EPILEPSY

Epilepsy is the second most common serious neurological disorder in the community, with approximately 9% of the population having a seizure at some stage in their lifetime and 3% developing epilepsy.

The epilepsies are a common group of chronic neurological conditions that are characterized by recurrent spontaneous unprovoked epileptic seizures. Epilepsy research at the MBC-RMH includes clinical trials to assess new and established anti-epileptic medications, to identify potential epilepsy susceptibility genes, and determine individual variability in drug response. There is strong emphasis on applying the knowledge gained in pharmacogenomics research into clinical practice through the development of technology-based testing systems and evaluating the health economics of personalized medicine. Longitudinal studies investigating clinical outcomes and quality of life following new onset seizures and treatment for epilepsy are currently being conducted in collaboration with the MBC Austin. In addition, collaborations within MBC-RMH have led to cross-disciplinary projects investigating tumour-associated epilepsy, neurodegenerative diseases and psychiatric conditions.

RESEARCHERS

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Dr John-Paul Nicolo

 

John-Paul Nicolo, MBBS (Hons), BMedSci, FRACP, is a consultant neurologist and epileptologist. He is currently acting head of the epilepsy program at Royal Melbourne Hospital, and also has clinical appointments at the Alfred Hospital and University Hospital Geelong.

Through his PhD he has pioneered the use of 7-tesla MRI to identify novel imaging biomarkers of post-stroke epilepsy, and has designed and led the PEPSTEP trial of perampanel for prevention of post-stroke epilepsy. He completed his neurology training and an epilepsy fellowship across RMH and the Alfred Hospital.

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Dr Andrew Neal

 

Andrew Neal, MBBS, BMedSci, FRACP, PhD is a consultant neurologist, epileptologist and clinical research fellow. Andrew has current clinical appointments at Alfred Hospital, St Vincent’s Hospital Melbourne (SVHM) and Royal Melbourne Hospital (RMH). He is a research fellow of Monash University and honorary research fellow of Melbourne University. Andrew completed neurology training and an epilepsy fellowship at RMH/SVHM. 

He completed a PhD (RMH/Melbourne University) in 2018 examining clinical and molecular factors associated with tumour associated epilepsy. During his PhD, Andrew designed and commenced two multi-centre, international phase II RCTs which examine targeted treatment for glioma associated epilepsy (PEGASUS). He is the chief investigator of these ongoing trials. 

In 2018 Andrew completed a 12 month stereo-EEG fellowship in Lyon, France where he gained expertise in SEEG and quantitative techniques for SEEG signal analysis. He is now leading the SEEG programs at Alfred and StV and founded a multi-site SEEG Clinical-research program. 

Andrew is currently supervising PhD candidates, Honours students and junior doctors undertaking epilepsy based projects. 

His major research interests are brain tumour associated epilepsy, stereo electro-encephalography and epilepsy surgery. 

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Professor Terence O'Brien

 

Terence J. O’Brien, MB, BS, MD, FRACP, FRCPE, FAHMS, FAES, is Chair of Medicine (Neurology) and Head, Central Clinical School, Monash University and Program Director, Alfred Brain and Deputy Director of Research, Alfred Health. He was formally The University of Melbourne’s James Stewart Chair of Medicine and Head, The Department of Medicine, The Royal Melbourne Hospitals (2008-17) and Van Cleef Roet Chair of Neuroscience at Monash University and Director of Neurology at Alfred Health (2017-20). He continues as an Honorary Neurologist at the Royal Melbourne Hospital and a Professorial Fellow in the Department of Medicine, The University of Melbourne.

He is a specialist in neurology and clinical pharmacology, with particular expertise in epilepsy and neurodegenerative diseases, pre-clinical and clinical trials, and in-vivo imaging in animal models and humans. He did his clinical and research training at St. Vincent’s and Royal Melbourne Hospitals in Melbourne, and then the Mayo Clinic, Rochester, Minnesota, USA (1995-1998). He leads a large translational research team undertaking both basic studies and clinical studies focused on developing improved treatments for people with epilepsy and related brain diseases, including traumatic brain injury, dementias and brain tumours.

He has been involved as a Principle Investigator in >100 commercially sponsored and investigator initiated clinical trials of new treatments for epilepsy, dementias, headache, movement disorders, and new PET radiotracers.  He has published >535 peer-reviewed original papers in leading scientific and medical journals which have been cited ~22,000 times (H-Index 78). He is currently the President of the Epilepsy Society of Australia (since 2018).

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Professor Patrick Kwan

 

Patrick Kwan is Professor of Neurology with joint appointment at the Central Clinical School and School of Public Health & Preventive Medicine, Monash University, and Director of Epilepsy Unit, Alfred Health. He is a MRFF Practitioner Fellow (2018-2022) and was elected Fellow of the Australian Academy of Health and Medical Sciences (FAHMS) in 2017.


