Frontal Lobe Epilepsies Clinical Trial
Official title:
Co-operative Behavior and Decision-making in Frontal Lobe Epilepsy
Epilepsy is a frequent neurological disorder with about a third of patients having seizures
despite treatment. At least some of these seizures can be linked to a low compliance and
therapy adherence of patients. Compliance is defined as "the extent to which a person's
behavior (in terms of taking medication, following diets, or executing life style changes)
coincides with medical or health advice". Therapy adherence of patients suffering from
epilepsy is low with reported rates between 30 and 50%, although adherence to anticonvulsive
drug therapy is critical for effective disease management and low therapy adherence is
associated to higher mortality in epilepsy. The reasons for low therapy adherence are still
a matter of research. Some known factors influencing compliance in epilepsy are related to
its chronic nature, but others seem to lie in a complex interaction between psychiatric
comorbidity and an impairment of neural systems underlying behavior. Furthermore, therapy
adherence rests a variable difficult to measure, especially in epileptic patients where
classical tools such as questionnaires and electronic monitoring devices have been shown to
be imprecise. It has been argued that the term 'compliance' should be replaced by
'co-operative behavior' and non-compliance can therefore be interpreted as troubled
co-operative behavior. This behavioral approach offers the potential of using tools and
methods of the latest developments in behavioral neuroscience. Neuroeconomics, a scientific
field on the border of psychology, economics and neuroscience, has used economic game
paradigms in order to operationalize cooperative behavior and to identify several brain
areas by functional brain imaging that have been linked to social co-operative behavior. The
majority of these brain areas are located in the frontal cortex [ventromedial
frontal/orbitofrontal cortex, and rostral anterior cingulate cortex. Epilepsies originating
in the frontal lobe are subsumed under the term "frontal lobe epilepsy" (FLE) and represent
20-30% of all partial seizures and 25% of all refractory focal epilepsies referred to
epilepsy surgery.
The investigator's project plans to study compliance and cooperative behavior of patients
suffering from frontal lobe epilepsies through a neuroeconomic approach by (1) comparing the
behavior of these patients in the prisoners' dilemma game to the behavior of age-, gender-,
and education-matched healthy controls, (2) correlation of game behavior to brain activation
measured by functional magnetic resonance imaging in both patients and healthy controls and
(3) studying the link between cooperative behavior to compliance captured by pill counts and
questionnaires.
n/a
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Basic Science