Robert Wood Johnson University Hospital (RWJUH) and Rutgers Robert Wood Johnson Medical School (RWJMS) neurosurgeon Hai Sun, MD, PhD, has been awarded a five-year, $2.9 million research grant from the National Institutes of Health (NIH) to support a groundbreaking study aimed at improving the accuracy of pre-surgical mapping and planning for patients who seek surgery as a treatment option for epilepsy. RWJUH is a RWJBarnabas Health facility.
Sun is also professor and assistant director of research; assistant residency program director; vice chair of clinical affairs at RWJMS and chief of neurosurgery at RWJUH.
Sun’s research will use advanced brain monitoring and computational analysis to identify the critical nodes (choke points) of the brain networks that trigger seizures. The goal is to establish a standardized approach for planning epilepsy surgery, which will help physicians identify the most effective surgical targets to improve outcomes for patients whose seizures cannot be controlled with medication.
“If medication is not adequately controlling a patient’s seizures, he or she may not be able to drive, work, or live independently, it can be very impactful on their well-being and quality of life,” Sun explains. “Surgery has proven to be effective in eliminating or reducing seizures in patients who do not respond to medications.”
While current diagnostic techniques such as scalp and intracranial electroencephalogram (EEG) and MRI are effective in helping clinicians identify areas of the brain that are causing seizures, their precision can be limited.
“Before performing surgery, we need to determine where the seizure is coming from,” Sun notes. “In some cases, the seizure zone may encompass a large area of the brain. We can’t resect (surgically remove) the area of the brain because some of these areas may impact language and motor skills.”
According to Sun, there is a new focus in epilepsy research and treatment on “the networks of the brain that are causing seizures.”
“We hope to identify the critical nodes (choke points) that are composed of these networks that are triggering the seizures to determine if they can be safely resected or mitigated through neuromodulation,” Sun explains. “The goal is to disrupt the nodes transmitting the signals causing the seizures. By targeting these choke points rather than the large area of the brain, we hope to make the surgery safer and more efficacious for the patients.”
Neurostimulation (sometimes called neuromodulation) treatment for epilepsy is a way of using electrical current to help calm the brain and reduce seizures. Unlike conventional surgery, neurostimulation doesn’t require removal of brain tissue and is a good alternative to resection when the targets are important for neurological function.
To define the choke points of these networks, Sun’s team will compare intracranial EEG signals from the rest period with those at seizure onset.
“We believe the choke points drive the transition between the rest period and a seizure. Focusing on this transition is the novelty of our approach,” Sun says.
Using a combination of data from laboratory models and patients, Sun and his team will compare the surgical targets defined using the current methodology with the new approach being developed by his research. If successful, the team plans to demonstrate the efficacy of their method through a prospective clinical trial so that it can become standard care for patients being considered for surgery.
The current study will enroll patients at RWJUH, Cooperman Barnabas Medical Center, and Emory University Hospital. Ezequiel Gleichgerrcht, MD, PhD, an assistant professor in neurology at Emory and a co-investigator, will lead the study at the site.
“Surgical treatment is superior to medical treatment,” Sun explains. “You can only adjust a patient’s medication so much. Currently, only about half of the patients being considered for surgery actually receive surgical treatment. And, only about half of patients undergoing surgical treatment are seizure-free. We are aiming to improve these numbers so that more patients can get the treatment they need and more can live without seizures. We are grateful for this grant, which will be critical to our goals.”
This is the second NIH grant that Sun has received for research on surgical procedures for seizure disorders. A year ago, Sun was awarded a $2.8M NIH grant to develop new implanted neurostimulation devices to prevent seizures.
Funding for this study was provided by the National Institutes of Health (NIH)’s National Institute of Neurological Disorders and Stroke, under award number 1RO1NS148383-01 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.