Imaging in children with focal epilepsy the development of a noninvasive approach to presurgical evaluation My initial research was into the development of noninvasive functional and optimised structural imaging in the presurgical assessment of children with drug resistant focal epilepsy. This work evaluated the use of optimised magnetic resonance imaging, including quantitative techniques of T2 relaxometry and proton magnetic resonance spectroscopy , as well as ictal and interictal single photon emission computed tomography (SPECT). Ictal and interictal SPECT now form part of the routine clinical presurgical evaluation at Great Ormond Street Hospital for Children NHS Trust.  Ongoing work includes evaluation of newer MRI techniques in determining structural abnormality, as well as combining functional and structural techniues wirh EEG fMRI
Why do children with early catastrophic epilepsy have a high rate of cognitive and behavioural comorbidity, what are the mechanisms of such and can we alter the natural history with early surgical intervention? With the development of the epilepsy surgery programme at Great Ormond Street Hospital, it has been our responsibility to evaluate benefits as well as prognostic indicators from such procedures. However, it has also given us the opportunity to evaluate the underlying cognitive and psychiatric morbidity associated with such epilepsy including the natural history. This has been in conjunction with neuropsychiatry as well as ongoing projects with neuropsychology. It is anticipated that in addition to the studies in progress, further follow up neuropsychology and MRI correlative studies, may also contribute to some understanding of this. A prospective epidemiological study of focal epilepsy with onset in infancy (grants awarded by Epilepsy Research Foundation, Bailey Thomas Charitable Trust The Foyle Foundation), has highlighted the high rate of neurodevelopmental disorder at presentation with epilepsy. Further work continues to determine the relative role of pathology and epileptic discharges in cognitive dysfunction
What is the role of other intervention can we determine a role for alternative treatments and the timing of such compared to that presently available? Current anticonvulsant medications in the majority have been found anecdotally to be effective, and in addition many are trialled late in children, in ways not specifically related to clinical practice. I have been involved in international collaborative drug trials. I have also been instrumental as the principal investigator in conducting the first randomised controlled trial of the ketogenic diet in the treatment of childhood epilepsy, recently published. Pathological, neurophysiological and genetic studies (from our own unit and others) have suggested alternative modes of epileptogenesis to our current understanding and reasons why individuals are resistant to existing medication, implying other possible treatments may be effective. Collaboration with colleagues in the Epilepsy Unit at the Institute of Neurology, Queen Square has enabled involvement in pathological and genetic studies