EPINAV- FUTURE DESTINATION OF EPILEPSY

About 500,000 people in the United Kingdom alone are affected by epilepsy, a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, associated with abnormal electrical activity in the brain. This sensory disturbance and loss of consciousness is known as a seizure which causes a temporary disruption to the way the brain normally works. Epilepsy can affect one’s life drastically: having epilepsy can impact a career choice, a person’s living and recreational activities!

The condition can be managed with anti-epileptic drugs; however, many patients do not respond to these drugs and thus have to suffer. However, these patients can undergo brain surgery to remove the part of the brain that is causing the seizures, but before this can be attempted, the surgeons need to know exactly which parts of the brain is causing the seizures. This could only be determined through a very complicated procedure that uses multiple electrodes that are temporarily implanted into the brain to measure the electrical activity. Placing these electrodes is extremely difficult and risky as the surgeons have to place them, without damaging blood vessels (can cause a haemorrhage) or the different parts of the brain e.g. the Cerebrum which controls things like speech or fine movement. Therefore, many surgeons are reluctant to operate on patients where too many risks are there.

However, a new approach aims to make epileptic/neurosurgery a much easier and safer procedure. EpiNav, which stands for epilepsy navigation, is a new software system developed by UCL, King’s College London and the Epilepsy society, which makes this surgery quicker and easier.

How it Works

The patient will have had multiple MRI and CT scans taken which make up a layer of a ‘’3D Map’’ that is created. The CT scans and MRI scans of a patient’s brain to create an incredibly detailed 3D map that can be used to plan surgery with millimetre accuracy, calculating safe routes through the brain for each electrode that will be implanted.

The safe routes are calculated by: Taking all entry points available on the scalp and removing any potential entry routes if they: 1) if its trajectory intersects critical structures; 2) if its angle is too sharp in relation to the skull; 3) is the routes length is longer than the electrode itself. The EpiNav data is then sent to a robot that assists the surgeons by lining up the precise trajectory for each electrode.

Stereo electroencephalography (SEEG) depth electrodes are placed within the brain to help identify the brain region responsible for seizures. These parts of the brain are either resected, disconnected or stimulated to either completely stop seizures or to at least control them and improve the quality of life of patients with epilepsy.

Conclusion

The researchers/ developers anticipate that this software and robot will help to make the operation quicker and even more accurate, which in turn could make epilepsy surgery available to nearly all patients that require help. The EpiNav has already been used successfully in 150 surgeries across the UK and is believed to even be useful for more applications in the future for e.g. treating conditions like Parkinson’s Disease.

Pratham Upadhyay

Photo Credits due to: https://epilepsynewstoday.com/2016/08/02/researchers-develop-virtual-brain-that-may-help-understanding-epilepsy/