Epilepsy Talk

Brave New Cures for the Future — Epilepsy and Neuroengineering | February 8, 2021

Traditionally, the mainstay of epilepsy therapy has been treatment with antiepileptic drugs (AEDs).

But for 30% of those affected, no combination of standard therapy — medications and/or surgery — can control their seizures.

Although more new AEDs have come to the market over the past 10 years than during any other time in history, their primary contribution has been to improve adverse effects of medication, rather than to make more people seizure-free.

The proportion of people with epilepsy worldwide — whose seizures cannot be controlled by medical therapy — has remained unchanged, despite all these new pharmaceutical interventions.

And as this search for better medications and surgical approaches continues, another avenue of epilepsy treatment is now gaining momentum, designed to predict, detect, prevent, and abort seizures.

It’s only recently that Neuroengineering first appeared.

Neuroengineering is a discipline at the frontier between neuroscience and engineering.

It encompasses experimental, computational, theoretical, clinical and applied aspects of research areas at the molecular, cellular and systems levels.

The emergence of this new field focuses on a multi-science combination of engineers, neuroscientists and clinicians using their combined knowledge and talent, working co-operatively to address the complexity of the brain and nervous system.

The evolution of engineering technology as applied to epilepsy presents renewed promise to potentially identify periods of time when the probability of seizure onset is increased, and to deliver responsive therapy to prevent seizures from happening.

On one side, understanding how the brain works allows developing engineering applications and therapies of extremely high impact.

On the other side, development of new measurement and data analysis techniques contributes to advance our knowledge about the brain.

The central clinical problem in epilepsy is that, during a seizure a network of neurons in the brain becomes abnormally excitable and synchronized.

Monitoring and localizing the resulting electrical discharge, forms the basis of electroencephalography (EEG)

For over 50 years, EEG was the only method of monitoring functional activity in the brain.

Over the past 20 years, new imaging techniques for measuring brain function have become available, including functional MRI, PET scanning, single-photon emission CT, and magnetoencephalography (MEG).

Yet despite the pervasiveness of these tests, scientists are only just beginning to understand the mechanisms underlying seizures.

Specifically, there’s still very little known about the relationship between neuronal mechanisms underlying inter-ictal spikes — periodic, and brief bursts of neuronal activity — and seizures that occur during epilepsy.

The beauty of neuroengineering is that it uses engineering technology to solve neuroscience-related problems and to provide rehabilitative solutions for neurological conditions.

And epilepsy is one of its primary targets.

Using the electrochemical properties of neurons as a foundation, neuroengineers seek to monitor abnormal brain function using several novel — and often nonpharmacological — methods.

There are two main approaches to neuroengineering research in epilepsy.

First, monitoring and interpreting epileptic and potentially epileptic brain activity on multiple scales in brain networks to understand how seizures and epilepsy are generated over time.

And second, using a creative array of approaches such as “closed loop” devices which trigger focal stimulation to feed back brain signals, controlling and stopping seizures.

The anticipated result is to identify periods of time when the probability of seizure onset is increased, and to deliver responsive therapy to prevent seizures from happening.

The future of this exciting new field will not be determined by what we believe neural engineering should be.

Rather it will be determined by its success in improving human health and quality of life.

This kind of restoration and enhancement of the brain and nervous system is the basis of neuoengineering’s purpose and the hopes of tomorrow.

“Neural Engineering is an emerging interdisciplinary research area that brings to bear neuroscience and engineering methods to analyze neurological function as well as to design solutions to problems associated with neurological limitations and dysfunction.” — The Journal of Neural Engineering

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Resources:

https://iopscience.iop.org/article/10.1088/1741-2552/4/4/E01/meta

https://www.researchgate.net/publication/231051657_What_is_Neural_Engineering

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904395/

http://www.ncbi.nlm.nih.gov/pubmed/18301414

http://www.nature.com/nrneurol/journal/v4/n4/full/ncpneuro0750.html

https://journals.sagepub.com/doi/full/10.1177/2398212818776475

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