He is a medical specialist in neurology, with particular expertise in epilepsy. He undertook his clinical and research training in the United Kingdom and Hong Kong, graduating in clinical medicine from the University of Cambridge and obtaining PhD from the University of Glasgow. He was recruited to take up clinical and academic appointments in Melbourne in 2011. He focuses in clinical research, particularly in the application of precision/personalised medicine to improve epilepsy outcomes and human health more broadly. To achieve this goal a range of tools are used, spanning across cellular and animal models, clinical epidemiology, genomics, neurophysiology, imaging, clinical trials, medical technologies, artificial intelligence, biostatistics/informatics and health services/economics.

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Associate Professor Piero Perucca

 

Piero Perucca, MD, PhD, FRACP is Associate Professor of Adult Epilepsy at the Department of Medicine (Austin Health), Melbourne Medical School, The University of Melbourne, and Director of the Comprehensive Epilepsy Program at Austin Health. He is also Adjunct Associate Professor at the Department of Neuroscience, Central Clinical School, Monash University, and holds honorary appointments at The Royal Melbourne Hospital and Alfred Health. He is an academic neurologist, with clinical and research interest in the diagnosis and management of epilepsy.

His research program covers different areas of epileptology, including the genetics of epilepsy, electroencephalography, the pharmacological and surgical treatment of epilepsy, and genomic and electrophysiological biomarkers of epilepsy outcomes. He has published widely in the field epilepsy, with publications in leading medical journals, including The Lancet Neurology, Nature Reviews Disease Primers, Brain, Annals of Neurology, and Neurology. He has received several awards/prizes for his research, including the 2019 Young Researcher of the Year Award from the Bethlehem Griffiths Research Foundation and the Young Investigator Award from the American Epilepsy Society.

He is currently Chair of the Victorian Epilepsy Centres and serves on committees of different scientific international and national organisations, including the International League Against Epilepsy, the American Epilepsy Society, and the Epilepsy Society of Australia. He also serves as an Associate Editor for Epilepsia Open and as an editorial board member for Neurobiology of Disease and Neurological Research and Practice.

Highlights

Current projects:

The PErampanel for the Prevention of STroke-related EPilepsy (PEPSTEP) study (trial registration number: ACTRN12618001984280) is a multicentre randomised controlled trial that aims to investigate the efficacy and safety of the antiseizure medication perampanel in preventing the development of seizures after ischaemic or haemorrhagic stroke. This trial complements our study of brain glutamate imaging by ultra-high-field MRI for prediction of post-stroke epilepsy, in collaboration with Alfred Health, the University of Melbourne.

The PErampanel in Glioma-ASsociated Seizures - efficacy and safety (PEGASUS) study (trial registration number: ACTRN12617000078358, ACTRN12617000073303) is a multicentre randomised controlled trial of perampanel for glioma-related seizures - PEGASUS1 examines the efficacy of perampanel in preventing seizures in glioma patients, and PEGASUS2 compares perampanel with levetiracetam (another antiseizure medication) in the treatment of existing epilepsy.

We are participating in several multicentre trials of new antiseizure medications for the treatment of refractory epilepsy. These include a randomised, double-blind, placebo-controlled, parallel group trial of CVL-865 as adjunctive therapy in adults with DRug-REsistAnt focaL onset SeIZurEs (REALIZE) and a randomised, double-blind, placebo-controlled study to evaluate the efficacy, safety and pharmacokinetics of ES-481 in patients with drug-resistant epilepsy.

Genomic sequencing for Refractory EPilepsy (GREP) study (trial registration number: ACTRN12618001444279) is a multicentre randomised controlled trial in Australia that aims to investigate the diagnostic efficiency, clinical utility and cost effectiveness of whole genome sequencing in children and adults with drug-resistant epilepsy.

Commenced large dual-centre (RMH & Austin Health) study of mortality after a new diagnosis of epilepsy. This innovative study comprises multiple data linkages between two large new-onset patient cohorts and three national Australian health databases. Principal Investigator Dr Anne McIntosh

Delay to diagnosis in new-onset epilepsy. The first paper from this study has been identified in an international review publication as one of the 5 important papers published internationally in clinical epilepsy in 2015. This study comprises collaboration between RMH & Austin Health epilepsy centres. Principal Investigator Dr Anne McIntosh

 

The Epilepsy Bioinformatics Study for Antiepileptogenic Therapy. Principal Investigator: Prof. Terence O’Brien. Co- investigators: A/Prof. Nigel Jones, Dr. Sandy Shultz, Dr. Andrew Morokoff and Prof. Patrick Kwan

Commenced large dual-centre (RMH & Austin Health) study of mortality after a new diagnosis of epilepsy. This innovative study comprises multiple data linkages between two large new-onset patient cohorts and three national Australian health databases. Principal Investigator Dr Anne McIntosh

Delay to diagnosis in new-onset epilepsy. The first paper from this study has been identified in an international review publication as one of the 5 important papers published internationally in clinical epilepsy in 2015. This study comprises collaboration between RMH & Austin Health epilepsy centres. Principal Investigator Dr Anne McIntosh

RESEARCH INSIGHTS

Epilepsy research