JEDDAH — The surgical treatment of medically intractable epilepsy was the main focus of the second day of the Brain Forum being held at the Laylaty Hall in Jeddah. Sponsored and organized by Walid Juffali, the meeting has brought together leading specialists in neurology to talk about their latest research. Professor Thomas Grunwald of the Swiss Epilepsy Center in Zurich gave a fascinating lecture on how he and his colleagues at the center have been able to scan the brains of epilepsy sufferers who did not respond to drug treatment, discover which part of the brain was causing the attacks and then surgically remove that part of the brain. In all of the cases he presented, the patients showed a full recovery from epileptic seizures. “Surgery can cure 18 percent of epilepsy patients as long as the exact location in the brain that is causing the problems can be found and extracted without causing any other problems,” said Grunwald. “We use MRIs to find these areas — a cure can be had in 70-80 percent of these cases by removing problematic tissue. For difficult cases we have to use intra-cranial electrodes to investigate their brains — these patients cannot have their brains monitored just with electrodes placed on their skull.” Grunwald related the case of an 11-year-old male patient of his who had gelastic seizures during which he used to laugh uncontrollably during the seizures. “But it was laughter without mirth as he didn't enjoy it — and sometimes it was accompanied with urination and defecation,” explained Grunwald. Four MRI exams of his brain over several years were inconclusive. Patients with this form of epilepsy cannot drive and may drown in their baths if left alone during an attack. Grunwald finally decided to place strips of electrodes on his frontal lobe to record his seizures. “I tested the patient by stimulating his brain with impulses and caused a seizure in him. I filmed him laughing,” said Grunwald as he showed the audience a video of the boy laughing while lying down in a bed. Grunwald said that the boy had 20-30 seizures such as these every day and that he was unconscious during each seizure. He added that it was very dangerous for someone so young to go to school without special precautions. “I removed the part of his brain that was causing the seizures and now he is 16 and rides horses and will be able to drive a car later. He's been seizure-free now for four years,” said Grunwald. But he pointed out that not all epilepsy sufferers are candidates for such treatment as in some of them the parts of their brains causing the seizures may be too crucial to remove. According to the Swiss researcher there are 270,000 sufferers of epilepsy in Saudi Arabia, with 180,000 of these seizure-free through the use of anti-epilepsy medication, and 27,000 seizure-free following brain operations. The mortality rate for epilepsy sufferers in the Kingdom is 3.9 for every 1,000, and there are approximately 2,000 deaths a year in the country caused by epilepsy attacks either through burns, trauma, drowning, asphyxiation and aspiration. Grunwald said the medical community globally needed to reach more epilepsy patients, develop new anti-epileptic drugs, and do more research in epilepsy surgery and presurgical evaluations. Grunwald also stressed that improved epilepsy seizure detection and prediction technology is needed, which was the topic of the next speaker. Predicting epileptic seizures Jamil El-Imad, the managing director of NeuroPro, a Swiss-based medical technology research, design and commercialization company, talked about the latest device that his company is testing to help predict epileptic attacks. NeuroPo is funded by the W Medical Fund, founded by Walid Juffali. This device was featured at a booth in the exhibition portion of the Brain Forum. The device is like an open helmet that an epilepsy-sufferer places on their head, and electrodes measure the brain waves sending the signals to an iPad loaded with special software that processes the data and warns the user when it detects an impending attack. “The biggest challenge is cleaning up all the noise that these devices pick up. We will start clinical trials next year, in 2014,” said El-Imad. Advances in neuroscience and technology Wolfgang Knecht, the managing director of the Neuroscience Center at Zurich University, talked about the advances in neuroscience and technology. “We are doing research in the regeneration of injured nerve fibers. These things take time. We are also working on immunotherapy for Alzheimer's disease,” said Knecht. “To study the removal of plaque in the brains of Alzheimer's sufferers we were part of a global drug trial, but there were side effects as some patients got meningitis. We found out through this research that there are antibodies in healthy patients that prevent them from developing Alzheimer's disease,” he added. Knecht said that they were also doing research in neuro-rehabilitation using intelligent robotics. “We also used deep brain stimulation for spinal cord injuries. The first trial in rats was in 2013. They had lesions at 20 percent, were completely paralyzed, and they were able to walk again following the treatment. We used electrodes placed in specific areas of their brains and sent currents through them,” he added. “We invite Saudi PhD students to come do research with us, and we hope to set up a neurological campus soon at Zurich University,” said Knecht. How gut hormones regulate our appetite Professor Sir Stephen Bloom, head of the diabetes division at Imperial College in London, presented findings of his research on how gut hormones affect appetite and how some sort of cocktail therapy of various peptides could have the same weight-loss effects and health benefits as surgical bypass surgery. “For most mammals if you're not fat then you are dead,” said Bloom. “We have now found that various hormones in our guts control our appetite and that many overweight individuals lack these hormones.” He added that his research has found that to successfully control appetite and cause weight loss in overweight patients, a combination of specific peptides should be administered to them. “We would want to see similar results as those found after bariatric surgeries in which the incidence of cancer and heart attacks is cut in half in patients,” Bloom explained. According to Bloom there are 3 billion obese people in the world and 800 obesity-related deaths every week in the United Kingdom alone. “There is no sufficiently safe medication currently on the market for weight loss that I would take myself,” admitted Bloom, saying this was why research into these hunger-regulating peptides was so important and promising.
