MELD as an Adjunct for SEEG Trajectories (MAST)
Primary Purpose
Epilepsy, Epilepsy, Focal, Epilepsy, Refractory
Status
Recruiting
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
MELD algorithm use to aid in the planning of SEEG electrode trajectories
Sponsored by
About this trial
This is an interventional diagnostic trial for Epilepsy
Eligibility Criteria
Inclusion Criteria:
- Patients aged 3-18 undergoing SEEG recording as part of the investigation of their epilepsy at Great Ormond Street Hospital for Children.
Exclusion Criteria:
- Tuberous sclerosis
- Prior resective epilepsy surgery
- Insufficient imaging datasets for the algorithm
- Lack of informed consent
Sites / Locations
- Great Ormond Street Hospital NHS Foundation TrustRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
MELD-assisted SEEG trajectory planning
Arm Description
Following routine clinical planning, the MELD algorithm will be run on the enrolled patient's scans. Up to 3 extra electrodes may be used to target lesion clusters identified by the algorithm such that the investigators will record from the top 3 clusters, with the aim of improving the rate of identification of a focal seizure onset zone in patients undergoing SEEG.
Outcomes
Primary Outcome Measures
Additional contacts in neurophysiologically defined seizure onset zone
For each patient, the investigators will assess whether any of the additional electrodes (added as part of the trial to record from detected lesions) were in the neurophysiologically (SEEG) defined seizure onset zone. This will be a dichotomous yes/no outcome for each patient.
Secondary Outcome Measures
Pre-implantation confidence
Pre-implantation confidence of the MDT members in identifying a seizure onset zone (prior to MELD information) ie. a measure of the difficulty of the SEEG exploration on Likert scale 0-10
Number of electrodes added
Simple number
Number of electrodes added
Number of electrodes already in identified lesions
Was a MELD-identified lesion part of the SOZ (and if so how many?)
Yes/no and simple numerical outcome
Would the SOZ have been identified without MELD?
Yes/No outcome
Blinded neurophysiological assessment of the SOZ contacts with and without additional electrodes
Description of contacts in SOZ with and without additional electrodes
Putative resection boundaries with and without the additional electrodes, to be modelled by a neurosurgeon ie. a measure of whether or not this would have changed subsequent surgical strategy
Description of resection and how it may have changes
adverse events such as bleeding
Safety of adding additional electrodes
Full Information
NCT ID
NCT04383028
First Posted
April 21, 2020
Last Updated
November 18, 2021
Sponsor
Great Ormond Street Hospital for Children NHS Foundation Trust
1. Study Identification
Unique Protocol Identification Number
NCT04383028
Brief Title
MELD as an Adjunct for SEEG Trajectories
Acronym
MAST
Official Title
MELD as an Adjunct for SEEG Trajectories (MAST Trial)
Study Type
Interventional
2. Study Status
Record Verification Date
November 2021
Overall Recruitment Status
Recruiting
Study Start Date
July 1, 2020 (Actual)
Primary Completion Date
April 30, 2022 (Anticipated)
Study Completion Date
May 30, 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Great Ormond Street Hospital for Children NHS Foundation Trust
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Epilepsy is a disorder of the brain which is associated with disabling seizures and affects 100,000 people under 25. Many children with epilepsy also have a learning disability or problems with development. Although better outcomes occur in children who are successfully treated early for their epilepsy, 25% continue to have seizures despite best medical treatment.
One potential treatment is a neurosurgical operation to remove parts of the brain that generate seizures. A proportion of these children have electrodes inserted into their brains as part of their clinical assessment, termed stereoelectroencephalography (SEEG), to help localise these regions. Subsequent surgery is not always successful - up to 40% of children will have ongoing seizures 5 years after surgery.
The planning of where to place SEEG electrodes relies on experts (neurologists, neurophysiologists and neurosurgeons) using information from multiple sources, which are used to generate hypotheses about where the seizures are coming from. The main components are the patient's magnetic resonance imaging (MRI) scan and video-electroencephalography (EEG) recordings during seizures. Using this information, between 5-18 electrodes are implanted and the recordings continue for 5-15 days in hospital. A focus is identified in about 75% of cases which means that the focus is sometimes missed.
