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, En effet, la seule possibilité pour les patients pharmaco-résistants d'être libérés de leurs crises est d'arriver à identifier et à réséquer la zone épileptogène. Ces dernières années, la recherche sur l'épilepsie s'est focalisée sur des oscillations à très haute fréquence (les fast-ripples, 200-600 Hz), apparaissant comme étant de bons biomarqueurs de la zone épileptogène. La résection des zones où sont retrouvés ces fast-ripples empêche la resurvenue des crises chez un grand nombre de patients épileptiques. Bien que les fast-ripples puissent être détectés à l'aide de macroélectrodes clinique, Cette thèse CIFRE en collaboration avec la société DIXI medical
, Une collaboration a alors débuté avec DIXI medical dans le but de créer une nouvelle électrode hybride avec un diamètre similaire à celui d'une macroélectrode clinique. La nouvelle électrode hybride comporte également d'autres avantages : (1) les microélectrodes sont organisées, pour la première fois chez l'homme, en tétrode (4 microfilaments collés ensemble), ce qui facilite l'identification de l'activité de neurones unitaires, les macroélectrodes clinique ont un diamètre de 800 microns
, Cette nouvelle électrode hybride est en cours d'investigation clinique au CHU de Toulouse depuis mars 2015. Le but de ma thèse est de démontrer l'innocuité de cette électrode mais également son bon fonctionnement au travers d'études à multi-échelle en épilepsie et en recherche fondamentale
, Les études 2, 3 et 4 sont en rapport avec l'utilisation de cette électrode en épilepsie. L'étude 2 décrit le cas d'une patiente souffrant d'une sclérose tubéreuse de Bourneville couplée à une épilepsie pharmaco-résistante. C'est la première fois que l'activité neuronale est enregistrée et rapportée dans cette pathologie. L'étude 3 est essentielle pour lancer la procédure de marquage CE, elle vise notamment à vérifier que les fast-ripples enregistrés avec les électrodes hybrides sont effectivement de bons prédicteurs de la zone épileptogène. L'étude 4 porte sur l'analyse de la neurophysiopathologie des fast-ripples, Ma thèse est organisée autour d'une revue de la littérature et de 5 études. L'étude 1 est une étude méthodologique visant à présenter les caractéristiques de la nouvelle électrode hybride et à démontrer son innocuité
, étude 5 rapporte la dynamique spatio-temporelle de la mémoire de reconnaissance visuelle à l'aide de macroélectrodes cliniques classiques. Il s'agit d'une étude préliminaire à l'analyse de l'activité neuronale pendant cette tâche
, This thesis was done in collaboration with DIXI medical, the CHU of Toulouse and the Centre de Recherche Cerveau et Cognition in order to validate the use of a new hybrid electrode in drug refractory epileptic patients. These electrodes are used in order to identify the seizure onset zone during stereo-electroencephalography. If this zone can be identified and removed, drug-refractory epileptic patients may become seizure free, recent years
, This problem leads to a collaboration with DIXI medical in order to manufacture a new hybrid electrode with the same diameter as the clinical ones. The new hybrid electrode has different advantages: (1) the microelectrodes are, for the first time in the human, in a tetrode configuration (4 microwires bundled together), which facilitates single neuron identification; (2) microelectrodes can be extended up to 2 mm, which enable to search for neurons, These oscillations appear to be a good biomarker of the seizure onset zone. Fast-ripples can be detected with clinical macroelectrodes (diameter 800-1300 µm) but their identification is facilitated with microelectrodes (diameter 80 µm). In the CHU of Toulouse, clinical macroelectrodes have a diameter of 800 µm and hybrid electrodes (combining macro and microelectrodes) available on the market have a diameter of 1300 µm, 2015.