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Robots and lasers are helping doctors treat severe epilepsy

AILSA CHANG, HOST:

Technology is changing the way doctors treat severe epilepsy. In San Diego, NPR's Jon Hamilton spent time with a team of researchers who are using high-tech sensors, tiny lasers and even robots to help patients reclaim their lives.

JON HAMILTON, BYLINE: Tom was 16 when he had his first big seizure. His mom heard it happening.

TOM: She went upstairs to my bedroom, and I was just in full convulsions. My bed was completely soaked through with sweat, and then my head was contorted.

HAMILTON: Tom woke up in the hospital. But doctors put him on an epilepsy drug, and the seizures stopped. Tom asked that we not use his full name because employers might reject him if they knew his medical history. Tom went to college, worked in Mexico, came back to California and moved in with his girlfriend. Then he had another big seizure.

TOM: Now, you know, I'm 25, and I'm diagnosed with a potentially devastating, potentially uncontrollable disorder.

HAMILTON: One that meant some daily activities were no longer safe.

TOM: Suddenly, you can't take a bath anymore. You can't go swimming anymore, no more free weights in the gym.

HAMILTON: Even so, Tom found a job, got married and had kids. But his uncontrolled epilepsy was taking a big toll on his family. So Tom asked his neurologist to refer him to the Epilepsy Center at the University of California, San Diego. In 2009, doctors there evaluated him for surgery to remove the brain tissue causing his seizures. He spent a week in the hospital and during his stay, had a convulsion so intense it caused compression fractures in his spine. After all that, the doctors told him...

TOM: You're not an optimal surgery patient. We don't feel safe operating on you, and I'm so sorry.

HAMILTON: Tom returned to work, still struggling with uncontrolled seizures. Within a couple of years, he lost his job, his marriage ended. But he never stopped looking for a way to control his epilepsy. And in 2018, that led him to Dr. Jerry Shih, who directs the Epilepsy Center at UCSD.

JERRY SHIH: When I saw him, I said, you know what? We're in a unique situation now where we have some of the newer technologies that were not available in 2010.

HAMILTON: Including a diagnostic procedure called stereoelectroencephalography or SEEG. Dr. Sharona Ben-Haim of UCSD did the procedure, which involved drilling small holes in Tom's skull and implanting electrodes deep in his brain.

SHARONA BEN-HAIM: We were able to see that there was one specific region of his brain that was really the driver of most of his seizures.

HAMILTON: Shih and Ben-Haim thought surgery could fix the problem. In the past, that would have meant opening up Tom's skull to cut out brain tissue. But Ben-Haim and Shih planned to remove the tissue with heat from a laser probe so thin it could pass through a drinking straw. Shih says the team used a special type of MRI to guide the probe to its target.

SHIH: Using laser ablation, we actually knocked out that very active seizure focus.

HAMILTON: And it worked. Tom is seizure-free as long as he takes his medication. He says the surgery that finally ended his seizures was a lot easier than the operation to diagnose his problem a decade earlier.

TOM: From 2009, I have a 5-inch scar on the side of my head. But this operation in 2019, it was a single stitch - a single hole, a single stitch. And I don't have a scar.

HAMILTON: The technologies that helped Tom have the potential to help a lot of other people. About 3 million adults in the U.S. have epilepsy. More than a quarter of them are unable to control their seizures with drugs. And Ben-Haim says many of these people still don't know about new options like SEEG or laser surgery.

BEN-HAIM: We help the vast majority of patients we treat, quite significantly, with a combination of these technologies.

HAMILTON: It all starts with better ways of monitoring the brain's electrical activity. Dr. Alexander Khalessi, a neurosurgeon at UCSD, says technological advances are transforming the field known as electrophysiology.

ALEXANDER KHALESSI: If you think about the brain like a musical instrument, the electrophysiology of the brain is the music. And so for so long, we were only looking at a picture of the violin. But for the first time, we're now able to actually listen to the music a little bit better.

HAMILTON: And identify the source of a sour note. Khalessi says that by combining the information from MRI scans and high-resolution electrophysiology, he now has a much clearer picture of what he needs to do.

KHALESSI: As a surgeon, just simply put, you can't hit what you can't see.

HAMILTON: Khalessi calls up an image of a patient's brain on his computer screen. It shows a diseased area. It also shows the bundles of critical nerve fibers that lie between the brain's surface and the problem.

KHALESSI: What you see here is a case where we can plan a trajectory to avoid those tracts and deliver laser energy to actually ablate that area.

HAMILTON: Some of the tools changing epilepsy care are being developed right on the UCSD campus. Shadi Dayeh, a professor of electrical and computer engineering, is the scientist in charge.

SHADI DAYEH: So this is our microfabrication lab. It's called Nano3 because it serves science, engineering and medicine.

HAMILTON: Dayeh says one goal here is to improve the resolution of brain sensors using technology developed for electronic displays.

DAYEH: So why not take these advances, what we've learned in the journey of the display technology, and implement it for the benefit of medicine?

HAMILTON: Dayeh hands me a sensor array slightly larger than a postage stamp.

DAYEH: You know, you can feel free to touch this if you'd like.

HAMILTON: Early versions of arrays like this had only a few dozen sensors. This one has more than a thousand.

DAYEH: This allows us to look at the activity from the surface of the brain with very high resolution. We call it the brain telescope.

HAMILTON: Then he hands me something that looks and feels like a floppy spaghetti noodle. It's a depth electrode, designed to be implanted deep in the brain where many seizures start. More than 100 closely spaced sensors along the device pick up the electrical activity of brain cells. They can also deliver deep brain stimulation.

DAYEH: The tip, as you can see, is really very thin. So it causes minimal tissue damage. Less tissue damage means better recording from the brain and less side effects.

HAMILTON: Both lasers and probes need to be positioned precisely in the brain. And Ben-Haim says that's where another technological advance can help - robots. At UCSD and other cutting-edge epilepsy centers, surgeons often use a system called ROSA, which acts as a sort of GPS for the brain.

BEN-HAIM: And it then allows us to essentially steer a surgical arm that takes us right to our target.

HAMILTON: Sometimes doctors find that seizures are coming from several brain areas or from an area that's too important to eliminate. That's when another new technology can help. Ben-Haim says it's a smart device that records the signals from electrodes permanently implanted in a patient's brain.

BEN-HAIM: It's constantly recording, in the background, seizure activity from where we place those electrodes. And then it's able to essentially defibrillate the brain when it senses the onset of a seizure.

HAMILTON: She says all of these advances mean that many more patients can now look beyond medication to prevent their seizures.

SHIH: We've transitioned to more of a surgical-base treatment, as well as minimally invasive surgical techniques that I think has really revolutionized the treatment of epilepsy.

HAMILTON: Tom is happy to be a part of that revolution. He's 48 now and still takes medication to prevent seizures. But he's remarried, working part-time and driving a car for the first time in years.

TOM: I do have a sense of independence now that I hadn't had since 2007.

HAMILTON: Thanks to technology that didn't exist back then.

Jon Hamilton, NPR News. Transcript provided by NPR, Copyright NPR.

Jon Hamilton is a correspondent for NPR's Science Desk. Currently he focuses on neuroscience and health risks.