Credit score: Duke College
Epilepsy is without doubt one of the commonest neurological ailments on this planet, afflicting greater than 50 million folks. Whereas most varieties might be handled with therapeutics, sufferers with drug-resistant epilepsy typically require surgical procedure to deal with their seizures.
In these cases, neurosurgeons usually lower out the portion of the mind liable for triggering seizures. However even these invasive strategies are solely efficient about 60% of the time.
A brand new instrument developed by neural engineers at Duke College might assist enhance these surgical outcomes by enabling neurosurgeons to extra precisely pinpoint the areas within the mind the place the seizures originate.
The analysis is printed within the journal Mind.
To determine the mind area liable for inflicting a affected person’s epilepsy, physicians first use an EEG to document mind exercise throughout a seizure by attaching electrodes across the affected person’s scalp. If this doesn’t present sufficient data, they use a stereo-EEG, which requires the insertion of electrodes into suspected mind areas through small holes drilled into the cranium. Whereas extra invasive, the stereo-EEG offers the next decision recording of mind exercise throughout a seizure than does EEG.
“If [we see] the brain [as a map of] Europe, the stereo-EEG can tell us if the seizure is happening in Brussels or Berlin. If the signal is coming from Brussels, then the surgeon removes Brussels,” stated Warren Grill, the Edmund T. Pratt, Jr. Faculty Distinguished Professor of Biomedical Engineering.
However these stereo-EEG recordings do not present the total path of the seizure because it spreads via the mind; they solely present the realm with the very best exercise. Whereas the realm with the biggest indicators could also be indicative of the seizure-causing area, it will also be the results of indicators combining because the seizure propagates via neural pathways and never indicative of the area that must be eliminated.
“Say the electrode that gives you the biggest signals happens to be in Brussels, but the activity actually started in Bruges,” stated Grill. “So, when you remove Brussels, the patient doesn’t get better because you didn’t cut out the region causing the problem.”
To resolve this, Brandon Thio, a current Ph.D. graduate from the Grill lab and first writer of the paper, developed TEDIE. Brief for Temporally Dependent Iterative Growth, the algorithm collects indicators from each implanted electrode and reconstructs how neural exercise travels and adjustments throughout a seizure.
“All you need is imaging data from the patient’s brain and recordings from the stereo-EEG to allow the algorithm to create a movie showing where the seizure originated and how it moved through their brain,” stated Thio. “We don’t just tell you where it starts—we also tell you how big it is. If you’re going to go through invasive brain surgery to cut out part of your brain, you want to make sure you get it all out on the first try.”
As soon as developed, the group examined TEDIE on simulated seizures with identified sizes and places and demonstrated efficiency that considerably outpaced different present algorithms. Then they utilized TEDIE to affected person knowledge by analyzing the stereo-EEG recordings from 46 epilepsy sufferers from Duke College Medical Heart and the College of Pennsylvania.
This evaluation confirmed that TEDIE’s reconstructions precisely recognized areas that had been eliminated in sufferers who confirmed no epilepsy signs after surgical procedure.
The algorithm additionally enabled identification of the places of seizure origin that had been totally different than the areas that had been eliminated in sufferers who continued to indicate signs after surgical procedure. Grill, Thio and their collaborators used TEDIE to determine potential new surgical targets in 12 out of 23 sufferers with epilepsy signs that continued after surgical procedure.
Buoyed by this success, the group hopes to increase their work by introducing TEDIE into medical research. Additionally they need to adapt the algorithm for use for standard EEG and thereby cut back the necessity for the invasive stereo-EEG and supply a extra accessible instrument for non-expert epilepsy facilities. And, the group provides, TEDIE is greater than able to mapping mind exercise to assist primary neuroscience research.
“Epilepsy is a very complex disorder. In some individuals, physicians will remove parts of the brain and the patient will get better, but then a year later seizures will return,” stated Thio. “TEDIE likely won’t bring the efficacy up to 100%, but we hope that it improves on the current 60% clinical success rate.”
Extra data:
Brandon Thio et al, Stereo-EEG propagating supply reconstruction identifies new surgical targets for epilepsy sufferers, Mind (2024). DOI: 10.1093/mind/awae297
Journal data:
Mind
Supplied by
Duke College
Quotation:
Algorithm higher identifies the origin of a seizure to information extra exact surgical interventions (2024, December 5)
retrieved 5 December 2024
from https://medicalxpress.com/information/2024-12-algorithm-seizure-precise-surgical-interventions.html
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