If the brain is a musical instrument, “electrophysiology is music,” says Dr. Alexander Khalessi. New tools are now treating patients with epilepsy, doctors “hear a little better music”.
KATERYNA KON/SCIENCE PHOTO BOOK/Getty Images/Science Photo Book
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KATERYNA KON/SCIENCE PHOTO BOOK/Getty Images/Science Photo Book
If the brain is a musical instrument, “electrophysiology is music,” says Dr. Alexander Khalessi. New tools are now treating patients with epilepsy, doctors “hear a little better music”.
KATERYNA KON/SCIENCE PHOTO BOOK/Getty Images/Science Photo Book
When Tom’s epileptic seizures could not be controlled with medication, he began to consider surgery.
Tom – who asked that his name not be used because he worries teachers might be intimidated by his medical history – hoped doctors would be able to remove the faulty brain tissue that sometimes caused him to convulse and lose consciousness.
He underwent a serious evaluation in the middle of the electoral illness at the University of California, San Diego. Doctors removed a piece of the skull and placed electrodes on the surface of the brain. He spent a week in the hospital while doctors observed him for the robbery.
then he received bad news.
“You are not an optimal patient for surgery,” he recalled telling the doctors. “We don’t feel safe working with you.”
That was in 2009. In 2018, with epilepsy taking a heavy toll on his work and family life, Tom returned to his doctors at UCSD to discuss treatment options. At this time he met with Dr. Jerry Shih, director of the center.
“I told him, you know what, we’re in a unique situation now where we have some newer technologies that weren’t available in 2009,” Shih says.
This time, the team implanted tiny electrodes into Tom’s brain to find the original source of his seizures. Then, in 2019, they used a laser to remove that part of his brain.
Tom, 48, is now seizure free while taking medication.
There are a growing number of Tom’s patients. Their stories show how new technology is changing the way doctors evaluate and treat drug-resistant epilepsy, which affects more than a quarter of the roughly 3 million people in the US with the disorder.
Technological advances include not only small electrodes and lasers, but MRI machines that provide high-resolution images during surgery, and implantable devices that can take over in their tracks.
“We help most patients with the combination of these technologies and treat them quite significantly,” says Dr. Sharona Ben-Haim, a neurosurgeon at UCSD, who in Tom.
All of these approaches involve surgery, which was once considered the last resort for treating epilepsy. Today, though, surgical treatment is more and more common, and many patients only need minimally invasive methods.
With the electoral disease, medicine is not enough
Like many people with epilepsy, Tom was initially able to control his disease with medication.
His first big occupation came when he was 16. His mom heard him making strange sounds.
“He went upstairs to my bedroom and I was just in full swing,” said Tom. “My bed was all wet with sweat, and my head was twisted.”
Tom woke up in the hospital. But the doctors immediately put him on an anti-epileptic drug, and his seizures stopped.
He went to college, worked as an English teacher in Mexico, returned to California, and later married a woman.
During that time, Tom’s doctor cleared him to stop taking the medicine. Both of them hoped that they had overcome the electoral diseases.
Then he had another major seizure and another trip to the hospital.
“Now, you know, I’m 25 and I’ve been diagnosed with a potentially devastating, power-incontinent disorder,” says Tom.
This meant that some everyday activities were no longer safe.
“All of a sudden you can’t take a bath anymore,” he said. “You can’t swim anymore. No more free weights in the gym.”
Tom tried to accommodate. He found a job, got married, and had kids. But his epilepsy began to take a heavy toll on his family.
After being told he was not a good candidate for surgery in 2009, Tom had returned to work still struggling with intractable seizures. Within two years, though, he lost his job. his marriage ended.
During this difficult time in Tom’s life, however, researchers introduced technologies that eventually helped him.
Hear the music of the brain
Improvements in the diagnosis and treatment of epilepsy are based on the monitoring of the brain’s electrical activity, or electrophysiology.
“If you think of the brain as a musical instrument, electrophysiology is music,” says Dr. Alexander Khalessi, a neurosurgeon at UCSD. “However, we were only looking at the image of the violin. Now we are able to hear the music a little better.”