This prospective single arm pilot study aims to assess a new automated lesion detection algorithm, MELD, designed to identify focal cortical dysplasias (the most common pathology associated with focal epilepsy in children) on otherwise 'normal' MRI scans. The investigators will assess whether MELD can be used to improve the targeting of abnormalities in children undergoing SEEG recording at Great Ormond Street Hospital
Detailed Description
Epilepsy is a disorder of the brain that is associated with disabling seizures. It affects 100,000 children in the UK, 25-30% of whom will be classed as drug resistant.3 In these children, there is increasing evidence that resective epilepsy surgery in appropriate candidates can lead to seizure freedom and improve quality of life and cognitive outcomes.4-6 However, about 30% of children do not achieve seizure freedom following epilepsy surgery and data suggests that these figures are not improving over time despite increasing use of intracranial evaluation via stereoelectroencephalography (SEEG). 7
The planning of where to place SEEG electrodes currently relies on an expert multidisciplinary team consisting of neurologists, neurophysiologists and neurosurgeons. Information from multiple sources, mainly the patient's magnetic resonance imaging (MRI) scan and video-electroencephalography (EEG) recording, are used to generate hypotheses about the location of the clinical seizure onset zone (SOZ). Using this information, between 5-18 electrodes are implanted and the recordings continue for 5-15 days in hospital. In a retrospective review of 75 SEEG cases, a focus was identified in about 77% of cases which means that the focus is sometimes missed.
This prospective single arm pilot study to aims assess a new automated lesion detection algorithm, MELD, designed to identify focal cortical dysplasias (the most common pathology associated with focal epilepsy in children) on otherwise 'normal' MRI scans.1 This algorithm was developed in-house by collaborators in this grant application. In our subsequent retrospective study of 34 SEEG patients, the algorithm colocalised with the SEEG-defined SOZ in 62% of all patients with a cortical SOZ and 86% of all patients with a histologically confirmed focal cortical dysplasia.2 Importantly, there were 3 patients whose SOZ was thought to be missed on SEEG who had MELD-identified lesions that were not implanted. In order to improve the algorithm, investigators have subsequently launched an international multicentre collaboration (https://meldproject.github.io//) to increase the number of lesion positive and control scans available to train the algorithm, improving its sensitivity, specificity and accuracy. This project has gathered over 550 lesional and 350 control scans, which will be used to train the algorithm. The prospective MAST Trial is therefore the ideal next step in the evaluating the utility of the MELD algorithm in identifying abnormal areas of the brain that could be responsible for seizures.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Epilepsy, Epilepsy, Focal, Epilepsy, Refractory
7. Study Design
Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
MELD-assisted SEEG trajectory planning
Arm Type
Experimental
Arm Description
Following routine clinical planning, the MELD algorithm will be run on the enrolled patient's scans. Up to 3 extra electrodes may be used to target lesion clusters identified by the algorithm such that the investigators will record from the top 3 clusters, with the aim of improving the rate of identification of a focal seizure onset zone in patients undergoing SEEG.
Intervention Type
Procedure
Intervention Name(s)
MELD algorithm use to aid in the planning of SEEG electrode trajectories
Intervention Description
During the routine SEEG planning meetings, the planning of SEEG trajectories, including the number and location of electrodes, will follow the usual clinical pathway and be planned according to the expertise of the attending neurosurgeon, neurophysiologist and neurologist at the multidisciplinary team meeting. Once the trajectories have been planned, anonymised scans for each patient (linked to them via a unique study ID) will be run through the MELD classifier and the top 3 MELD identified lesion clusters will be considered for further implantation.
These top 3 MELD classifier identified clusters will then be merged with the existing clinical plan to assess if each of the clusters are already being sampled by an SEEG electrode. If there is already an electrode in each lesion, no adjustments will be made. If there are clusters that are not being recorded from, and it is technically possible, extra electrodes (up to 3) will be added to record from these additional locations.
