Epilepsy Patients Help Decode The Brain's Hidden Signals : Shots - Health News When doctors stick electrodes into the brain of a patient with epilepsy, they're hoping to find a cure for debilitating seizures. But they're also exploring a still-mysterious landscape. And they couldn't do it without a patient willing to help.
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Epilepsy Patients Help Decode The Brain's Hidden Signals

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Epilepsy Patients Help Decode The Brain's Hidden Signals

Epilepsy Patients Help Decode The Brain's Hidden Signals

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On a Monday, it's MORNING EDITION from NPR News. Good morning, I'm Steve Inskeep.


And I'm David Greene.

Today in Your Health: A rare glimpse into the human brain. Neuroscientists are studying some patients with severe epilepsy to see if surgery might cure their seizures. The procedure has been an opportunity to see the brain in action while awake. And as we're about to hear, this is leading to some remarkable findings.

Amy Standen from member station KQED in San Francisco has the story.

AMY STANDEN, BYLINE: Nate Bennett has been having seizures since he was a teenager. But he's 41 now and they've gotten much worse. If one were to strike right now, he told me, he'd get ready for it.

NATE BENNETT: I would begin to get this feeling.

STANDEN: People with epilepsy call it an aura, this pre-seizure feeling.

BENNETT: I would tell you I'm beginning having a seizure, I would find a spot on the floor.

STANDEN: Alone, ideally. He says he doesn't want to scare people.

BENNETT: And then I would get my custom wallet out.

STANDEN: He pulls it out to show me.

BENNETT: Yup, this wallet that I've designed, piece of Velcro - you see it's full of bite marks.

STANDEN: The wallet is black leather, about the size of an envelope. His teeth have left gray scars along the spine.

BENNETT: I lay down on the floor. I put this in my mouth and that way, when I wake up from the seizure, I may not have bitten my tongue.

STANDEN: Nate's seizures have progressed to the point where he worries about losing his job. Medication isn't helping. This makes him a candidate for surgery. But the first step is to find out whether Nate's seizures originate in a specific place. And if so, whether that's a part of the brain that could safely be removed, which brings Nate to Stanford Hospital.

Finding the source of Nate's epilepsy involves a procedure in which electrodes are surgically implanted into his brain.

BENNETT: Hey, there.

UNIDENTIFIED WOMAN: Great. How are you?

STANDEN: I visit him as he's waking from anesthesia. He's groggy, but he gives me a thumbs up.

BENNETT: I'm putting reality back together here, gradually.

STANDEN: Nate asks a doctor how the surgery went.

BENNETT: I've got five or six electrodes at this point.

UNIDENTIFIED MAN #1: You've got seven electrodes - two on the right and then five on the left.

BENNETT: Wow, what a party.

STANDEN: Each of those is actually a string of electrodes, embedded along plastic wires just a little thicker than a human hair. Nate will spend a week in the hospital with these electrodes implanted in his brain. When he has his next seizure, they should be able to track where it's coming from. But the electrodes can do something else too. They can show us things about the brain that have implications well beyond epilepsy.

A few days after the electrodes have been implanted, I go back to see Nate at the hospital. His head is wrapped in bandages. A thick braid of wires hangs from his left temple.

JOSEF PARVIZI: Take a deep breath, and just relax.

STANDEN: At the bedside is Josef Parvizi, Nate's doctor.

PARVIZI: So let's see.

STANDEN: Parvizi is an epilepsy specialist at Stanford University Medical Center and a brain researcher. And today, he's going to send tiny jolts of electricity along the electrodes and into Nate's brain.


STANDEN: Essentially, he's exploring Nate's brain, neuron by neuron.

PARVIZI: One, two, three...

STANDEN: To be clear, this is completely painless. But very strange things happen when you stimulate the brain this way.

PARVIZI: I want you to tell us if you feel anything that resembles your seizures. OK?


STANDEN: One of Nate's electrodes is located in a part of the brain associated, among other things, with automatic speech - like saying: ouch or whoa. Parvizi sends a small jolt there.

BENNETT: I- I, yup, change.

STANDEN: Nate's suddenly lurched forward.

BENNETT: I became unable to speak and I was going to say jinx. I-I-I-I started stuttering. I couldn't get the words out.

STANDEN: Scientists have been doing this kind of brain stimulation on people with epilepsy since the 1960s. That's when a Canadian neurosurgeon named Wilder Penfield found that by stimulating certain parts of the brain, he could make people move their hands involuntarily or report a smell of burning leather. In many ways, this was the birth of modern brain mapping; the idea that specific functions can be traced back to specific brain areas.