What doctors are more likely to detect is the grape brand, as it is produced when brain cells produce faulty signals that can cause an epileptic seizure.
One key advance involves a procedure known as stereoelectroencephalography (SEEG). Surgeons either drill small holes in the patient’s skull and insert electrodes into areas of the brain that are supposed to cause seizures in the patient.
Then they wait while the patient is occupied. For Tom, this meant many days in the hospital with wires coming out of several holes in his head. But the price is off.
“We could see that there was one specific region of the brain that was the driver of their biggest prey,” says Ben-Haim.
Tom also benefited from technology that allows SEEG information to be combined with high resolution MRI scans. That shows surgeons where the bottlenecks are.
“A surgeon, what you can’t see, you can’t hit,” said Khalessi.
New forms of MRI also help surgeons reach their target without damaging other areas of the brain, Khalessi says.
To illustrate a point, he brings up an image of the patient’s brain on his computer screen. The area shows the disease. It also shows the critical nerve tracts that are between the surface of the brain and the problem.
“What you see here is a case where we can establish a trajectory to avoid those treatments and deliver laser energy to wash away that area,” he said.
In Tom’s case, laser energy was delivered through a probe so thin that it could pass through a drinking straw. With the probe, guided by an MRI scanner in the operating room, the target area is illuminated and “the focus of the seizure is very active,” says Shih.
“There was one hole, one hole, and I don’t have a scar,” says Tom. That’s all the more impressive given that he left a five-fingered, J-shaped scar running from his right ear to his forehead in 2009.
Getting better all the time
Some of the technology changes are raising electoral concerns on the UCSD campus.
“This is our microfabrication lab,” says Shadi Dayeh, walking through a high-tech facility that could be in Silicon Valley. Dayeh, a professor of electrical and computer engineering, is the scientist in charge here.
Inside a glass-enclosed room, figures dressed in white tyvek work with devices like those used to make electronic displays.
One of the goals here is to improve devices for studying brain activity. The limit factor is the number of electrodes, or sensors, that scientists can squeeze into a small space. So Dayeh borrowed from the techies to refuse electronics that make high-resolution monitors.
“Why not take these developments and implement them” [them] for the benefit of medicine? says.
Dayeh showed me that the sensor needs to be a little bigger than Sumit. It is very flexible and thinner than human hair.
Previously, a denser and less flexible version of this type of grid was placed on the surface of Tom’s brain in 2009 to measure lower electrical activity. But he had a few dozen sensors, finishing his sentence. Dayeh has a thousand new grills.
“This allows us to see the activity of the brain at a very high level,” he said. “We call it the brain telescope.”
Dayeh and his team also improved the type of probe used deep inside Tom’s brain in 2018 activity studies.
More than 100 closely spaced sensors across the probe collect the electrical activity of brain cells, and can also deliver deep brain stimulation.
“The tip is really thin so it causes minimal tissue damage,” Dayeh says. “Less tissue damage means better memory from the brain – and fewer side effects.”
Robots and brain defibrillators
Both lasers and diagnostic probes must be precisely positioned in the brain. That’s where another technological advancement can help: robots.
At UCSD and other epilepsy surgery centers, surgeons often use a system called ROSA, which acts like a GPS for the brain.
“It allows us to essentially point the arm of the robot, which takes it right to our target,” Ben-Haim says.
Sometimes, doctors find that seizures arise from multiple areas of the brain, or from an area that is too large to remove. That’s when doctors can test a device that receives permanent signals from electrodes implanted in the patient’s brain.
“In the background” is constantly remembered, “Ben-Haim” says. “And then it’s actually possible to defibrillate the brain when it feels a seizure attack.”
All of these developments mean that more patients with drug-resistant epilepsy are now looking beyond medication to prevent seizures.
“We’ve made the transition to more surgical-based treatment and minimally invasive surgical techniques that I think have really revolutionized the treatment of epilepsy,” Shih says.
Tom would like to be part of that revolution. It also takes the company as a free capture. But here he is married, working part-time, and driving a car for the first time in years.
“I have a sense of freedom now that I haven’t had since 2007,” he says. All thanks to technology that didn’t exist then.
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