Primary Outcome Measure Information:
Title
Additional contacts in neurophysiologically defined seizure onset zone
Description
For each patient, the investigators will assess whether any of the additional electrodes (added as part of the trial to record from detected lesions) were in the neurophysiologically (SEEG) defined seizure onset zone. This will be a dichotomous yes/no outcome for each patient.
Time Frame
Baseline (During inpatient admission)
Secondary Outcome Measure Information:
Title
Pre-implantation confidence
Description
Pre-implantation confidence of the MDT members in identifying a seizure onset zone (prior to MELD information) ie. a measure of the difficulty of the SEEG exploration on Likert scale 0-10
Time Frame
Baseline (During inpatient admission)
Title
Number of electrodes added
Description
Simple number
Time Frame
Baseline (During inpatient admission)
Title
Number of electrodes added
Description
Number of electrodes already in identified lesions
Time Frame
Baseline (During inpatient admission)
Title
Was a MELD-identified lesion part of the SOZ (and if so how many?)
Description
Yes/no and simple numerical outcome
Time Frame
Baseline (During inpatient admission)
Title
Would the SOZ have been identified without MELD?
Description
Yes/No outcome
Time Frame
Baseline (During inpatient admission)
Title
Blinded neurophysiological assessment of the SOZ contacts with and without additional electrodes
Description
Description of contacts in SOZ with and without additional electrodes
Time Frame
Baseline (During inpatient admission)
Title
Putative resection boundaries with and without the additional electrodes, to be modelled by a neurosurgeon ie. a measure of whether or not this would have changed subsequent surgical strategy
Description
Description of resection and how it may have changes
Time Frame
Baseline (During inpatient admission)
Title
adverse events such as bleeding
Description
Safety of adding additional electrodes
Time Frame
Baseline (During inpatient admission)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients aged 3-18 undergoing SEEG recording as part of the investigation of their epilepsy at Great Ormond Street Hospital for Children.
Exclusion Criteria:
Tuberous sclerosis
Prior resective epilepsy surgery
Insufficient imaging datasets for the algorithm
Lack of informed consent
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Aswin Chari, MRCS
Phone
+447726780817
Email
aswin.chari@gosh.nhs.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Martin Tisdall, FRCS
Phone
+447726780817
Email
martin.tisdall@gosh.nhs.uk
Facility Information:
Facility Name
Great Ormond Street Hospital NHS Foundation Trust
City
London
ZIP/Postal Code
WC1N 3JH
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Aswin Chari, MRCS
Phone
+447726780817
Email
aswin.chari@gosh.nhs.uk
First Name & Middle Initial & Last Name & Degree
Martin Tisdall, PhD
Phone
+447726780817
Email
martin.tisdall@gosh.nhs.uk
First Name & Middle Initial & Last Name & Degree
Konrad Wagstyl, PhD
First Name & Middle Initial & Last Name & Degree
Martin Tisdall, MD
First Name & Middle Initial & Last Name & Degree
Rachel Thornton, PhD
First Name & Middle Initial & Last Name & Degree
Aswin Chari, MRCS
First Name & Middle Initial & Last Name & Degree
Sophie Adler, PhD
First Name & Middle Initial & Last Name & Degree
Torsten Baldeweg, PhD
First Name & Middle Initial & Last Name & Degree
Zubair Tahir, FRCS
First Name & Middle Initial & Last Name & Degree
Helen Cross, PhD
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
As is current good scientific practice, heavily anonymised matrices of processed data and the processing code will be made available as part of any publication. These datasets will be fully anonymised and in abstract space (ie will not contain primary MRI scan images or electrode locations) and will rather be matrices that will in no way be relatable to the patient. They will definitely not contain any patient identifiable information and will not be able to be back-processed to get identifiable information.
Learn more about this trial
MELD as an Adjunct for SEEG Trajectories
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