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 a bit of bit higher.”
Kateryna Kon/Science Photograph Library/Getty Photographs
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Kateryna Kon/Science Photograph Library/Getty 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 a bit of bit higher.”
Kateryna Kon/Science Photograph Library/Getty Photographs
When Tom’s epileptic seizures might 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 could be alarmed by his medical historical past – hoped docs might take away the defective mind tissue that generally prompted him to convulse and lose consciousness.
He underwent a grueling analysis on the epilepsy center 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 per week within the hospital whereas docs watched him having seizures.
Then, he bought dangerous 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 therapy choices. This time he met with Dr. Jerry Shih, the middle’s director.
“I instructed him, you realize what, we’re in a singular state of affairs now the place we’ve a number of the newer applied sciences that weren’t accessible” 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 expertise 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 folks within the U.S. with the dysfunction.
Technological advances embrace not solely tiny electrodes and lasers, however MRI machines that present high-resolution photographs 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 mix 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-about a final resort for treating epilepsy. At the moment, although, surgical therapy is more and more frequent, and lots of sufferers want solely minimally invasive procedures.
When epilepsy medicine aren’t sufficient
Like many individuals with epilepsy, Tom was initially capable of management his dysfunction with medicine.
His first large 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 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 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 large seizure, and one other journey to the hospital.
“Now, you realize, I am 25 and I am recognized with a doubtlessly devastating, doubtlessly uncontrollable dysfunction,” Tom says.
That meant some every day actions had been not secure.
“All of the sudden you’ll be able to’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 children. However his epilepsy started taking a giant toll on his household.
After being instructed he wasn’t an excellent candidate for surgical procedure in 2009, Tom had returned to work nonetheless combating 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 will finally assist him.
Listening to the music of the mind
The adjustments in epilepsy prognosis and therapy depend on enhancements in monitoring the mind’s electrical exercise, or electrophysiology.
“If you concentrate on 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 an image of the violin. Now we’re capable of take heed to the music a bit of bit higher.”
Meaning docs usually tend to detect a bitter observe, just like the one produced when mind cells produce the defective alerts 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 had been capable of 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 expertise that permits SEEG info to be mixed with high-resolution MRI scans. That reveals surgeons exactly the place the difficulty spots are.
“As a surgeon, you’ll be able to’t hit what you’ll be able to’t see,” Khalessi says.
New types of MRI additionally assist surgeons attain their goal with out damaging different mind areas, Khalessi says.
As an example his level, he calls up a picture of a affected person’s mind on his pc display screen. It reveals a diseased space. It additionally reveals the bundles of important nerve tracts that lie between the mind’s floor and the issue.
“What you see here’s a case the place we are able to plan a trajectory to keep away from these tracts and ship laser vitality to ablate that space,” he says.
In Tom’s case, that laser vitality was delivered by way of a probe so skinny it might cross by way 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 lively 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 operating from his proper ear to his brow.
Getting higher on a regular basis
Among the expertise 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 could possibly 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 aim right here is to enhance the units used to review 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 screens.
“Why not take these advances and implement [them] for the good thing about drugs?” he says.
Dayeh reveals 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 1000’s.
“This permits 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 enhancing the kind of probe used to review 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 injury,” Dayeh says. “Much less tissue injury means higher recording from the mind – and fewer negative 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 will 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 primarily steer a robotic arm that takes us proper to our goal,” Ben-Haim says.
Generally, docs discover that seizures are coming from a number of mind areas, or from an space that is too vital to get rid of. That is when docs could attempt a tool that research the alerts coming from electrodes completely implanted in a affected person’s mind.
“It is continuously recording within the background,” Ben-Haim says. “After which it is capable of primarily 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 therapy in addition to minimally invasive surgical strategies that I feel have actually revolutionized the therapy of epilepsy,” Shih says.
Tom is completely satisfied 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 expertise that did not exist again then.
