Advanced MRI imaging methods are helping Australian epilepsy researchers move closer to faster, more accurate, individualised diagnoses and treatment options for patients.

The cause of epilepsy can be different for every person who lives with the condition – and that is nearly 250,000 Australians. Currently, it is extremely difficult for doctors to predict what will happen for people after a seizure, and which treatment is best.

The Australian Epilepsy Project’s neuroimaging lead, NIF Florey Node Co-Director Dr David Vaughan, explains that advanced brain imaging will help guide diagnosis and opportunities for precision treatment. For example, “whether they will have another seizure; which medication is likely to be the most beneficial; and whether any other forms of treatment, such as epilepsy surgery, would be right for them.”

Dr Vaughan is part of the team using advanced human 3T MRI methods to understand network changes in brain disorders like epilepsy. By combining patient images with cognitive and genetic data, and integrating them using AI, the Australian Epilepsy Project (AEP) team is developing predictive tools, spearheading an innovative approach to research-based care, that focuses on expediting diagnoses, enhancing the precision of detection, and improving patient outcomes.

Results captured as part of the AEP testing, not only contribute to future research for predicting health outcomes in epilepsy, but they are also being used by neurologists to support immediate treatment decisions for patients. 

NIF’s national advanced human imaging network is contributing to this initiative through advanced imaging capabilities, computational techniques and informatics.

No two brains are the same

Given the variation in causes and treatment for epilepsy, doctors need a complete ‘picture’ for each patient to improve their diagnosis and treatment. Brain imaging, cognitive testing, genetic screening and questionnaires are all important parts of the puzzle.

“What we can do for people with epilepsy is manage their seizures with medications, surgery and other healthcare strategies,” Dr Vaughan says.

“The better the information we have, the more accurate the diagnosis and the better the outcome for the person being treated.”

When this information is analysed by researchers with the help of AI tools, they can spot potentially hidden patterns in the data. This helps them to provide diagnostic information for predicting patient outcomes, which can then be used to optimise treatment.

Patient stories match new data on epilepsy burden

AEP’s Lived Experience Ambassador and Participant Lead, Amanda Anderson, describes her first experience with seizures at age 23; a time in life when many young people find themselves working and travelling, instead, she was plagued by seizures. “At times, they were occurring daily. I once received third-degree burns from a seizure while cooking,” she says.

Although Amanda was on medication, “it didn’t work, so by age 30, I felt completely isolated.”

A pilot study from the AEP formalises these difficulties, having analysed data from Australians diagnosed with epilepsy. People whose epilepsy is resistant to drug treatments had lower quality of life scores and were less likely to participate in paid employment compared to people with a new diagnosis of epilepsy.

AEP’s Health Economics Lead A/Prof Zanfina Ademi said, “given the current burden of epilepsy in terms of healthcare cost and wellbeing, national investment in health programs such as the AEP will help to classify unprovoked seizure better, provide better and early management for newly diagnosed epilepsy and speed the process of surgery in people with drug resistant epilepsy.”

“This in turn will reduce healthcare costs, improve quality of life and reduce productivity burden on society,” A/Prof Ademi said.

The data also showed that almost one in five people needed care (median 16 hours/week), provided through friends and family, and one in 20 needed formal care (median 20 hours/week). This highlights the immense contribution of carers to our economy for people living with epilepsy.

Eventually, Amanda recounts, she found and accessed advanced MRI testing, similar to what is being offered as part of the AEP, where doctors found scar tissue on her right temporal lobe which may have been caused by encephalitis as a baby.

“I finally had a precise diagnosis, and I could act. Twelve years after surgery I have regained my quality of life,” she says.

Other quality of life takeaways include:

• Epilepsy itself is not necessarily a barrier to achieving a productive working life, but other socioeconomic variables are also important.
• People with drug-resistant epilepsy have significantly lower workforce participation. This may be because of reduced educational attainment, sick days due to seizures and seizure-related problems, and time off work to attend medical appointments.
• Seizure control, adequate treatment of mood disorders, and supporting accessible education are key factors for improving quality of life and employment prospects, and further underscores the need for holistic management.

A national Lived Experience Reference Group ensures that the needs of people with epilepsy and their carers are integrated into the project’s design process.

NIF imaging: accelerating innovation in epilepsy understanding

AEP’s Chief Investigator Professor Graeme Jackson says his life’s work is to have “every Australian living with epilepsy to be free from seizures”. The AEP aims to provide a national network for local access to advanced testing.

The $30 million funding granted by the Australian Government’s Medical Research Future Fund, for the five-year study, echoes the importance of this aim.

AEP’s work is supported by NIF’s national network Partners in Brisbane at Herston Imaging Research Facility (HIRF), Newcastle at Hunter Medical Research Institute (HMRI), Melbourne at The Florey and Adelaide at South Australian Health and Medical Research Institute (SAHMRI).

They also join AEP collaborators from the University of Melbourne, Monash University, Alfred Health, RMIT University and Austin Health. Commercial partners such as Siemens also work closely with the AEP team.

NIF’s advanced human imaging network underpins the project, accelerating innovation and research and enabling translation of research solutions to clinical care.

NIF-affiliated experts that are part of the AEP leadership team are:

• Associate Professor Heath Pardoe, Science Operations Lead
• Dr David Vaughan, Imaging Lead
• Professor David Abbott, Information Lead
• Dr Eric Pierre, Postdoctoral Research Fellow, Advanced MRI Development – Imaging Division
• Dr Robert Smith, Senior Research Officer – Imaging Division
• Dr Bahman Tahayori, Senior Research Scientist