Epilepsy is an odd beast. It can affect people of all ages and ethnicities. It can be caused by a variety of underlying issues, such as head trauma, or sometimes the person can just be a victim of hereditary happenstance. Sometimes, there is no apparent reason for it whatsoever. It’s just there.
Adding to that, there are many types of treatments from pharmaceuticals to electronic implants to brain surgery. Sometimes they work, sometimes they don’t — again, in a fashion that’s hard to predict. As a result, we now have a menagerie of treatments and drugs used to combat the illness, but none of them is perfect.
To add even more to this, people suffering from epilepsy are still stigmatized because of how bizarrely the disease sometimes manifests. According to the Centers for Disease Control and Prevention, as of 2015 3.4 million people in the United States (1.2% of the population) had epilepsy. Expand your search to the entire globe and the number jumps to 50 million. But a new, revolutionary procedure could bring big changes.
Deep inside the brain
While brain surgery was always considered a last resort, a treatment left in a doctor’s back pocket to use only when absolutely necessary, research out of the University of Virginia School of Medicine and Stanford University may have found a way to make the operation less intrusive and more effective.
A procedure called PING, currently in pre-clinical research, has been created to treat neurological diseases without the invasiveness of regular surgery. If successfully translated to the operating room, it could revolutionize the treatment of some of the most challenging and complex neurological diseases.
The approach uses low-intensity focused ultrasound waves combined with microbubbles to briefly penetrate the brain’s natural defenses and allow the targeted delivery of a neurotoxin. This neurotoxin kills the culprit brain cells while sparing other healthy cells and preserving the surrounding brain architecture.
“This novel surgical strategy has the potential to supplant existing neurosurgical procedures used for the treatment of neurological disorders that don’t respond to medication,” said researcher Kevin S. Lee, PhD, of UVA’s Departments of Neuroscience and Neurosurgery and the Center for Brain Immunology and Glia (BIG) in a statement. “This unique approach eliminates the diseased brain cells, spares adjacent healthy cells and achieves these outcomes without even having to cut into the scalp.”
Now, if a patient which does not respond to medications is at the end of the pharmaceutical rope (which happens in up to a third of those with epilepsy), the new procedure could provide a critical treatment without the angst and recovery time of normal brain surgery. In an email to ZMEScience, Lee explained that PING has recently been shown to reduce or eliminate seizures in two research models of temporal lobe epilepsy.
A key advantage of the approach is its incredible precision. PING utilizes the power of magnetic-resonance imaging (MRI) to let scientists peer inside the skull so that they can precisely guide sound waves to open the body’s natural blood-brain barrier exactly where needed. This barrier is designed to keep harmful cells and molecules out of the brain, but it also prevents the delivery of potentially beneficial treatments. Lee said that importantly, PING spares other non-target cells, such as glia, blood vessels and axons of passage, which are damaged with currently-available neurosurgical procedures.
“The hope for PING is that it will also be effective in reducing seizures, while reducing side effects that attend currently-available procedures,” Lee told ZME Science. “The operation requires a focused ultrasound (FUS) system that is combined with an MRI (which) allows accurate targeting of FUS to a brain area of interest. In current clinical practice, high-intensity FUS can be used to produce thermal lesions to treat essential tremor and Parkinson’s Disease. PING differs from that procedure because it uses low-intensity FUS to focally open the blood brain barrier to deliver a systemically-administered drug to destroy culprit neurons in a targeted area.”
Another huge advantage of PING is that it can be used on irregularly shaped targets in areas of the brain that would be almost impossible to reach through regular brain surgery. “If this strategy translates to the clinic,” the researchers write in their paper, which was published in the Journal of Neurosurgery, “the noninvasive nature and specificity of the procedure could positively influence both physician referrals for and patient confidence in surgery for medically intractable neurological disorders.”
The results could change the lives of millions of people around the world if its safety and efficiency are confirmed in larger trials.