Parvizi is one of a handful of neuroscientists who have picked up Penfield's torch. Last week, the journal Neuron published a paper describing some of this work, not with Nate but with two other patients.


PARVIZI: Let me know what you feel.


STANDEN: In the video released with the paper, a man sits in bed. Like Nate, this man has severe epilepsy. He's in the hospital so to find the source of his seizures. Parvizi sends a small jolt of electricity to a part of the brain called the anterior cingulate. The patient's heart began to race.


UNIDENTIFIED MAN #2: My chest and respiratory system started getting kind of shaky.

PARVIZI: Really? OK.

STANDEN: He sort of flutters his hands, clutching his chest, to demonstrate.


PARVIZI: Did you feel any changes in emotion or mood?

STANDEN: Yes, the man nods. And then he tries to explain the weird feeling he had, when this part of his brain was stimulated.


UNIDENTIFIED MAN #2: I started getting this feeling like I was driving into a storm.

STANDEN: As if he was driving into a storm. And the car he was driving, it had a flat.


UNIDENTIFIED MAN #2: Like one of the tires was half flat and you're only half way there. And you had no other way to turn around and go back, you had to keep going forward.

STANDEN: Like he was in danger and might not make it. He pounds his chest, for emphasis.


UNIDENTIFIED MAN #2: Am I going to get through this? Am I going to get through this?

PARVIZI: Was it negative, or was it positive?

STANDEN: Now this is the part that's most interesting to Parvizi and his co-authors. Because while the patient clearly feels a sense of danger, he feels something else, too - a determination to get through it, to survive.


UNIDENTIFIED MAN #2: It was more of a positive type thing of push harder, push harder, push harder to try to get through this.

PARVIZI: Will to persevere.

STANDEN: That's what the paper in Neuron is called, based on these reports from two patients, "The Will to Persevere."

PARVIZI: They have the will to go towards the storm and fight it rather than giving up, being scared, depressed and running back.

STANDEN: And it makes perfect sense, says Parvizi, that this will to survive, would be coupled with a pounding heart.

PARVIZI: That's the beauty of evolution, right? If you really are going to go through difficulty, you'd better have a higher blood pressure so your muscles can get the blood and run or fight, or whatever.

STANDEN: And that this hard-wired urge might even feel good.


PARVIZI: Is this unpleasant?

UNIDENTIFIED MAN #2: I don't find it bad at all.

STANDEN: Part of what's remarkable here, is access, says Orrin Devinsky, a professor of neurology at NYU's Langone School of Medicine.

It is one thing to study the brain through MRI scans, another thing entirely to literally zap a specific part of the brain and then ask the patient to describe what happens. Devinsky calls epilepsy patients like Nate Bennett heroes of neuroscience.

ORRIN DEVINSKY: A lot of things that the brain does, we can look at with these patients who have been incredibly generous.

STANDEN: And there are clues in this work that hint at future treatments. Brain stimulation is already used to treat certain disorders, including Parkinson's disease and in experimental settings, depression. Maybe the part Parvizi's stimulating could be another target.

DEVINSKY: There are patients I take care of who have injured their frontal lobes and because of that, their overall spontaneity, their will to do things...

STANDEN: Is just gone, he says.

DEVINSKY: For people like that, stimulation of this area could potentially be a very promising treatment.


STANDEN: For now, back at the hospital, the goal is to solve the problem of Nate's epilepsy, starting by figuring out where his seizures are coming from.

PARVIZI: And tell me if you notice any change.

BENNETT: Yeah, there is a change.

PARVIZI: Open your eyes.

BENNETT: And I might have a seizure.

STANDEN: Nate's face hardens. His eyes fix on some invisible spot across the room. He's having a seizure. This is a good thing. The electrodes implanted in his brain have recorded exactly where it came from.


UNIDENTIFIED MAN #3: It's very clammy. Very clammy.

STANDEN: A doctor injects Nate with a dose of Atavan to stop the seizure. A nurse ushers me out of the room.


PARVIZI: You're OK. You're OK.

STANDEN: A couple weeks later, I call Nate at home. The electrodes have been removed and he's back at work.

BENNETT: My first day back was Friday of last week.

STANDEN: He says in the end, his doctors decided not to go with the surgery. The source of his seizures is too spread out across his brain. This was disappointing, he says. But being part of scientific experiments, that was a silver lining.

BENNETT: For me, I'd like to see something positive come out of it all, even if it's for somebody else.

STANDEN: And his story is not over, he says. A new epilepsy device called the Neuropace - kind of like a pacemaker for the brain - recently got FDA approval. Pretty soon, he'll start looking into that.

For NPR News, I'm Amy Standen.


GREENE: And you're listening to MORNING EDITION from NPR News.

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