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A New Epilepsy Unit Advances Possibilities for Science and Patients at the Hospital of the University of Pennsylvania Pavilion

 

Approximately one million people are suffering from drug-resistant epilepsy in the United States. But far fewer get surgery for the condition — only around one thousand surgeries a year — even though these procedures end seizures in around 70 percent of patients.

The average patient suffers twenty years with epilepsy before surgery. “It’s a neurodegenerative disorder,” said Kathryn Davis, MD, MS, FAES, an assistant professor of Neurology in the Perelman School of Medicine at the University of Pennsylvania and medical director of the Epilepsy Monitoring Unit and Epilepsy Surgical Program at Penn Medicine. “Patients can get worse with memory and function over time before they finally get to me.”

With the Epilepsy Monitoring Unit (EMU) and the Human Neurophysiology Research Laboratory at the new Pavilion at the Hospital of the University of Pennsylvania (the new building opening this fall, also known as HUP East), Davis hopes to change those statistics. The future twelve bed unit will be equipped with cameras, recording equipment, and monitor–advanced imaging to help find where seizures coming from in the brain.

Patients who come to HUP East for advanced neurological monitoring, including patients preparing for epilepsy surgery, will receive care in a state-of-the-art unit, with advanced technology: a combined patient care and laboratory space that is specifically designed to give scientists and clinicians the ability to provide top-notch patient care and also do pioneering scientific research.

While these patients are being treated and studied for neurological disorders, they have an opportunity to volunteer to participate in other cognitive and neuro-related research projects — from investigating the nature of consciousness to how the brain interacts with sensory experiences.

“People who did research in the past cobbled it together — they wheeled patchwork equipment into patient rooms to try to do these experiments,” said Daniel Yoshor, MD, chair of Neurosurgery at the Perelman School of Medicine. “And most EMUs are designed to just do clinical work. The Human Neurophysiology Research Laboratory is designed to push the cutting edge of neurological and neuroscientific research and treatment, and invent new technologies.”

Yoshor notes one of the main reasons he and his research team were so excited to come to Penn Medicine is the opportunity to collaborate with the outstanding neurologists, neurosurgeons, bioengineers, and neuroscientists on campus, including Drs. Brian LittMichael KahanaDani BassettJosh GoldTim LucasDavid Brainard, Kate Davis, Jay GottfriedMichael Platt, and many, many more.

“There is an amazing future ahead in neurology and neuroscience at Penn Medicine,” he said. “Our team of experts, plus the setting of the Pavilion’s new Human Neurophysiology Research Laboratory, should make this the premier human intracranial electrode research program in the world.”

Penn Medicine News talked to eight scientists and clinicians who will be researching and caring for patients in the new EMU at the Pavilion to preview how the facility can help transform their research today into the research of tomorrow.

Advancing Care for Drug-Resistant Epilepsy

Kathryn Davis, MD, MS, FAES

As the medical director of the EMU, I am thrilled to be moving into the new state-of-the art unit. We will be expanding the size of our unit and able to provide the most advanced care available to our patients.

My research is focused on the drug resistant (also termed “intractable”) epilepsy patient population. This group of patients will be provided the highest level of care and most advanced treatment options in the new Pavilion. In order to localize the epilepsy “hotspots” in these patients we frequently need to implant intracranial electrodes to measure the brain activity from inside the brain. The purpose of locating hotspots is to find the best type of clinical intervention to prevent an individual patient’s seizures. We have carefully designed the new epilepsy unit to optimally study brain activity with intracranial electrodes. Not only will this enable our clinical team to provide optimal care to our patients, but it will also allow us to analyze these big data sets from our patients using computational data science and network theory to further develop automated quantitative tools to determine the best therapies for patients and improve the chance of cure from epilepsy. In addition, we will be able to study normal brain function by doing bedside tests with the patients undergoing intracranial EEG which will enable us to push forward the field of cognitive neuroscience.

For the Blind, Using the Brain to See 

Daniel Yoshor, MD, Charles Harrison Frazier Professor and chair of Neurosurgery

My long-term research goals are to understand how neural activity in the brain is linked to visual perception and to develop a cortical visual prosthetic device to restore vision to the blind, in collaboration with a larger team of scientists, engineers, and clinicians. 

