Last weekend, I attended the Internet Cowboys Un-Conference (ICUC) in Jackson Hole, WY, organized by Yossi Vardi at the ranch of Yuval and Idith Almog. I was really glad to meet a lot of interesting folks in such a spectacular setting. One highlight was a presentation on 3D imaging of the brain by Guillermo Sapiro of Duke University and Noam Harel of the University of Minnesota. New MRI technology using high magnetic fields (7 Tesla) produces a higher-resolution 3D image of the brain that can be used to guide a neurosurgeon who is placing electrodes in the brain of patient with Parkinson’s disease. This technique is called deep brain stimulation (DBS). The presentation offered an amazing insight into the role that technology is playing in science, and helping to restore the life of a person with such a debilitating disease as Parkinson’s.
Above is a video from a Parkinson’s patient who underwent DBS, a treatment that applies electricity to a specific region of the brain. A surgeon implanted electrodes in the patient’s brain. Wires run from the electrodes to a controller placed inside patient’s chest, very similar to a heart pacemaker. This surgery takes 5-6 hours during which the patient is conscious. Afterwards, as demonstrated in the video, the patient is free from his Parkinson’s symptoms with full control where he can turn on and off the stimulation, as well as control the level, to eliminate the tremors caused by Parkinson’s.
New higher resolution MRI can be used to build a 3D model of a particular patient’s brain, so that the surgeon can know with greater precision where to place the electrodes during surgery, which is what takes up most of the time during the operation. Moving the electrodes a millimeter or two can result in either less effectiveness or unexpected side effects. The difficulty is finding exactly the right place.
subthalamic nucleus (yellow), and substantia nigra (blue) fused with a T2-weighted image.
[Image source: “An Assessment of Current Brain Targets for Deep Brain Stimulation Surgery With Susceptibility Weighted Imaging at 7 Tesla”, Aviva Abosch et al, Neurosurgery, December 2010.]
The brain model that surgeons typically use is just that — a reference model, based on one patient’s donated brain from many years ago. They would try to locate electrodes based on a general idea of where the target regions are located. The new technology allows the surgeon to study the brain’s structure for this individual’s brain; it is a highly specific map of the patient’s brain rather than a reference map. Eventually this kind of MRI will be done in real-time during surgery. Now it’s done in advance of surgery, but it offers a better guide for the surgeon who does use lower-resolution MRI during the operation to follow the electrodes moving through the brain.
Professor Sapiro and Dr. Harel, who have been developing the 3D imaging techniques, say that scientists don’t really know why DBS works, but that it is proven to work. I found that really interesting.
When we think of applying electricity to the brain, we might think about electroshock, a brute-force method which had mostly negative results. DBS is much different. DBS is applying a current to a specific location in the brain that has been mapped with great precision. This approach has had profoundly positive effects for Parkinson’s patients. However, only an estimated 15 percent of Parkinson’s patients are electing this surgery, perhaps because they fear the lengthy surgical procedure. There are experiments applying DBS for those suffering chronic depression and memory loss because of Alzheimers.
Dr. Harel said to me that new techniques and new technology are emerging that are “in search of new applications.” It’s an exciting time, creating new opportunities for innovation. We see a lot of stories about fairly trivial uses of technology and innovation that is rather mundane. This is a story with elements that are familiar to most makers such as 3D scanning and modeling and electric circuits, but it is a medical story about how technology changes people’s lives. “You should see the patient’s face during/after surgery when they understand that they are free from tremors,” Dr. Harel wrote in an email. “It’s priceless! It’s a great feeling knowing that you are part of this amazing procedure.”
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