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If the mind is a musical instrument, “the electrophysiology is the music,” says Dr. Alexander Khalessi. New instruments to deal with epilepsy sufferers now let medical doctors “take heed to the music a bit of bit higher.”
KATERYNA KON/SCIENCE PHOTO LIBRA/Getty Photos/Science Picture Libra
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KATERYNA KON/SCIENCE PHOTO LIBRA/Getty Photos/Science Picture Libra
If the mind is a musical instrument, “the electrophysiology is the music,” says Dr. Alexander Khalessi. New instruments to deal with epilepsy sufferers now let medical doctors “take heed to the music a bit of bit higher.”
KATERYNA KON/SCIENCE PHOTO LIBRA/Getty Photos/Science Picture Libra
When Tom’s epileptic seizures may not be managed with medicine, he began contemplating surgical procedure.
Tom – who requested that we not use his final identify as a result of he worries that employers is likely to be alarmed by his medical historical past – hoped medical doctors may take away the defective mind tissue that typically brought on him to convulse and lose consciousness.
He underwent a grueling analysis on the epilepsy heart on the College of California, San Diego. Medical doctors eliminated a chunk of his cranium and positioned electrodes on the floor of his mind. He spent every week within the hospital whereas medical doctors watched him having seizures.
Then, he bought dangerous information.
“You are not an optimum surgical procedure affected person,” he recalled the medical doctors telling him.” We do not really feel secure working on you.”
That was in 2009. In 2018, with epilepsy taking a heavy toll on his work and household life, Tom went again to his medical doctors at UCSD to debate remedy choices. This time he met with Dr. Jerry Shih, the middle’s director.
“I informed him, you recognize what, we’re in a novel state of affairs now the place we’ve among the newer applied sciences that weren’t obtainable” in 2009, Shih says.
This time, the crew inserted tiny electrodes into Tom’s mind to seek out the first supply of his seizures. Then, in 2019, they used a laser to take away that little bit of his mind.
Tom, 48, is seizure free now, so long as he takes his medicine.
There are a rising variety of sufferers like Tom. Their tales present how new know-how is altering the best way medical doctors assess and deal with drug-resistant epilepsy, which impacts greater than 1 / 4 of the roughly 3 million folks within the U.S. with the dysfunction.
Technological advances embody not solely tiny electrodes and lasers, however MRI machines that present high-resolution pictures throughout surgical procedure, and implanted units that may cease a seizure in its tracks.
“We assist the overwhelming majority of sufferers we deal with fairly considerably with a mixture of those applied sciences,” says Dr. Sharona Ben-Haim, the neurosurgeon at UCSD who operated on Tom.
All of those approaches contain surgical procedure, which was as soon as thought of a final resort for treating epilepsy. At the moment, although, surgical remedy is more and more widespread, and lots of sufferers want solely minimally invasive procedures.
When epilepsy medicine aren’t sufficient
Like many individuals with epilepsy, Tom was initially in a position to management his dysfunction with medicine.
His first massive seizure got here when he was 16. His mother heard him making unusual sounds.
“She went upstairs to my bed room and I used to be simply in full convulsions,” Tom says. “My mattress was utterly soaked by means of with sweat and my head was contorted.”
Tom awoke within the hospital. However as soon as medical doctors put him on an epilepsy drug, his seizures stopped.
He went to varsity, labored as an English trainer in Mexico, got here again to California, and moved in with the girl he would later marry.
By that point, Tom’s physician had cleared him to cease taking medicine. They each hoped he had outgrown his epilepsy.
Then he had one other massive seizure, and one other journey to the hospital.
“Now, you recognize, I am 25 and I am recognized with a doubtlessly devastating, doubtlessly uncontrollable dysfunction,” Tom says.
That meant some each day actions have been not secure.
“Abruptly you possibly can’t take a shower anymore,” he says. “You may’t go swimming anymore. No extra free weights within the fitness center.”
Tom tried to adapt. He discovered a job, bought married, and had children. However his epilepsy started taking a giant toll on his household.
After being informed he wasn’t a very good candidate for surgical procedure in 2009, Tom had returned to work nonetheless fighting uncontrolled seizures. Inside a few years, although, he misplaced his job. His marriage ended.
Throughout this troublesome interval in Tom’s life, although, researchers have been introducing the applied sciences that will ultimately assist him.
Listening to the music of the mind
The modifications in epilepsy prognosis and remedy depend on enhancements in monitoring the mind’s electrical exercise, or electrophysiology.
“If you consider the mind like a musical instrument, the electrophysiology is the music,” says Dr. Alexander Khalessi, a neurosurgeon at UCSD.”For thus lengthy, we have been solely taking a look at an image of the violin. Now we’re in a position to take heed to the music a bit of bit higher.”
