A Pioneer Does It Again
An OHSU neurosurgeon who blazed the trail for deep brain stimulation 30 years ago helped clear the path for another novel treatment option this year. Kim J. Burchiel, M.D., F.A.C.S., performed a new regenerative neural cell therapy procedure to manage drug-resistant epilepsy for only the second time in the United States.
If proven safe and effective and approved by federal regulators, the therapy would be an option for people with epilepsy whose seizures aren’t controlled by medication. That means a new treatment for potentially millions of people.
Burchiel believes regenerative cell therapy implants — rather than battery-powered devices like stimulators — will be the next logical step in treating epilepsy, movement disorders including Parkinson’s, or even some forms of chronic pain. With cell therapies, no batteries need replacing.
Burchiel performed the surgery on a patient with epilepsy who had an average of 14 seizures a month, with no real relief from medication. The OHSU patient is among 10 enrolled in the first open-label stage of the trial, which involves a single implantation of the NRTX-1001 cell therapy. A total of 40 patients will be enrolled.
RNS and DBS Surgeries for Children
“Really good people are dealing with really bad epilepsy,” Collins says. “Some children can have dozens of seizures a day and take multiple sedating medications. They can’t go to school, and it’s hard for their parents to go to work. Kids can fall and injure themselves because of their seizures. They can’t climb a ladder or swim unsupervised. When they get older, they won’t be able to drive. So, these procedures can have a big impact for kids and their families.”
Few pediatric patients qualify for RNS and DBS surgeries. They have to have seizures that can’t be effectively treated by drugs. In these rare patients, traditional brain surgery isn’t an option because removing the involved tissue would interfere with a child’s ability to speak or move. For these toughest cases, the results of RNS or DBS can be transformative.
“We’re doing cutting-edge work for kids right here in Oregon,” Collins said. “RNS and DBS surgeries, awake craniotomies, clinical trials and technology advances - we’re at the forefront.”
Watching for Seizures
Despite years of effort, scientists have not found a practical, reliable way to predict the full spectrum of epileptic seizures. Detecting and predicting seizures is a potentially life-saving innovation that could improve quality of life for the estimated 3 million Americans with active epilepsy.
But the current wearable device with FDA approval doesn’t detect all seizures, produces false positives, and isn’t predictive.
“The hope is that our project could accomplish a goal that has eluded the field for many years,” Motika said. “More importantly, it would offer a critically needed service to our patients with epilepsy and their families.”
“Modern medicine and biomedical research benefit greatly from advances in wearable devices,” said Dan Marks, M.D., Ph.D., senior associate dean for research at OHSU School of Medicine. “This collaboration is a perfect example of the potential of these technologies to improve the lives of our patients and their families.”
Millions of households use “high-def” devices to improve the viewing experience. For brain surgeons, higher definition means improved detection of brain lesions and structures and a better chance for a curative outcome with full function. A breakthrough sensor technology packs that one-two punch of promise.
Physicians and engineers explained that the sensor arrays record electrical signals directly from the surface of the brain’s cortex in record-breaking detail. The arrays feature densely packed grids of tiny electrocorticography (ECoG) sensors which record electrical activity inside the skull. The grids are 10 micrometers thick, approximately one 10th the size of a human hair and 100 times thinner than the one millimeter thick and clinically approved ECoG grids. If approved for clinical use, these arrays would offer surgeons information at 100 times higher resolution than they get today.
“We could have the ability to conduct surgery with greater precision,” Raslan said. “The goal is always to remove as much of a tumor or lesion as possible, while not damaging nearby tissue.”
With FDA approval as a medical device, the technology could not only provide better guidance for planning surgeries but also shed more light on how the brain works. With an exponentially larger number of nano-rods built into these next-generation arrays, scientists can detect brain activity with greater specificity. For example, Raslan said his surgical team could identify mini-seizures occurring, as well as pinpoint areas of the brain that suppress those seizures.