Dream Content Clinical Trial
Official title:
The Impact of Epilepsy Surgery on Dream Content
Prospective observational study on epilepsy patients undergoing partial brain resection surgery (i.e. anterior temporal lobectomy) to assess the change in dream content before and 3 months and 1 year after surgery using anonymized dream-recall questionnaires. A control group of epilepsy patients undergoing diagnostic depth electrodes placement will complete the same questionnaires pre- and postoperatively to asses the factor 'general anesthesia' as a potential confounder.
STUDY RATIONALE Dream research, unlike sleep research, has not greatly developed anymore as
there are few dream research laboratories only and not much systematic dream research is done
outside the laboratory either(1) although validated methods of collecting and analyzing dream
reports on the basis of the coding system developed by Calvin S. Hall and Robert Van de
Castle are readily available.(2) According to Domhoff et al.,(3) the main features of the
default dream network include the medial prefrontal cortex, the medial temporal lobe, the
bilateral inferior parietal lobule/temporoparietal junction, and the posterior cingulate
cortex, with the medial pre- frontal cortex and the posterior cingulate cortex serving as
major hubs. The dorsal medial subsystem including the dorsomedial prefrontal cortex, the
temporoparietal junction/anterior inferior parietal lobule, the lateral temporal cortex, and
temporopolar cortex (the anterior pole of the temporal lobe) is activated by instructions to
think about the present situation or a present mental state (''present self'').(3) The medial
temporal subsystem including the ventral medial prefrontal cortex, posterior inferior
parietal lobule, retrosplenial cortex, parahippocampal cortex, and hippocampal formation is
activated by thinking about personal situations and decisions in the future (''future
self'').(3) A lot of what is known about the neuronal function of dreaming comes from lesion
studies that are well-summarized by Solms.(4) To the best knowledge, investigators are the
first to prospectively investigate the change of dream content in patients electively
undergoing surgical resection of brain tissue (i.e. the anterior temporal lobe for temporal
lobe epilepsy).
The merits of the current study are the following:
- To better understand the dream network (academic significance)
- To better consult epilepsy patients with respect to the impact of surgery on dreaming
(practical significance)
PURPOSES AND OBJECTIVES
Purpose:
- To assess the change in dream content in patients following epilepsy surgery compared to a
control group of patients undergoing general anesthesia.
Hypothesis:
- Dream content is markedly changed in patients before and after epilepsy surgery.
Objective:
- To quantify dream content in patients before and after epilepsy surgery using the MOST
RECENT DREAM questionnaire and compare these results to patients undergoing general
anesthesia (control group).
STUDY DESIGN AND METHODOLOGY Setting/Design: Prospective observational study on epilepsy
patients undergoing elective surgical resection of brain tissue (study group: Epilepsy
surgery=ESx) or depth electrode insertion in general anesthesia (control group=DE).
Methodology: Patient baseline characteristics are Age (minimum age: 16 years); Date of birth
(DOB); Sex; Handedness: RH/LH; Education (years); Occupation according to the International
Standard Classification of Occupation(5); Seizure history (years); Seizure frequency ENGEL
classification; Antiepileptic drugs; Other medication (antidepressants, dopaminergic agonists
and antagonists, etc.); Pathology (Ammon's horn sclerosis y/n); Side (right/left); Any
previous cranial surgery; Other relevant medical history (dementia, depression and other
psychiatric disorders, Parkinson's, etc.) Questionnaire: MOST RECENT DREAM (STANDARD
INSTRUMENT (2)
STUDY PROCEDURES AND SPECIFIC TESTINGS In this observational study, the MOST RECENT DREAM
questionnaire, a standard validated instrument(2) represents the only study specific testing
outside of standard care. The questionnaire is handed out to patients to record the most
recent dreams five times pre- and post-operatively. The length of each dream summary lies in
between 50 and 300 words. Study participation and the questionnaires will not affect standard
patient care in any way and carries no additional risks.
STUDY GROUP:
Visit 1 (pre-op outpatient clinics or epilepsy monitoring unit) - Study information -
Informed consent - Hand-out anonymized MOST RECENT DREAM (5x), return by mail before surgery.
Visit 2 (post-op outpatient clinics at ~1 month) - Hand-out anonymized MOST RECENT DREAM (5x)
to be completed and returned by mail at 3 months postoperatively - Outcome according to the
Engel classification Long-term FU at 12 month - Mail anonymized MOST RECENT DREAM (5x),
return by mail.
CONTROL GROUP (Diagnostic depth electrodes):
Visit 1 (pre-op outpatient clinics/epilepsy monitoring unit) Study information - Informed
consent - Hand-out anonymized MOST RECENT DREAM (5x), return before surgery.
Visit 2 (post-op epilepsy monitoring unit) Hand-out anonymized MOST RECENT DREAM (5x) to be
completed and returned by mail at 1 month postoperatively.
DATA ANALYSIS Major indicators for main content categories in the Hall/Van de Castle
system(2) are compared before and after the index procedure and results will be presented
graphically similar to Bentes et al.(6). Data analysis is done using EXCEL spreadsheets
available from http://www.dreamresearch.net/ and analysis performed as explained at
http://www2.ucsc.edu/dreams/Info/statistics.html
;