Australian-Doctor-Ar

News Review Getting ahead of EPILEPSY Ou’ve no doubt heard Could developments in medical bionics lead researchers permanently implanting elec- about the bionic eye and trodes on the surface of the brain the cochlear implant — to the ‘Holy Grail’ for treating epilepsy? to monitor electrical activity 24 Ysome of the most famous hours a day. A pacemaker-like developments in the fast-growing MEGAN HOWE device implanted under the clavi- world of medical bionics. cle records the information and But Professor Mark Cook is qui- transmits the records, analyses etly optimistic that an even bigger and real-time ambulatory iEEG group of patients — the 15 million them from working, threatens better, what if the seizure could be unpredictable condition a real pos- data to a small pager-sized device people worldwide whose lives are their safety, costs their life some- averted completely? sibility. that the patient carries with them. disabled by uncontrolled epilepsy times.” A compact, driven man with One of the first implantable It has a series of coloured lights: — have reason to hope they could But imagine if people with epi- the knack of explaining exactly devices to be trialled in humans — blue indicates a very low risk of be offered new, more effective lepsy could know when a seizure what his complex research could including 15 Australian patients seizures, white indicates a medium therapies in the not-too-distant was going to occur. And what mean to patients, Professor Cook — is the Seizure Advisory System, risk and red indicates a very high future, thanks to developments in if the drugs to treat the seizure told the conference that ground- which predicts when a seizure is risk. neurobionics. could be delivered directly to the breaking Australian research into likely to occur. “If effective, it would remove a Currently, of the one in 100 affected part of the brain, exactly implantable devices is now mak- Developed by US company lot of the disability from people people worldwide who suffer when they are needed. Or, even ing that kind of control over this NeuroVista, the system involves with seizures — it might let them recurrent seizures throughout their get to work, play sport, conceiv- lives, about one-third cannot be Neurologist Professor ably even drive. It might be that adequately treated with available Mark Cook tells the you can provide therapies when medications or surgical therapies, Wollongong TEDx event their status changes on the record- the Melbourne neurologist and how neurobionics ing,” Professor Cook says. world leader in epilepsy treatment could help people with While the device hasn’t proved told the recent TEDx Wollongong epilepsy. the answer for all the Australian event at the University of Wollon- trial participants — some have had gong, NSW. it removed and some have gone on “A lot of the problem with epi- to have surgery — for young Tas- lepsy relates to its unpredictability. manian Jason Dent it has been life- We have to soak people in medica- changing. tions to prevent seizures that might In an interview with Epilepsy be occurring for only a few min- Australia 10 months after the utes a year,” says Professor Cook, device was implanted, Jason said head of neurology at St Vincent’s that when a red light appeared on Hospital, Melbourne and chair of the monitor, he took fast-acting medicine at the University of Mel- medication. As a result, the sei- bourne. zures that had previously dom- “It prevents them driving, stops cont’d next page www.australiandoctor.com.au 10 August 2012 | Australian Doctor | 21 NEWS REVIEW from previous page The potential of these DIAGRAM OF A DEVICE (LEFT): Arrays of electrodes surgically implanted on inated his life — occurring the surface of the brain will monitor the complex patterns of brain activity. suddenly and without warning — devices goes beyond These signals will be sent to a processor (similar to a bionic ear stimulator) had completely stopped. simply predicting the and proceed to detect/predict the epileptic seizure. Once a seizure is detected, “I feel more confident in the a therapeutic electrical stimulus can be applied to the electrodes in the Epilepsy: the impact appropriate area of the brain to suppress the seizure. things that I do from day to day onset of a seizure. and I enjoy the fact that I am not Image courtesy of Bionics Institute. having seizures every fortnight,” Among epileptic people and their family members he said. “I feel like I have more control over my life, as before the seizure would come with no warning and stop me doing the things 55% 48% 16% 49% 78% 61% 33% that I love doing, like my cricket had been injured as considered they had had full-time jobs were living below faced medicine were on multiple reported full control and timekeeping at the local footy a result