinal, population-based study we investigate 5 and 10-year outcomes (seizure outcomes, complications, psychosocial outcomes) in all patients who have been operated in Sweden since 1995.

PI Kristina Malmgren
Co-workers:
Anna Edelvik, MD PhD student
Elisabet Sager-Magnusson, MD PhD student
Bertil Rydenhag, adj prof in neurosurgery
Ingrid Olsson ass professor in neuropaediatrics
Roland Flink, ass professor in clinical neurophysiology, Uppsala
Gerd Ekstedt, research nurse

Cognitive outcomes of resective epilepsy surgery

Epilepsy surgery can have negative effects on cognition and especially memory. The most consistently reported postoperative cognitive change in adults is decline in verbal memory and learning especially after language dominant temporal lobe resection. Most publications concern cognitive outcome 1-2 years after surgery, while few describe late cognitive effects. In this study we investigate the long-term (10 years) cognitive effects of temporal lobe resection on memory. We are also currently exploring the much less studied cognitive effects of frontal lobe resections.

PI Kristina Malmgren
Co-workers:
Lena Andersson-Roswall PhD, neuropsychologist
Hans Samuelsson, PhD, neuropsychologist
Elisabeth Engman PhD, neuropsychologist
Sofia Ljunggren, neuropsychologist

Systemic inflammation and epilepsy

Inflammation has been shown to contribute to brain tissue damage in a number of disease or injury models, but the role of inflammation in human epilepsy is not clear. Our aim is to determine whether (1) the complement activation in plasma, alone or in combination with the levels of other inflammatory mediators or molecules involved in modulating CNS plasticity are altered in patients with focal epilepsy (2) complement activation and other parameters of the immune response in plasma are correlated with seizure frequency and selected modulators and parameters of CNS plasticity in patients with focal epilepsy, and (3) genetic variants of the third complement component (C3) are associated or predispose to epilepsy.

PI Kristina Malmgren
Co-workers
Marcela Pekna, ass professor in medical and physiological chemistry
Ingrid Olsson ass professor in neuropaediatrics
Christina Jern professor in neurology
Gerd Ekstedt, research nurse

Clinical development of new therapies for the treatment or prevention of refractory epilepsy when resective epilepsy surgery is not possible

During the years we have been involved in the development of all the newer antiepileptic drugs in an effort to try to understand how to use these new agents when treating patients, Through these studies we have collaborated internationally in developing new study protocols, orphan drug uses and treatment guidelines. Through our research patients have now a better chance of not becoming refractory in the first place and refractory patients can look forward to improvement in their condition..
Current clinical trials include the following therapies; brivaracetam, eslicarbazepine, lacosamide, perampanel, new vagus nerve stimulator (FitNess) and psychological treatment through relaxation and hypnosis. Ideas for studies are influenced by the NINDS Benchmark statements for epilepsy, which we try to follow.
http://www.ninds.nih.gov/research/epilepsyweb/2007_benchmarks.htm

PI Elinor Ben-Menachem
Co-workers:
Pontus Wasling, MD, PhD. Department of Neurology
Lennart Persson, MD, PhD, assoc Prof in Neurology

The Mechanism of Action profile

is currently focusing on vagus nerve stimulation in epilepsy, depression and weight reduction. The mechanism of action of vagus nerve stimulation in epilepsy is not established. The fact that vagal nerve stimulation is also proven to have antidepressive effects led us to hypothesize that similar mechanisms could be involved in both these diverse effects, possibly relating to hippocampal function. We are studying the effects from vagal nerve stimulation on the hippocampal structure in both rat and human models, focusing on neuroplasticity in rat models and MRI volumetry for evaluation of hippocampal structures in depressed patients and epilepsy patients treated with vagus nerve stimulation.

PI Elinor Ben-Menachem
Co-Workers
Thorleif Thorlin, MD, PhD, Department of Neurorehabilitation
David Revesz, MD, PhD student, Department of Neurosurgery

Development of educational programs for epileptologists and general neurologists to be able to better treat epilepsy and to better develop new programs for research.

These educational programs follow the Epilepsy Benchmarks and the Accreditation Council for Continuing Medical Education (ACCME) through active involvement in the Educational Council of the American Epilepsy Society (EBM is Chair of the Annual Meeting educational programs of the American Epilepsy Society). One major project is developing epilepsy programs with emphasis on the recertification of American neurologists through the American Board of Psychiatry and Neurology who must learn specifically about epilepsy and the newest treatment and diagnostic methods in order to maintain board and specialty certification. Our emphasis has been on developing programs based on adult learning techniques and on developing methodologies on how to assess long term learning of the immediate gained knowledge and how it is practically applied in future clinical practice.

PI Elinor Ben-Menachem