New Tech Targets Epileptic Seizures With Lasers, Robots And Precision Surgery : Short Wave About three million people in the United States have epilepsy, including about a million who can't rely on medication to control their seizures. For years, those patients had very limited options. But now, in 2023, advancements in diagnosing and treating epilepsy are showing great promise for many patients, even those who had been told there was nothing that could be done. Using precise lasers, microelectronic arrays and robot surgeons, doctors and researchers have begun to think differently about epilepsy and its treatment. Today on Short Wave, host Aaron Scott talks with NPR science correspondent Jon Hamilton about these advances in treating epilepsy. He explains why folks should ask their doctors about surgery — even if it wasn't an option for them a few years ago.

New tech gives hope for a million people with epilepsy

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EMILY KWONG, BYLINE: You're listening to SHORT WAVE from NPR.

AARON SCOTT, HOST:

Hey, SHORT WAVErs. Today, we are going to talk about new ways to treat severe epilepsy, which means we have summoned NPR's resident brainophile, Mr. Jon Hamilton. Hello, Jon.

JON HAMILTON, BYLINE: Hey, Aaron.

SCOTT: So I understand you were recently in California, reporting on some cutting-edge advances in epilepsy care.

HAMILTON: I was. I was at the University of California San Diego. They have a major epilepsy center there, and it does a lot of research on diagnosing and treating the disorder. So while I was there, I was really struck by how fast this field is changing because of advances in technology.

SCOTT: I am hoping today's episode involves robots.

HAMILTON: Of course it does, Aaron. We are talking about microelectronics that can help find the source of seizures. We're talking about tiny lasers that can zap the brain tissue causing a problem and, of course, robot surgeons to help out in the operating room.

SCOTT: Excellent.

HAMILTON: And what all this technology is doing is making it possible for many more patients to get their seizures under control. It's also allowing people who do get surgery to spend less time in the hospital and to get back to their lives.

SCOTT: Tell us a bit about the patients who need this sort of high-tech care.

HAMILTON: Well, these are people who just a decade or so ago - they would have had to accept that medication alone was not going to stop their seizures. So we're talking about roughly a million people here. That's out of the 3 million people in the U.S. who have epilepsy. And let me give you an example. This is a story I got from the doctors at UCSD. They told me about a man who had been having seizures for well over a decade. Drugs didn't stop them, and the doctors told him he wasn't a good candidate for surgery. But that was back in 2010.

SCOTT: OK.

HAMILTON: Flash forward to 2016. This man comes to UCSD, and he sees Dr. Jerry Shih, who directs the epilepsy center there.

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, and we found out where his seizure foci were. And using laser ablation, we actually knocked out that very active seizure focus, and he has subsequently been seizure free.

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SCOTT: So today on the show, how technology is changing the way we diagnose and treat epilepsy. I'm Aaron Scott, and you're listening to SHORT WAVE, the daily science podcast from NPR.

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SCOTT: OK, Jon. Before we dive into the tech, can you remind us what epileptic seizures are and what causes them?

HAMILTON: So doctors often describe an epileptic seizure as a sort of electrical storm in the brain. The cause is typically a group of brain cells that are just malfunctioning. You have these neurons that lose their normal firing patterns, and they start producing these bursts of activity. And all of those out-of-control signals can spread through the brain, which prevents normal communication among brain cells.

SCOTT: OK.

HAMILTON: So what the brain tries to do is kind of like reboot or reset itself, so it's like a computer that's crashed. And while it's doing that, that is why people may lose muscle control or start shaking or lose awareness or even pass out.

SCOTT: And how is epilepsy usually treated?

HAMILTON: A bunch of ways. For most people, drugs can either greatly reduce or eliminate seizures. Some people also do well with electrical stimulation to the vagus nerve. You know, there's a nerve that runs up your neck and into the brain. Or they may do well with stimulation of specific areas of the brain. There are also special diets, like the ketogenic diet, that can also work. But for a lot of people, these things don't work well enough. They're still having seizures. And for these people, the most reliable way to treat these seizures is to actually remove the bit of abnormal brain tissue that is responsible for the problem. In other words, surgery, right? And that is where all the lasers and robots and electronics come in. All this technology is making surgery faster and more accurate and much easier on patients.

SCOTT: Wow, Jon. So if the doctors can locate this problem area and remove it, there's this good chance they can get rid of the seizures. And yet our brains are so complex, and there's so little we understand about them. How do they find that exact brain area that's responsible for each individual patient's seizure?

HAMILTON: Well, one way is through this technology, and it's making a huge difference. I talked to a neurosurgeon at UCSD. His name is Dr. Alexander Khalessi. And here's how he described how technology is letting doctors and scientists study the brain's electrical activity - or, you know, electrophysiology is what he would call it. And that is, of course, the key to diagnosing and treating epilepsy.

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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, and so that's going to help us understand, you know, the symphony that makes us us.

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SCOTT: That is such a beautiful metaphor. Tell us, then, about the tools that they're using to tune into this symphony.

HAMILTON: Well, one of them is an array of electrodes that surgeons place under the skull on the surface of the brain. And an array like that allows doctors to monitor the electrical activity in the brain tissue that is underneath the electrodes. So the idea is to say, aha, the problem area is just below this electrode. Then a surgeon knows where to go to either get rid of the brain tissue or place a wire that can deliver electrical stimulation. But the thing is the accuracy of this approach depends on how many electrodes are in the array. So imagine it's like a computer screen. The more pixels you have, the sharper the image is, right?

SCOTT: Right.

