Computer algorithms can significantly facilitate the work of surgeons when, for example, they measure the thickness of a bone from images or determine where exactly the cerebral cortex is located. Currently, Janča and his colleagues are preparing a publication in which they will summarize the work of the last ten years.
“The operated areas of the brain shrink significantly. This means that the treatment is more targeted, more precise, while maintaining the same success rate. The intention is that the patient no longer has seizures after the operation,” explained Janča.
“Today, our teams are able to operate on patients they would never have dared to operate on before,” added the scientist, who has been working on the topic for thirteen years.
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It is part of the EpiRec consortium, which deals with epilepsy from basic research, where experiments are done on cells, to working with the patient.
“In this project, four institutions come together: the Institute of Physiology of the Academy of Sciences, CTU, the 2nd Faculty of Medicine of Charles University and the Motol University Hospital. Altogether there are about eighty of us,” said Janča.
In Motola, the mentioned modern technologies are used both in the diagnosis and for the treatment of epilepsy. The team at CTU has only five members, but it plays a key role.
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His work begins by identifying a “suspected” area in the brain that could be causing the seizures. Scientists have developed algorithms that are capable of sharpening images from examinations and pointing out abnormal parts of the brain themselves.
The researchers then create a three-dimensional model of the brain. Thanks to this, the surgeon can see exactly where the electrodes will be inserted into the patient, which then monitor the activity in the brain.
“They are inserted through holes in the skull. The algorithm can accurately measure not only the thickness of the bone, but also the angle between the electrode and the surface of the skull. The surgeon knows in advance how difficult the drilling will be,” described the expert.
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Computer programs are also involved in the subsequent measurement of brain activity. “They can find connections between individual parts of the brain, how they communicate with each other, and find out where the epileptic seizure is spreading. In this way, they help an experienced neurologist,” explained Janča.
During the procedure itself, when part of the brain is removed, the operators must proceed with particular care so as not to hit the centers of speech or movement.
“We helped develop a method where the patient’s cerebral cortex is stimulated in the hall, thereby causing muscle twitching. When the surgeon approaches this brain area during surgery, we can tell by the behavior of the muscle. The operator stops, otherwise the patient could, for example, become paralyzed in a limb,” explained the scientist.
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They also come from Slovenia
Together with his colleagues, Janča also modified the given stimuli so that they could be used with children.
“Previously, half of the children didn’t get the answers in their muscles. I don’t want to say that the surgeon operated blindly, but he was not so sure. It could therefore happen that he performed the operation to an insufficient extent, so that the child patient also had epileptic seizures after it. Or, on the contrary, it could have been too radical and thereby affected the limb’s momentum,” described the researcher, who also participates in the operations themselves in a supporting role.
During the aforementioned thirteen years of research, approximately 150 patients with the most serious forms of epilepsy tried these modern methods, in addition to Czech patients, there were also those from Slovakia and Slovenia. Czech scientists also share their valuable experience with foreign universities, most recently with the University of Ghent, Belgium.
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Tags: Previously intractable cases epilepsy managed doctors algorithms
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