Donna Barajas http://www.cbs.com/primetime/60_minutes/video/?pid=GQIzNJWFeZA3_UdBSl8JcB58XdIud78c
This episode has some interesting info on a new procedure for people with siezures. My son has had seizures for over 20 yrs and part of his frontal lobe removed. He went 6 wonderful yrs without any siezures, until a year ago. They are back... This gives me hope again!
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In the Grip of the Unknown
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The principles of epilepsy surgery have been known since the first operations took place more than a century ago: identify the area where the seizure begins and cut it out, as precisely as you can. Obviously this excludes most patients with generalized epilepsy, since you can't take out an entire brain (although in rare cases, you can remove half a brain; the patients sometimes compensate surprisingly well). Werner Doyle is one of two neurosurgeons at the NYU center; he does around 260 procedures a year, there and at St. Barnabas. In contrast to Devinsky's holistic approach to patient quality of life, Doyle's discipline requires an obsessive focus on brain stuff, on the paper-thin margin between diseased and healthy tissue. Sometimes, he says, he can feel the difference with his dissecting instruments, which cut easily through normal gray matter but meet resistance where the tissue is scarred from repeated seizure.
Like many surgeons, he is matter-of-fact about the manual dexterity he deploys inside the skull. The intellectual challenge for him is to find the focus of the seizure and trace the networks along which it spreads, while also mapping the boundaries of the unaffected areas. The basic tool for that is the EEG, but the standard device, with around 20 external leads, is a clumsy instrument for mapping a three-dimensional brain. That has led to the adoption of intracranial electrodes, which are inserted into the brain and can sample as many as 200 points. Inserting these requires opening the skull and takes as much of Doyle's skill and time—six or seven hours—as the subsequent operation itself. Patients may stay in the hospital for a week or more, trailing a Medusa-head of wires, under continuous monitoring both by EEG and video, while the doctors wait for the iconic seizure. Then Doyle goes to work.
In contrast to many types of neurosurgery—for tumors, notably—epilepsy surgery is generally performed on healthy people, and the risks are not that high. But Doyle believes, and hopes, that the future of his field lies not in the relatively blunt procedure of ablation, or cutting tissue, but in augmenting brain function through electronic devices. The first of these, the vagal nerve stimulator, has been in use since 1997, and more than 50,000 have been implanted. Its purpose is to disrupt an incipient seizure by sending an electrical signal to the brain through the vagus nerve in the neck. Again, no one knows exactly why it works, but it often does. Deep-brain stimulation, which has been successful in treating Parkinson's disease, is meant to do the same thing, by delivering a pulse directly to the brain itself, but clinical trials for its use in epilepsy so far have been disappointing. The VNS, though, is a primitive tool, which delivers a small current for a fixed duration at regular intervals of several minutes. Researchers now are working to develop a responsive device that could be implanted in the brain and "sense when a seizure is beginning, to release a small amount of medication or electrical stimulation where needed," says Harvard neurologist Steven Schachter, president of the American Epilepsy Society.
The key to such a device will be the computer algorithms that can predict a seizure, ideally in the "aura" stage that sets in before it even begins. We are accustomed to the idea that computers can process limitless amounts of data, but the brain, with its 100 billion neurons, each linked to as many as 10,000 others, is pushing the limits of information theory. The effort represents an audacious assault on a devastating disease, just what Devinsky was dreaming of in medical school. To conquer epilepsy we will have to outwit our own brains.
With Sarah Kliff
© 2009
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