HAMILTON: So at UCSD, they've actually created a kind of small-scale factory to make better arrays. And I got a tour of this facility from Shadi Dayeh, who is a professor of computer and electrical engineering.

SHADI DAYEH: Here we're looking at the thin film deposition lab, where...

HAMILTON: Everybody's gowned up.

DAYEH: ...Everybody is gowned up.

HAMILTON: Dayeh told me that the arrays made here use technology developed for electronics displays, you know, like on a watch or a cell phone.

DAYEH: It's catching up with how we see the trend in electronics and displays, 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?

SCOTT: And so how many electrodes are we talking here, Jon? And I'm trying to picture this, but how big is the array that's getting implanted into the patient's skull?

HAMILTON: So imagine something maybe a little bit bigger than a postage stamp, right?

SCOTT: OK.

HAMILTON: You know, years ago, those arrays might have had one or two dozen electrodes. Actually, they started with four. But, you know, they got up to, you know, a dozen or two. And Dayeh says now they are making arrays that have more than a thousand electrodes.

SCOTT: Wow.

HAMILTON: And these devices are - not only do they have more electrodes. They're also more flexible, and they're thinner than a human hair. So they can be placed on the surface of the brain without disturbing anything.

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 because it allows us to see broad regions of the brain with microscopic resolution.

HAMILTON: But sometimes, just placing electrodes on the surface of the brain isn't enough to figure out precisely where a seizure is coming from. So Dayeh's team has been working on high-resolution electrodes that can be placed deep into the brain. And that, Aaron, is where the robots come in.

SCOTT: (Laughter) I was waiting for the arrival of the robots. I'm guessing that we are not talking here about, say, tiny little nano robots that are cruising around the brain and, like, zapping the problem spots. But what are the robots actually doing?

HAMILTON: Well, they're helpers. And they can be a big help, it turns out, in the operating room, because you've got these depth electrodes, the ones that go deep into the brain, and they have to be placed in exactly the right spot. And that's where even a surgeon that has really great hands - you know, they've got limits to how precise they can be. So at UCSD, these surgeons have been using a robotic system called ROSA. I spoke about it with Dr. Sharona Ben-Haim, who directs the surgical epilepsy program.

SHARONA BEN-HAIM: You know, the ROSA robot has become an incredible tool for specifically this type of surgery because it allows us to fuse our MRI, essentially, in real time with the three-dimensional space of the patient's head. And it then allows us to essentially steer in stereotactic place a surgical arm that takes us right to our target.

HAMILTON: And, of course, finding the right target is the key to stopping a patient's seizures.

SCOTT: Wow. So I'm trying to picture how this works. Are they drilling, like, a little hole through the skull, and then this tiny surgical arm with the laser is basically kind of going in and navigating the brain to find that exact spot?

HAMILTON: Exactly. So back in the day, surgeons used a scalpel to remove a brain area that was causing seizures. And that meant that they first had to remove a fairly large section of the skull, you know, so they had room to operate. Ben-Haim told me that now with a laser, surgery usually requires only making this tiny incision in the scalp and then drilling a tiny hole in the skull. So this is a hole that is smaller than the diameter of, say, a No. 2 pencil - right? - really small. And that means the recovery is a lot quicker. And usually, patients can go home just a day after surgery.

SCOTT: Wow. So I have to ask because I like to think we're using all of our brain. Is that part that's getting removed doing something? Like, is something being lost by removing this part that's triggering the seizures? Or are our brains actually resilient enough that they can patch over that removed area?

HAMILTON: Yeah. We don't really have lots of brain tissue that (laughter) is just sitting there doing nothing, right?

SCOTT: (Laughter) Right.

HAMILTON: So the trick is to remove as little brain tissue as possible. You know, brain tissue is generally doing something. There are definitely some patients who cannot get surgery because their seizures are coming from an area of the brain that is doing something critical. There are other patients who may have to weigh whether getting rid of their seizures is worth the risk of losing some brain function. You know, it could be memory or vision, things like that.

SCOTT: OK. And, I mean, this is all still very new. Do they have a sense of what the success rate is like for this advanced surgery?

HAMILTON: Nationwide, it appears to be higher than 60%. Ben-Haim told me that most of the patients who get laser surgery at UCSD end up with either no seizures or a lot fewer. It's worth noting, though, that so-called open surgery - you know, the old style where they open up the skull - still seems to have a slightly higher success rate, but it also has more risks. And you take out more brain tissue, and there can be a longer recovery time. Ben-Haim told me one obstacle she has now is that all these advances are so new that many patients aren't even aware of them, so she says people who may have been told years ago that surgery wasn't an option - they really should visit an epilepsy center again and ask whether surgery might be an option now.

SCOTT: Thank you for another deep dive into our gray matter, Jon.

HAMILTON: Always a pleasure, Aaron.

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SCOTT: Before we wrap up, a quick shout out to our SHORT WAVE Plus listeners. Thank you, thank you, thank you. Your support means the world to us. SHORT WAVE Plus helps support our show. So if you're a regular listener and you're not signed up, we'd love for you to join. It means you get to enjoy every episode without sponsor interruptions. Find out more at plus.npr.org/shortwave.

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SCOTT: This episode was produced by Thomas Lu, edited by Gabriel Spitzer and fact-checked by Anil Oza. The audio engineer was Hannah Gluvna. Rebecca Ramirez is our supervising producer. Brendan Crump is our podcast coordinator. Beth Donovan is our senior director of programming. And Anya Grundmann is our senior vice president of programming. I'm Aaron Scott. Thanks for listening to SHORT WAVE from NPR.

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