Rod Scott, MD

Rod Scott’s Photo

WC1N 1EH

Title Dr.
Department Institute of Child Health
Position Senior Lecturer
Research Area Developmental, Clinical, Systems
Research Title Consequences and Outcomes from convulsive status e
 

Web Link
http://www.ich.ucl.ac.uk/publications/research_review_current/neurosciences_mental_health.html

Research Interests
Mechanisms of adverse outcomes in epilepsy

Research Description
I am a senior lecturer and clinically active consultant paediatric neurologist, with a specialist research focus on convulsive status epilepticus (CSE) and brain damage/dysfunction associated with childhood epilepsy. CSE (a seizure lasting at least 30 minutes) is the most common medical neurological emergency in childhood and has significant mortality and morbidity. My research relates to the epidemiology of CSE, the causative relationships between CSE and brain injury (particularly to the hippocampus), and the emergency treatment of seizures in the community. The scientific questions that I have attempted to answer have all been predicated on important clinical problems with a view to translating my scientific findings back into clinical practice. Clinical Activity: I spend 30% of my time on epilepsy-related clinical work. I participate in the comprehensive epilepsy service which spans Great Ormond Street Hospital NHS Trust, the National Centre for Young People with Epilepsy (NCYPE) and the North London epilepsy interest group. This provides an important and strong clinical base for my research activity. Research Activity: I straddle the interface between basic and clinical science and have developed skills in both domains. This has enabled me to carry out and lead multidisciplinary research projects, with scientific findings that could have major clinical implications. I have set up collaborations with colleagues who have expertise in magnetic resonance, statistics, neuropsychology, neural development and epidemiology and this has led to three major contributions to the understanding of CSE in childhood: 1. I carried out studies showing the absorption and effectiveness of buccal midazolam for the early treatment of CSE (published in Epilepsia and Lancet). The translation of the findings from the randomised controlled trial was facilitated through my clinical practice, and buccal midazolam is becoming a widely used treatment for seizures in the community. Further randomised controlled trials of buccal midazolam use in the community are ongoing. 2. There is debate on whether CSE can cause hippocampal sclerosis, the most common structural abnormality identified in patients who have surgery as part of treatment for epilepsy. Through cohort studies, I have shown that a particular form of CSE (prolonged febrile convulsion) is associated with early hippocampal oedema which may represent an early manifestation of mesial temporal injury. Follow-up imaging revealed an increase in hippocampal asymmetry supporting the view that prolonged febrile convulsion can cause hippocampal injury. I am the principal investigator on a project recently funded by the Wellcome Trust which extends this work to all CSE and to the understanding of non-hippocampal injury and associated cognitive outcomes. 3. I led a major epidemiological study of CSE in childhood. Previous epidemiological studies have ascertained mainly adult populations. Our data suggest that the incidence, aetiologies and outcomes from CSE in childhood are different from those identified in adults (published in Lancet) and that child-specific strategies that may improve outcomes from CSE in childhood are required. In addition, I have more recently designed and led animal experiments. We have shown a mismatch between energy demand and blood supply in the hippocampus during CSE, and this may be an important component of hippocampal injury associated with CSE. CSE also sets in train a process which results in hippocampal abnormalities 48 hours after CSE, and these abnormalities predict final tissue status in the hippocampus. The proteins expressed at the time of maximal hippocampal abnormality are associated with both neuroprotective and neurone injuring functions (published in Proteomics). These studies led to a hypothesis that the outcome from CSE is related to inflammation, and I am the principal investigator on a project funded by Epilepsy Research UK to pursue this avenue of research.

Collaborators (Internal)
Prof Matthew Walker

Collaborators (External)
Dr Daniel Anthony Dr Tomis Panayiotopoulos

Keywords
Epilepsy, Brain imaging, Brain injury, Cerebral blood flow, Cognition, DTI, Epidemiology

Conditions
Epilepsy

Methods
Cross-sectional and cohort studies, Diffusion tensor imaging (DTI), Image analysis, Magnetic resonance imaging (MRI), Neuropsychological testing, Proteomics

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