A US-Mexico Collaborative Effort to Improve Epilepsy Control and Diagnosis

美国-墨西哥合作改善癫痫控制和诊断

• 批准号: 8211126
• 负责人: Walter Grant Besio
• 金额: $ 10.46万
• 依托单位: UNIVERSITY OF RHODE ISLAND
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8211126
• 关键词: Address; Adverse effects; Affect; Age; Anticonvulsants; Antiepileptic Agents; Behavioral; Brain; Brain Diseases; Cessation of life; Clinical; Clinical Pharmacology; Collaborations; Country; Data; Detection; Developing Countries; Diagnosis; Diagnostic; Discipline; Effectiveness; Electrodes; Electroencephalography; Engineering; Epilepsy; Future; Goals; Grant; Impaired cognition; Income; Institution; Investigation; Knowledge; Lead; Life; Medical; Medical Research; Mental Depression; Mentors; Methods; Mexican; Mexico; Neurosciences; Noise; Operative Surgical Procedures; Patients; Persons; Pharmacotherapy; Plant Roots; Preparation; Problem behavior; Rattus; Refractory; Research; Research Project Grants; Resolution; Risk; Scalp structure; Scientist; Seizures; Sensitivity and Specificity; Signal Transduction; Social Class; Surface; System; Techniques; Technology; Therapeutic; Training; base; brain disorder diagnosis; career development; cost effective; design; follow-up; high risk; implantable device; improved; innovation; nervous system disorder; neuroregulation; next generation; novel strategies; sound; stem; tool; treatment strategy

DESCRIPTION (provided by applicant): Epilepsy is the most common brain disorder worldwide with no age, racial, social class, national, or geographic boundaries. It affects 67 million people, 85% of whom live in developing countries. Refractory (uncontrolled) epilepsy and misdiagnosis are two major challenges in the field of epilepsy worldwide. Despite decades of research, new antiepileptic drugs (AEDs), and advances in surgical therapy, many patients suffer from uncontrollable epilepsy or the side effects of AEDs and surgical treatment. Furthermore, misdiagnosis of epilepsy is very common in patients of all ages. Misdiagnosis of epilepsy can lead to serious complications as seizures and antiepileptic drugs can cause cognitive impairments and behavioral problems. There is growing evidence that brain stimulation may be used as a potential therapy for refractory epilepsy. However, the therapeutic results of stimulation are not proven. Existing stimulation approaches demonstrate suboptimal effect or involve significant risks. Presently, the primary diagnostic tool for epilepsy is conventional electroencephalography (EEG) which suffers from poor sensitivity/specificity, a root cause of misdiagnosis because it leads to inaccurate spike and seizure detection and foci localization. To address these problems, our long-term research goals are, through multi-disciplinary collaboration between the U.S. and Mexico, to develop (1) a tripolar concentric ring electrode (TCRE) based noninvasive transcutaneous focal stimulation (TFS) neuromodulation system for epilepsy therapy, and (2) a TCRE EEG system to improve epilepsy diagnosis. Preliminary studies generated promising results, thus warrant further investigation. The proposed techniques are cost effective and noninvasive, which are particularly advantageous for use in low-to-mid income countries because they reduce the financial burden and surgical risks caused by implantable devices. To achieve the long-term goals, the objectives of the current R21 proposal are to assess needs in Mexico, initiate preliminary studies and training, and plan, prepare, and assemble the information and data for a more comprehensive R01 submission. The team has made a preliminary assessment of the epilepsy research and medical needs in Mexico. Based on this pre-assessment, the following Specific Aims are designed to accomplish the proposal objectives: Aim 1 - Finalize the assessment of epilepsy research capacity and training needs in Mexico. Aim 2 - Develop multi-disciplinary collaboration to build Mexico research and clinical capacity in epilepsy. Aim 3 - Acquire preliminary data that will prepare the team for a follow-up R01 submission. Aim 4 - Integrate capacity building and collaborator training. Successful completion of the proposed research will change methods, treatments, and technologies in the field of epilepsy. This grant will help build sustainable research capacity in Mexico in epilepsy and neurological disorders in general. PUBLIC HEALTH RELEVANCE: For epilepsy control, successful demonstration of the effects of transcutaneous focal stimulation (TFS) will potentially change the current paradigms to noninvasive TFS for alternative or additive epilepsy therapy. For diagnosis, in the short-term, we expect the benefits of tripolar concentric ring electrodes (TCREs) to significantly improve the interpretability of EEG and, in the long-term, to advance epilepsy diagnosis.

描述（由申请人提供）：癫痫是世界范围内最常见的脑部疾病，没有年龄、种族、社会阶层、国家或地理界限。它影响到 6700 万人，其中 85% 生活在发展中国家。难治性（不受控制的）癫痫和误诊是全世界癫痫领域的两大挑战。尽管经过数十年的研究、新的抗癫痫药物 (AED) 以及手术治疗的进步，许多患者仍患有无法控制的癫痫或 AED 和手术治疗的副作用。此外，癫痫误诊在所有年龄段的患者中都很常见。癫痫的误诊可能会导致严重的并发症，因为癫痫发作和抗癫痫药物可能会导致认知障碍和行为问题。越来越多的证据表明，脑刺激可作为难治性癫痫的潜在疗法。然而，刺激的治疗效果尚未得到证实。现有的刺激方法表现出次优效果或涉及重大风险。目前，癫痫的主要诊断工具是传统的脑电图（EEG），其灵敏度/特异性较差，这是误诊的根本原因，因为它会导致不准确的尖峰和癫痫发作检测以及病灶定位。为了解决这些问题，我们的长期研究目标是，通过美国和墨西哥之间的多学科合作，开发（1）基于三极同心环电极（TCRE）的用于癫痫治疗的无创经皮局灶刺激（TFS）神经调节系统，以及（2）改善癫痫诊断的TCRE脑电图系统。初步研究产生了有希望的结果，因此值得进一步研究。所提出的技术具有成本效益且无创，特别有利于在中低收入国家使用，因为它们减少了植入设备造成的财务负担和手术风险。为了实现长期目标，当前 R21 提案的目标是评估墨西哥的需求，启动初步研究和培训，并规划、准备和汇总信息和数据，以提交更全面的 R01。该团队对墨西哥的癫痫研究和医疗需求进行了初步评估。根据预评估，设计了以下具体目标来实现提案目标： 目标 1 - 最终完成对墨西哥癫痫研究能力和培训需求的评估。目标 2 - 发展多学科合作，建设墨西哥癫痫研究和临床能力。目标 3 - 获取初步数据，为团队提交后续 R01 做好准备。目标 4 - 整合能力建设和合作者培训。拟议研究的成功完成将改变癫痫领域的方法、治疗和技术。这笔赠款将帮助墨西哥建立癫痫和神经系统疾病方面的可持续研究能力。 公共健康相关性：对于癫痫控制，经皮局灶刺激 (TFS) 效果的成功证明将有可能改变当前的非侵入性 TFS 替代或附加癫痫治疗模式。对于诊断而言，短期内，我们预计三极同心环电极（TCRE）的好处将显着提高脑电图的可解释性，并从长远来看，促进癫痫诊断。