of a seizure, been unfairly treated even though the the current poverty costs between $11 medicines for (ie, no seizures games.” with 64% of those because of their majority were of line and $300 per month epilepsy over 12 months) Professor Cook says Jason’s requiring hospital epilepsy at some working age implant remains in place and, treatment for their stage in their lives The new research is finally shin- sor Cook and fellow researchers hopefully, can stay there forever. injuries ing a light at the end of a long tun- stated: “The Holy Grail has so “Suddenly this changes every- nel for the many people who have far eluded researchers in the field, thing.” unpredictable and debilitating however, strong progress is being In fact, the potential of these epileptic seizures, says Epilepsy made.” devices goes beyond simply pre- Findings of survey of 343 participants on the Australian Epilepsy Research Register, 87% of whom were people with Australia chief executive Denise So are they truly within sight of dicting the onset of a seizure. epilepsy and 13% were family members and carers. Chapman. epilepsy’s Holy Grail?” “Conceivably you could use Source: ‘Out of the Shadows’: Needs, Perceptions and Experiences of People Living with Epilepsy in Those people face constant anx- “I used that term about being devices like these to actually con- Australia. Findings from Wave 2 of the Longitudinal Survey, Epilepsy Foundation of Victoria, March 2012. iety about when a seizure might able to predict seizures and peo- trol the release of drugs,” says Pro- occur, meaning both the loss of ple ridiculed me,’’ Professor Cook fessor Cook. their independence and serious admits. “We’ve got the old system To try and make this vision a risks to their health. where you ingest drugs and they reality, he approached nanobion- the drugs we have in polymers and This would be remarkable.” ficult to understand what is possi- infused implants are a couple of St Vincent’s Hospital, Melbourne. “I think it’s wonderful, it’s a soak the whole brain. Imagine if ics pioneer Professor Gordon Wal- we implant them — at the moment ble if you have never had exposure years away but Professor Cook Rather than predicting seizures, very exciting development,” she you could put the solution where lace, founder and director of the in animals only … over the surface Marriage of two worlds to what people in this area can says it is entirely plausible that we the implantable stimulator device says. “What promise it can hold the problem is. I think that is a bit University of Wollongong Intel- of the brain in the part where the The epilepsy research he is con- do.” could see such devices available to will monitor the electrical activ- for people with very difficult to of a therapeutic Holy Grail.” l ligent Polymer Research Institute, seizures come from.” ducting with the Intelligent Poly- While there are still big hurdles treat uncontrolled epilepsy within ity of the brain via electrodes. control epilepsy to have that con- and told him he wanted to “put Eventually, the electrically acti- mer Research Institute and the to overcome — the formation of 5-10 years. If abnormal neural activity is trol and independence, to feel they You can view the TEDx drugs where they work”. vated polymers might be able to Bionics Institute at the Univer- suitable polymers for diffusing the And if the polymer implants detected, a therapeutic waveform can contribute and get out and Wollongong conference Not having to give antiepileptics actually drive drug release, he says. sity of Melbourne marks a long- drugs, finding the optimal medica- do not prove the answer, he says is then delivered to the right part work and participate in commu- @ talks online via www. systemically could avoid the dam- “Conceivably, we could construct overdue marriage of two scientific tions and ensuring the implants another approach to suppressing of the brain to stop the seizure (see nity life, “she says. “It could really tedxuwollongong. aging side effects medication has polymer implants, which could not worlds, says Professor Cook. are safe to use in humans — there seizures — electrical stimulation of image above). open doors.” com, or watch Professor Mark on the CNS and elsewhere in the only release the drug but detect the “I have always been interested is an air of optimism among those the brain — is also under investi- “It might liberate us altogether In a recently published paper on Cook’s presentation here: www. body.ELB0185_AD_193x540. pdf Page 1 20/ 06/ 12,seizure 11:and use 22 the AMenergy in the in how to join the medical sciences in the field. gation in a project run by the Bion- of the need to take medications to their research into drug-infused tedxuwollongong.com/Mark-Cook “So that’s what we do.

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