Epilepsy procedure may treat mental health disease

13 December 2016

A new surgical procedure that’s helping cure epilepsy is also helping researchers find signals and networks in the brain that could treat other diseases. The ground-breaking procedure being used at Brisbane’s Mater Hospital has stopped or significantly reduced epileptic seizures in patients, since doctors began using it early this year. It involves the use of what’s called “stereo EEG”, in which electrodes are placed deep into the brain with the help of a robot to pinpoint the source of, and correct, the signals that cause seizures. “It really is incredible. You're taking patients who have been told that there is nothing that we can do for them and your transforming their lives,” said Dr Sasha Dionisio, the head of the advanced epilepsy unit at Mater Centre for Neurosciences. “We have patients who in the past were told, ‘Look, there’s nothing we can do,” and now we've actually done epilepsy surgery for them and they are completely seizure free. So, it's a very humbling that we are able to do that. Where extremely fortunate, and we know we are.” One of the spin offs of the deep brain technology and techniques developed to treat epilepsy is that it also can be used to probe the possible sources of other diseases, such as schizophrenia. “What we’re actually seeing is neuronal networks,” said Dr Dionisio. “We’re seeing those within the live human being and so we can actually track how messages are moving. We can also understand how certain areas are connected to other areas and how well that may or may not be working. So, for example, one of the ideas that is now coming out with schizophrenia research is that there is this problem of communication between the insula and anterior cingulate cortices.” These are areas of the brain that are critical for things such as cognitive control, pain, emotion, consciousness, working memory, and decision making. The problem has been that they’re so deep within the brain that they are difficult for an fMRI (a machine that measures brain activity) to see. “Being able to insert electrodes into those regions means being able to better track and map those networks,” and therefore test theories involved with processes involving other brain disorders such as schizophrenia. The Mater Centre for Neurosciences is a member of the Brisbane Diamantina Health Partners, a collaboration of hospitals and research institutes that’s exploring better treatments in mental health, including epilepsy. Epilepsy affects one percent of the population which, in Queensland alone, represents about 45,000 people. “Now most of them will be well controlled on medication, but one third of them (10 to 15 thousand people) will be refractory, which means two or more anti-drugs haven't worked,” said Dr Dionisio. “In these cases, epilepsy surgery provides the best solution to help them with their seizures.” The new technique being used at Brisbane’s Mater Hospital, of placing electrodes deep into the brain with the help of a robot, is already having astonishing results. “We have one patient in which we were actually able to switch off his seizures. He had 300 seizures a month and we were able to terminate a seizure as it was happening. When that happened, it was almost a Eureka moment. We could see that if we can control his seizures by stimulation then if we were to insert a stimulator, could we stop the seizures. We did that, and this patient has now gone from 300 seizures a month into 10 seizures a month, and he's expected expecting a baby in the next two months. That’s a huge thing.” Being able to place electrodes deep within the human brain is also giving the team the unique ability to record signals that would otherwise not be visible to scientists. “In neuroscience, there’s been a shift in understanding of the brain,” said Dr Dionisio. “The old idea was that one part of the brain does this, and another does that. We don't believe that any more. With research such as the monitoring in epilepsy, we’re now beginning to understand that it's one part of the brain in connection with these other parts of the brain that produces a function. And different signals, different frequencies, different amplitudes, all interact to do a job.” It’s opening up new areas for research to find cures for mental illnesses, such as epilepsy and schizophrenia, that were once thought incurable. “It really goes beyond just epilepsy,” said Dr Dionisio. “If you look at these signals, they are relevant to some movement disorders such as Parkinson’s Disease. And we have a lot of research that can be done, and that we are doing, on memory which has massive connotations for dementia. “We’ve been doing research to help patients with epilepsy, but a byproduct of that is an understanding of things that have never really been understood well. So it's absolutely massive. It shows how important is is to have this research behind the clinical work. “You know, you hear the stories of those old sailors who heard that the world was flat, but they went out in a boat to the edge of the world and kept going. That's exactly how I feel with this. It's like we're going out on this adventure and were not looking back, and the more we go forward the more we begin to realise how incredibly vast and unknown and mysterious, but how exciting, the brain is.”

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