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

描述（由申请人提供）：癫痫是世界上最常见的脑部疾病，没有年龄、种族、社会阶层、国家或地理界限。它影响6700万人，其中85%生活在发展中国家。难治性（未控制的）癫痫和误诊是世界范围内癫痫领域面临的两大挑战。尽管经过几十年的研究，新的抗癫痫药物（aed）和手术治疗的进步，许多患者仍然遭受无法控制的癫痫或aed和手术治疗的副作用。此外，癫痫的误诊在所有年龄段的患者中都很常见。癫痫的误诊会导致严重的并发症，因为癫痫发作和抗癫痫药物会导致认知障碍和行为问题。越来越多的证据表明，脑刺激可能被用作难治性癫痫的潜在治疗方法。然而，刺激的治疗效果尚未得到证实。现有的增产方法要么效果不理想，要么风险很大。目前，癫痫的主要诊断工具是传统脑电图（EEG），其敏感性/特异性较差，这是误诊的根本原因，因为它导致不准确的尖峰和癫痫发作检测和病灶定位。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)基于三极同心圆电极（TCRE）的无创经皮局灶刺激（TFS）神经调节系统用于癫痫治疗，以及(2)TCRE脑电图系统以提高癫痫诊断。初步研究产生了令人鼓舞的结果，因此值得进一步研究。所提出的技术具有成本效益和非侵入性，特别有利于在中低收入国家使用，因为它们减少了由植入式装置引起的经济负担和手术风险。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，并为更全面的R01提交计划，准备和收集信息和数据。该小组对墨西哥的癫痫研究和医疗需求进行了初步评估。根据这一预评估，设计了以下具体目标，以实现提议的目标：目标1 -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，为后续R01提交做准备。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在癫痫和一般神经系统疾病方面建立可持续的研究能力。

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.