Which means medical doctors usually tend to detect a bitter be aware, just like the one produced when mind cells produce the defective indicators that may trigger an epileptic seizure.
One key advance entails a process referred to as stereoelectroencephalography (SEEG). Surgeons drill a number of small holes in a affected person’s cranium and insert electrodes into areas of the mind considered inflicting a affected person’s seizures.
Then they wait till the affected person has a seizure. For Tom, that meant many days within the hospital with wires popping out of a number of holes in his head. However it paid off.
“We have been in a position to see that there was one particular area of his mind that was actually the driving force of most of his seizures,” says Ben-Haim.
Tom additionally benefited from know-how that enables SEEG data to be mixed with high-resolution MRI scans. That exhibits surgeons exactly the place the difficulty spots are.
“As a surgeon, you possibly can’t hit what you possibly can’t see,” Khalessi says.
New types of MRI additionally assist surgeons attain their goal with out damaging different mind areas, Khalessi says.
For example his level, he calls up a picture of a affected person’s mind on his laptop display. It exhibits a diseased space. It additionally exhibits the bundles of essential nerve tracts that lie between the mind’s floor and the issue.
“What you see here’s a case the place we will plan a trajectory to keep away from these tracts and ship laser power to ablate that space,” he says.
In Tom’s case, that laser power was delivered by means of a probe so skinny it may cross by means of a ingesting straw. The probe, guided by an MRI scanner within the working room, heated up the goal space and “really knocked out that very energetic seizure focus,” Shih says.
“It was a single gap, a single sew, and I haven’t got a scar,” Tom says. That was all of the extra spectacular provided that the surgical procedure to diagnose his situation in 2009 left a five-inch, J-shaped scar operating from his proper ear to his brow.
Getting higher on a regular basis
Among the know-how altering epilepsy care is being developed proper on the us campus.
“That is our microfabrication lab,” Shadi Dayeh says as he walks by means of a high-tech facility that may very well be in Silicon Valley. Dayeh, a professor {of electrical} and laptop engineering, is the scientist in cost right here.
Inside a glass-enclosed clear room, figures in white tyvek fits work with machines like those used to make digital shows.
One objective right here is to enhance the units used to check mind exercise. A limiting issue has been the variety of electrodes, or sensors, scientists can squeeze right into a small area. So Dayeh has been borrowing from strategies used to shrink the electronics that produce high-resolution displays.
“Why not take these advances and implement [them] for the advantage of medication?” he says.
Dayeh exhibits me a sensor grid barely bigger than a postage stamp. It is extraordinarily versatile and thinner than a human hair.
An earlier, thicker and fewer versatile model of this kind of grid was positioned on the floor of Tom’s mind again in 2009 to measure {the electrical} exercise beneath. However that one had just a few dozen sensors, limiting its decision. Dayeh’s new grids have hundreds.
“This enables us to take a look at the exercise from the floor of the mind with very excessive decision,” he says. “We name it the mind telescope.”
Dayeh and his crew have additionally been bettering the kind of probe used to check exercise deep in Tom’s mind in 2018.
Greater than 100 closely-spaced sensors alongside the probe choose up {the electrical} exercise of mind cells, and may ship deep mind stimulation.
“The tip is absolutely very skinny so it causes minimal tissue harm,” Dayeh says. “Much less tissue harm means higher recording from the mind – and fewer unwanted side effects.”
Robots and mind defibrillators
Each lasers and diagnostic probes must be positioned exactly within the mind. And that is the place one other technological advance might help: robots.
At UCSD and different cutting-edge epilepsy facilities, surgeons usually use a system known as ROSA, which acts as a kind of GPS for the mind.
“It permits us to basically steer a robotic arm that takes us proper to our goal,” Ben-Haim says.
Typically, medical doctors discover that seizures are coming from a number of mind areas, or from an space that is too necessary to eradicate. That is when medical doctors might attempt a tool that research the indicators coming from electrodes completely implanted in a affected person’s mind.
“It is continually recording within the background,” Ben-Haim says. “After which it is in a position to basically defibrillate the mind when it senses the onset of a seizure.”
All of those advances imply that extra sufferers with drug-resistant epilepsy can now look past medicine to stop their seizures.
“We have transitioned to extra of a surgical-based remedy in addition to minimally invasive surgical strategies that I believe have actually revolutionized the remedy of epilepsy,” Shih says.
Tom is completely happy to be part of that revolution. He nonetheless takes medicine to stay seizure-free. However he is remarried, working half time, and driving a automobile for the primary time in years.
“I’ve a way of independence now that I hadn’t had since 2007,” he says. All due to know-how that did not exist again then.
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