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Thomas Henry, who directs the Medical School's Epilepsy Care and Research Program, uses neuroimaging to help find better treatment options for people with epilepsy.
Calming the storm
U launches new era in epilepsy care
By Mary Hoff
From eNews, March 6, 2008
To the ancients, it was a sign of connection with the spirit world. To Napoleon, Handel, Kierkegaard, Socrates, and Dostoevsky, it was an unwelcome intruder, bursting unannounced into their brains at unexpected and unexplained times. To 50 million people today, epilepsy is a disruptive disease that injects their lives with uncertainty and stigma. To three new faculty members at the University of Minnesota, epilepsy is a problem they aim to solve. Bolstering the U's growing emphasis on the brain, Aviva Abosch, Thomas Henry, and Steven Rothman are exploring a variety of innovative approaches to treating and curing the disorder. If imaging shows that an epileptic seizure arises in a certain area of the brain--the hippocampal region of the temporal lobe--Abosch, assistant professor and director of epilepsy and functional neurosurgery in the Department of Neurosurgery, may be able to calm the storm within by removing the offending portion.
Norys Andrea was what Abosch calls a "pretty characteristic" candidate for such surgery. A native of Venezuela, Andrea has been experiencing epileptic seizures since she was four years old. As a young adult, she began an exciting career as a pharmaceutical sales representative. She loved the part she played in helping people get the medical care they needed. But her condition worsened with the job stress. Uncontrolled seizures meant no driving, and no driving meant no sales, and she was forced to give up her job. "We tried all the treatments on the market," she says, "and they didn't work." When Andrea moved to Minnesota three years ago, she was experiencing one or two seizures a month and her medications provided no relief. Fortunately, her physician back home had referred her to Miguel Fiol, associate professor of neurology at the University of Minnesota. Fiol told Andrea that her seizures originated in a part of her brain that might make her a good candidate for surgery. He referred her to Abosch, who sent her through a battery of tests that confirmed Fiol's suspicions and indicated that the proposed surgery would not impair Andrea's quality of life. Andrea didn't hesitate. On June 12, 2007, in a six-hour operation, Abosch opened up the right side of Andrea's skull, then used suction to remove a portion of her brain the size and shape of a person's thumb. After four days in the hospital, Andrea was home again. She hasn't had a seizure since. "It was incredible," Andrea says. "It let me start my life again." Within three weeks, she was starting class at the University. In the fall, she began work as a teacher's aide at a local elementary school. On November 16--her 34th birthday--Fiol gave her the okay to apply for a driver's license. "It was the best birthday gift!" she says.
Deep in the brainAndrea was one of the lucky ones. Her seizures started in a part of her brain she could function without, and the imaging results were unambiguous. In some individuals, the seizures originate in a part of the brain that's too close to brain tissue that controls critical functions, such as speech or movement. In others, the site of seizure onset cannot be clearly determined, also making them unsuitable for surgery. "What do you do with those people?" Abosch asks. "As a surgeon, I want to fix the problem."
Neurosurgeon Aviva Abosch is exploring the use of deep-brain stimulation to treat epilepsy.
One approach Abosch and Henry, director of the Medical School's Epilepsy Care and Research Program and a professor of neurology, are exploring together is using high-resolution structural and functional imaging to identify locations in the brain--other than that in which the seizure originates--where surgery might make a difference. "Mapping out areas of brain function is an important new research area," Henry says. Such mapping, he hopes, will eventually allow doctors to perform surgery that stops seizures originating outside the temporal lobe--without disrupting critical brain function. Mapping also plays a key role in another novel therapy Abosch and Henry are investigating: deep-brain stimulation, or DBS. This approach involves implanting an electrode in the brain, then delivering electrical current via a pacemaker-like device before or at the onset of a seizure. Abosch already uses DBS to calm tremors in patients with Parkinson's disease. Given a better understanding of the right place in the brain and the right timing and dose of electricity, she thinks it could make a difference for epilepsy patients, too.
Other innovative approachesRothman, who joined the University as director of the Division of Pediatric Clinical Neuroscience last July, is exploring new techniques for patients whose epilepsy is not amenable to drugs or conventional surgery, and he has found a surprising ally in the electronics industry.
One innovation attracting Rothman's attention is a refrigerator the size of a watermelon seed that has been developed to help cool the central processing units of computers and other electronic components. Animal studies have repeatedly shown that rapid, localized cooling of the right spot in the brain can stop a seizure in its tracks. Why not, Rothman wonders, implant into the brains of people with epilepsy a miniature cooling device that can deliver a quick chill at the right place and time to do just that? "This technology is very effective in our animal models," he says. But there are plenty of details to refine: removing waste heat generated by the cooling process, cutting the amount of power needed, and figuring out how to anticipate or sense early seizure. In collaboration with Tay Netoff, assistant professor in the Department of Biomedical Engineering, Rothman hopes to begin testing inside-the-brain cooling devices within a couple of years. Rothman is also looking into using light to help prevent or interrupt seizures. The idea, he says, is to insert a light-activated therapeutic drug, along with a light-emitting diode, into the part of the brain where the seizure is centered. The light could be turned on at the seizure onset, activating the drug and terminating the seizure. As Rothman's research progresses, both Henry and Abosch will be welcome partners. Implanting new devices depends on precisely pinpointing seizure centers and key functional parts of the brain--an endeavor in which Henry will prove an invaluable collaborator. If the devices Rothman is developing advance to the point of clinical trials, Abosch would be the one to place them.