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KATERYNA KON/SCIENCE PHOTO LIBRA/Getty Pictures/Science Picture Libra
When Tom’s epileptic seizures might now 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 is perhaps alarmed by his medical historical past – hoped docs might take away the defective mind tissue that typically precipitated him to convulse and lose consciousness.
He underwent a grueling analysis on the epilepsy middle 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 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 instructed him, you realize what, we’re in a novel state of affairs now the place we’ve a number of the newer applied sciences that weren’t obtainable” in 2009, Shih says.
This time, the staff 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 remedy.
There are a rising variety of sufferers like Tom. Their tales present how new expertise is altering the best way 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 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. In the present day, although, surgical remedy is more and more frequent, and plenty 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 remedy.
His first huge 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 with sweat and my head was contorted.”
Tom awakened within the hospital. However as soon as docs 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 lady he would later marry.
By that point, Tom’s physician had cleared him to cease taking remedy. They each hoped he had outgrown his epilepsy.
Then he had one other huge seizure, and one other journey to the hospital.
“Now, you realize, I am 25 and I am identified with a probably devastating, probably uncontrollable dysfunction,” Tom says.
That meant some every day actions have been now not secure.
“Out of the blue 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 health club.”
Tom tried to adapt. He discovered a job, bought married, and had youngsters. However his epilepsy started taking an enormous toll on his household.
After being instructed he wasn’t a very good candidate for surgical procedure in 2009, Tom had returned to work nonetheless battling 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 adjustments in epilepsy prognosis and remedy 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 therefore lengthy, we have been solely taking a look at an image of the violin. Now we’re in a position to hearken to the music a little bit bit higher.”
Which means 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 includes 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 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. 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 expertise that permits SEEG info to be mixed with high-resolution MRI scans. That exhibits 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.
For example his level, he calls up a picture of a affected person’s mind on his pc display screen. It exhibits a diseased space. It additionally exhibits 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 power to ablate that space,” he says.
In Tom’s case, that laser power was delivered by a probe so skinny it might go by 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
A few of 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 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 aim 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 methods used to shrink the electronics that produce high-resolution screens.
“Why not take these advances and implement [them] for the advantage of 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 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 only some 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 staff 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 decide up {the electrical} exercise of mind cells, and also can 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 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 can assist: robots.
At UCSD and different cutting-edge epilepsy facilities, surgeons typically 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.
Generally, docs discover that seizures are coming from a number of mind areas, or from an space that is too necessary to remove. 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 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 remedy to stop their seizures.
“We have transitioned to extra of a surgical-based remedy in addition to minimally invasive surgical methods that I feel have actually revolutionized the remedy of epilepsy,” Shih says.
Tom is completely satisfied to be part of that revolution. He nonetheless takes remedy to stay seizure-free. However he is remarried, working half time, and driving a automotive 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.
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