Lasers, robots and tiny electrodes are remodeling epilepsy remedy : Photographs

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 docs “take heed to the music somewhat bit higher.”

KATERYNA KON/SCIENCE PHOTO LIBRA/Getty Photographs/Science Picture Libra

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KATERYNA KON/SCIENCE PHOTO LIBRA/Getty Photographs/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 docs “take heed to the music somewhat bit higher.”

KATERYNA KON/SCIENCE PHOTO LIBRA/Getty Photographs/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 title as a result of he worries that employers may be alarmed by his medical historical past – hoped docs may take away the defective mind tissue that generally prompted him to convulse and lose consciousness.

He underwent a grueling analysis on the epilepsy middle on the College of California, San Diego. Docs eliminated a chunk of his cranium and positioned electrodes on the floor of his mind. He spent every week within the hospital whereas docs watched him having seizures.

Then, he bought unhealthy information.

“You are not an optimum surgical procedure affected person,” he recalled the docs 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 docs at UCSD to debate remedy choices. This time he met with Dr. Jerry Shih, the middle’s director.

“I advised him, you recognize what, we’re in a novel state of affairs now the place we now have among the newer applied sciences that weren’t accessible” in 2009, Shih says.

This time, the workforce inserted tiny electrodes into Tom’s mind to search 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 treatment.

There are a rising variety of sufferers like Tom. Their tales present how new know-how is altering the way in which docs assess and deal with drug-resistant epilepsy, which impacts greater than 1 / 4 of the roughly 3 million individuals within the U.S. with the dysfunction.

Technological advances embody not solely tiny electrodes and lasers, however MRI machines that present high-resolution photos throughout surgical procedure, and implanted gadgets 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 this time, 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 treatment.

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 fully soaked by way of with sweat and my head was contorted.”

Tom wakened within the hospital. However as soon as docs put him on an epilepsy drug, his seizures stopped.

He went to school, labored as an English trainer in Mexico, got here again to California, and moved in with the lady he would later marry.

By that point, Tom’s physician had cleared him to cease taking treatment. 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 probably devastating, probably uncontrollable dysfunction,” Tom says.

That meant some each day actions had been not secure.

“All of the sudden you may’t take a shower anymore,” he says. “You possibly can’t go swimming anymore. No extra free weights within the gymnasium.”

Tom tried to adapt. He discovered a job, bought married, and had youngsters. However his epilepsy started taking a giant toll on his household.

After being advised he wasn’t an excellent candidate for surgical procedure in 2009, Tom had returned to work nonetheless scuffling with uncontrolled seizures. Inside a few years, although, he misplaced his job. His marriage ended.

Throughout this tough interval in Tom’s life, although, researchers had been introducing the applied sciences that might finally 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 had been solely taking a look at an image of the violin. Now we’re in a position to take heed to the music somewhat bit higher.”

Meaning docs usually tend to detect a bitter word, just like the one produced when mind cells produce the defective alerts that may trigger an epileptic seizure.

One key advance entails a process generally known as stereoelectroencephalography (SEEG). Surgeons drill a number of small holes in a affected person’s cranium and insert electrodes into areas of the mind regarded as 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. Nevertheless it paid off.

“We had been in a position to see that there was one particular area of his mind that was actually the motive force of most of his seizures,” says Ben-Haim.

Tom additionally benefited from know-how that permits SEEG data to be mixed with high-resolution MRI scans. That exhibits surgeons exactly the place the difficulty spots are.

“As a surgeon, you may’t hit what you may’t see,” Khalessi says.

New types of MRI additionally assist surgeons attain their goal with out damaging different mind areas, Khalessi says.

For instance his level, he calls up a picture of a affected person’s mind on his pc 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 way of a probe so skinny it may cross by way of a ingesting straw. The probe, guided by an MRI scanner within the working room, heated up the goal space and “truly 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 on condition that the surgical procedure to diagnose his situation in 2009 left a five-inch, J-shaped scar working 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 united states campus.

“That is our microfabrication lab,” Shadi Dayeh says as he walks by way of a high-tech facility that might be in Silicon Valley. Dayeh, a professor {of electrical} and pc 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 purpose right here is to enhance the gadgets 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 methods used to shrink the electronics that produce high-resolution displays.

“Why not take these advances and implement [them] for the good thing about drugs?” 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 type 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 1000’s.

“This permits us to have 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 workforce have additionally been enhancing the type 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 also can ship deep mind stimulation.

“The tip is admittedly very skinny so it causes minimal tissue injury,” Dayeh says. “Much less tissue injury means higher recording from the mind – and fewer unintended 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 may help: robots.

At UCSD and different cutting-edge epilepsy facilities, surgeons typically use a system referred to as ROSA, which acts as a type 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, docs discover that seizures are coming from a number of mind areas, or from an space that is too necessary to eradicate. That is when docs could strive a tool that research the alerts coming from electrodes completely implanted in a affected person’s mind.

“It is always 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 treatment to forestall their seizures.

“We have transitioned to extra of a surgical-based remedy in addition to minimally invasive surgical methods that I believe have actually revolutionized the remedy of epilepsy,” Shih says.

Tom is blissful to be part of that revolution. He nonetheless takes treatment 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 because of know-how that did not exist again then.

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