Having completed my Bachelors and on my way to finish my Masters in Biomedical Engineering I was looking for an opportunity to further my graduate education and continue with research in the field of Neuroengineering. At that time, in January 2013, I approached Dr. Ioannis Vlachos, a Research Assistant professor in Biomedical Engineering; this meeting reminded me of the royal protocol of approaching the Minister before getting to meet the “King”. It was about a couple of weeks later, after exchanging a few more e-mails, that I got the chance to meet the Director of Brain Dynamics Laboratory (BDL), Prof. Leonidas Iasemidis.
Dr. Iasemidis (pronounced Yah-si-me-dees) is a world renowned academician in the field of nonlinear brain dynamics and epilepsy research. He joined Louisiana Tech University as the H.A. ‘Dusty’ Rhodes Eminent Scholar Chair in biomedical engineering and rehabilitation science program. His research has stimulated global research interest in the prediction and control of epileptic seizures. Prof. Iasemidis is a co-author of ten patents and co-founder of two companies in neuromodulation and control of epilepsy. He is a senior member of IEEE and a fellow of the American Institute of Medical and Biological Engineers (AIMBE) and is recently inducted into the National Academy of Inventors (NAI).
Prof. Iasemidis was born in Athens, Greece, the ancient crucible of philosophy, democracy, and mythology. It is also where the term epilepsy originated, that is, an illness assumed to be “delivered by Gods.” After earning a degree in electrical engineering from the National Technical University of Athens in 1982, he set his sights on the most complex biological system known, the human brain. At that time, respectable programs for graduate studies in biomedical engineering had not been developed in Greece, so he first landed at Brown University and subsequently at the University of Michigan, Ann Arbor, to pursue a doctorate in biomedical engineering.
In US alone nearly 3 million people live with epilepsy, and 50,000 die from epilepsy-related causes each year. Epilepsy affects more people than multiple sclerosis, cerebral palsy and Parkinson’s combined. Current solutions available either do not address more than one aspect of this physiological condition, or are so ineffective that the condition becomes a constant reminder and defines a person’s life.
Seizures, the hallmarks of epilepsy, can be more complicated than you think; there are different types of seizures and locations of epileptogenic regions in the brain that can affect people in different ways. Epilepsy patients are always thinking when the next seizure will strike them. The storms in the brain are very much unpredictable in any given day, blue skies become calamitous cloud busters. Scientists know quite a bit about the anatomy of the epileptic brain but have just started unveiling the complexity of its function.
Several different views are held about the genesis and paths that lead to the aberrant pulses of seizures. The physiological mainstay in the diagnosis of epilepsy is a dramatic change of the electroencephalogram (EEG) during seizures. “I wanted to see if there was some kind of a warning signal hidden in the EEG long before seizures,” Prof. Iasemidis says. Development of algorithms and devices based on early detection of such precursors could issue on-time warnings and trigger on-demand interventions. “We are one of the leading research groups in the world in this effort” says the eminent professor. Dr. Iasemidis was the first to present results on the predictability of epileptic seizures from analysis of the EEG [1]. Over the years, through publications and continuous support from NIH, the VA, NSF, DoD, state and industry sponsors, Dr. Iasemidis’s team has developed the field of epileptic seizure prediction in collaboration with neurologists, neurosurgeons, bioengineers and scientists from physics, mathematics, chemistry and statistics (see [2] for a recent review). At BDL, analysis is performed of data from computer simulation models of the epileptic brain, as well as EEG and magnetoencephalographic (MEG) data from patients and animals with epilepsy recorded at highly reputable medical centers like Mayo Clinic, Cleveland Clinic and Barrow Neurological Institute (BNI), which closely collaborate with Dr. Iasemidis’ and Dr. Vlachos’ research team.
From a treatment’s perspective, while research into the predictability and prediction of seizures seeks to answer the question of “when to intervene”, answers to the questions of “how” and “where” to intervene in the brain are also of paramount importance and constitute a significant part of BDL’s ongoing research effort. Implementation of seizure prediction algorithms into devices implanted in proper brain locations and controlling an actuator (e.g. electromagnetic stimulator or drug release device) is anticipated to provide the bioengineering solution to seizure control and should decisively enhance the effectiveness of existing neuromodulation devices, like vagus nerve stimulators (VNS), deep brain stimulators (DBS), transcranial magnetic stimulators (TMS), as well as of others based on timely administration of anti-epileptic medication. There is currently an explosion of interest in academic centers and medical industry (e.g. Medtronic, Neuropace, Cyberonics, Neurovista) with clinical trials underway to test potential prediction of seizures and intervention devices for FDA approval [3-4].
At Tech’s Brain Dynamics Laboratory, research in other related areas of clinical and engineering importance is also conceived, tested and validated. Applications include the identification and localization of the epileptogenic focus; differential diagnosis of epileptic versus psychogenic non-epileptic seizures, as well as epilepsy versus other conditions (e.g. metabolic encephalopathy) presented in the emergency room (ER) and intensive care unit (ICU); evaluation of anti-epilepsy treatment, especially in the case of status epilepticus, which is the most severe and life-threatening form of epilepsy; development of seizure susceptibility indices that would help monitor the susceptibility of patients to seizures over time and warn patients to change their medication accordingly; identification of patients with traumatic brain injury who may develop epilepsy in the future, so that they are treated early with anti-epileptic medication (supported by a grant from DoD); evaluation of the efficacy of rehabilitation schemes for patients with other brain disorders than epilepsy, for example, stroke survivors and patients with Parkinson’s and Alzheimer’s disease.
Prof. Iasemidis says this knowledge will be valuable to physicians and patients. Physicians can intervene in many ways if they have a warning signal of an impending seizure. They can use a variety of treatments to reduce the severity of seizure or even help fend it off entirely. Patients who suffer from epileptic seizures may get a tool that can help restore some sense of order to their lives.
[1] L.D. Iasemidis et al., “Nonlinear dynamics of electrocorticographic data”, J. Clinical Neurophysiology, 5: 339, 1988.
[2] L.D. Iasemidis, “Seizure prediction and its applications”, Neurosurg. Clin. North America, 22: 489-506, 2011.
[3] M.J. Cook et al., “Prediction of seizure likelihood with a long-term, implanted seizure advisory system in patients with drug-resistant epilepsy: a first-in-man study”, Lancet Neurology, 12(6): 563-71, 2011.
[4] C.N. Heck et al., “Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: Final results of the RNS system pivotal trial”, Epilepsia, 55(3): 432-441, 2014.
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