The new Human Neurophysiology Research Laboratory will be built into to our new EMU in the Pavilion. It will enable us to carry out cutting-edge research studies in our epilepsy surgery patients better than any other center in the nation. This will help increase our understanding of how the human brain process information, and will advance the study of epilepsy, depression, OCD, and other neurological disorders. It will also accelerate the development of novel neurotechnologies that will restore neurologic function to patients, such as restoring vision to the blind.

Is Your Sense of Smell the Canary in the Coal Mine?

Jay Gottfried, PhD, Arthur H. Rubenstein Penn Integrates Knowledge Professor of Neurology and Psychology

Our research focuses on how odors at the nose are transformed into olfactory signals in the human brain. We use a multidisciplinary set of tools, including task-based functional MRI, intracranial EEG recordings in patients with medically-resistant seizures, and anatomical and cellular analysis of the human olfactory system. We are also conducting a study on smell loss in patients with suspected COVID-19, the goal being to predict whether more severe smell loss at the onset of illness is predictive of a more complicated long-term outcome.

The new pavilion will be instrumental in helping us advance the pace, caliber, and breadth of our intracranial EEG research in epilepsy patients. I expect these amplified resources will place the Perelman School of Medicine as the top U.S. academic medical center pushing the cutting edge of this type of research.

How the Brain Makes Sense of the World Around Us

Tim Lucas, MD, PhD, MHCI, an associate professor of Neurosurgery, and Max B. Kelz, MD, PhD, a distinguished professor of Anesthesiology & Critical Care and member of the Mahoney Institute for Neurological Sciences

I examine the neurophysiology of consciousness and sensory perception in an effort to develop sensory-brain machine interface devices to restore sensation to paralyzed individuals. We also perform gene therapy for neurodegenerative conditions.

In the Pavilion, our work will be trying to understand human consciousness. We all have thoughts, feelings, and emotions that happen within our brain that no one else can hear — those things define us and our souls. Our brains are receiving all kinds of sensory information 24/7 and, remarkably, our consciousness can filter out the vast majority of this and focus on just on the things it wants to focus on. If you’re sitting in an office chair, you could be sitting for eight hours and not feel your butt even though you’ve been sitting on it all day — the brain has mechanisms to filter out exogenous information. One of our questions is, how does the human brain do that?

In its broadest sense we are attempting to understand more about how the human brain processes the world around each of us. 

Investigating Decision-Making in the Brain to Illuminate Mental Health Disorders

Joshua Gold, PhD, Professor of Neuroscience, and Ashwin Ramayya, MD, PhD, neurosurgery resident

We aim to better understand how the human brain makes decisions, and to use that understanding to develop new ways to diagnose and treat clinical conditions that can affect our decision-making abilities, including attention deficit hyperactivity disorder, anxiety, depression, and schizophrenia. The Pavilion provides an unprecedented opportunity to directly measure human brain activity on the rapid time scales that support our cognitive abilities. We will collaborate with neurologists and neurosurgeons to better relate our basic-research findings to clinically relevant advances.

If a Tree Falls in the Woods, How Do You Know It’s a Tree?

Yale E. Cohen, PhD, a professor of Otorhinolaryngology, Neuroscience, and Bioengineering

My lab studies how we hear. We study how the brain interprets auditory stimuli as “sounds.” For example, how do we recognize that a fiddle is playing? How do we pay attention to a person’s voice — or ignore it?

We study this by testing behavior and by testing brain function. At the Pavilion, we will be able to conduct more sophisticated hearing studies and be able to collect better and more data. This will facilitate our interactions with the other faculty members in the group so that we can better examine the relationship between neural activity and perception as well as developing computational brain models.

Building New Technologies to Aid Epilepsy Patients

Brian Litt, MD, a professor of Neurology and Bioengineering

The new epilepsy unit will be a place where tons of systems neuroscience research converges — everything from basic science research to the stuff I do to develop and build devices for people with neurologic disease and epilepsy. We do a lot of brain implants and every one of those patients is part of research to understand brain networks, health, and disease. We’re working to build a computer-aided epilepsy surgery to figure out exactly where in the brain networks we need to make a lesion with a laser to stop seizures.

The work I do also facilitates the work of other faculty members all converging on the study and care of the brain with neuroengineering — engineering technologies to understand normal and disease networks in the brain so we can build new diagnostic and therapeutic technologies.



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