November 9th, 2015 Text by WebContent
One of the main lines of research among BRAINN’s diverse studies is trying to better understand and treat epilepsy. This neurological condition affects about 1% of the world population – in Brazil, Ministry of Health´s data for 2013 indicates that there were 228 cases per 100 thousand inhabitants. It is a high number of people that live with a treatable, but yet incurable, condition, one that can trigger seizures at any time. Therefore, research in this area is urgent and extremely important.
“We are trying to understand epilepsy under many aspects”, says Fernando Cendes, researcher responsible for the CEPID. “Examples of our research include studying how the disease progresses over time, what is its relation to cognitive disorders (such as memory impairments) and, especially, why some patients respond to medicine and others don’t”.
EPILEPSY: WHAT IS IT? WHAT ARE THE CAUSES?
Epilepsy occurs when a set of brain cells behaves in a hyper excitable manner – they become very active. When this happens, the electrical signals of this region become disorganized, and that can lead to seizures.
There are many different types of epilepsy and various factors that may cause them, both genetic and environmental. Genetic factors can be inherited (they come from the family) or not. Sometimes infections, medications, radiation and other factors can lead to genetic damage (not hereditary) that cause epilepsy. Environmental causes, such as head trauma, can also lead to the development of the disease.
There are different types of epilepsy, and there are also different types of epileptical crises. The most common one is the seizure.
“Epileptogenesis (the epilepsy development process) is very complex and varies from person to person,” explains Cendes. “The type of epilepsy depends on the characteristics of the injury, the brain region where it occurred, the patient’s age, among other factors”.
“Even two people of the same age, who suffer the exact same injury, may react in completely different ways,” explained the neuroscientist.
TREATMENTS – BRAZIL AS A REFERENCE IN THE SURGICAL FIELD
Faced with a variety of “types” of epilepsy, scientists and doctors have no standard treatment for all of them. The condition can be treated with medication or surgery. Cendes explains that about 70% of people respond well to drug treatments and are able to control seizures through them. One of the main questions that the researcher and his group try to answer is why the other 30% don’t have satisfactory results only with medication.
Research projects are now seeking genetic factors by analyzing DNA and brain tissue. But the results still take some time to come. For most of these patients, a more immediate option is surgery to remove the set of brain cells responsible for the crises.
Surgery for Epilepsy
Epilepsy surgery is very invasive, as it needs to go directly into the structure of the brain. For this reason, dozens of previous examinations need to be made and various criteria filled. The first one is that the patient should not respond to drug treatments. If this happens, neuroimaging tests will be done, such as MRI and fMRI, which will teach doctors where the brain injury responsible for the crisis is located.
Before surgery, it is necessary that exams show a well located and well delimited affected region.
Furthermore, it is essential to determine whether the removal of this area will not cause any cognitive impairment in the patient – that is, making sure that he won´t have memory problems, language problems, or any other type of complications after the intervention.
“We try to obtain the largest possible amount of information before performing a surgery”, says Cendes. “If surgery is recommended, we are in a privileged place. Brazil is far ahead than any other Latin America country in this area. Here at Unicamp’s HC, we have a great epilepsy surgery program”.
“We perform an average of one surgery per week. Next month, we will complete 500 surgeries. And, after these procedures, approximately 70% of our patients become seizure-free, a success rate of international standards”, says the researcher.
FURTHER UNDERSTANDING EPILEPSY
In addition to studying what leads to the development of epilepsy, BRAINN researchers are also interested in preventing the condition. These lines of research try to find new biomarkers for epilepsy.
Biomarkers are factors of our organism that vary according to the presence or absence of a disease. Once identified, they can help predict, for example, whether a patient will have a good or bad response to a drug treatment, or whether or not it would be worth to have surgery. This way, surgeries with a very low probability of success can be avoided.
“We search for different types of biomarkers – they can be molecular, related to brain images or to any quantitative data”, says Cendes.
As the unpredictability of crises is one of the worst factors for those who have epilepsy and can lead to serious accidents, another BRAINN line of research aims to develop algorithms which can predict crises minutes – or even seconds – in advance.
Epilepsy is one of BRAINN’s main lines of research. The group´s scientists employ state of the art techniques to reveal details on all aspects of the disease, from its origin to its progression and treatments. And – as if it was not enough! – they still actively work on improving the lives of patients by providing medical treatment of the highest quality to the population.
Learn more about epilepsy by watching the videos of ABCérebro TV, produced by BRAINN researcher and ambassador of epilepsy in Brazil, Dr. Li Li Min.