Join us as we learn about MEG technology and how it is used to improve epilepsy surgery outcomes for patients. Elizabeth Davenport, Ph.D., Technical Director for the UT Southwestern Magnetoencephalography (MEG) Center of Excellence, shares about harnessing the power of this technology for diagnosis and treatment with pinpointing where a patient's seizure originates in their brain. Additionally, Sasha Alick Lindstrom, M.D., UT Southwestern Triple Boarded Neurologist and Chief Neurophysiologist/Epileptologist for the MEG Program, shares details about her work in caring for patients with epilepsy and how she uses technology tools like the MEG with the latest medications and treatments to find the best options for each patient. Find out more about the work these doctors are doing to determine a surgical plan that can relieve seizures, reduce functional risk, and allow their patients to maintain or improve their quality of life.
Good evening everyone Welcome to our newest episode of the UT Southwestern Science Cafe. We hope your summer is fantastic and that each of you have stayed healthy and in good spirits. We're glad to be back on the air with you and for our regulars were glad to and for our new guests were so pleased to meet you this evening. My name is jenny King and I leave the public affairs team at UT Southwestern on behalf of of my new public affairs colleagues channel under Thompson and Gioia lang as well as our guest speakers, Dr Sasha alec Lindstrom and dr Elizabeth Davenport Report. Thank you for joining us tonight. Science cafes are online conversations where our speakers take you on deep dives into science topics. We want to have fun while we learn our format is casual and interactive and we encourage you to ask questions and engage with Graham. This evening we will be discussing magnificent brains mapping the path to a cure for seizures before we get started. We do have a few technical matters to briefly mention. So here we go we are recording tonight's program and also live streaming it on our UT Southwestern twitter page, please go ahead and mute your microphones to help with everyone's audio clarity and just unmute yourself if you were called on to ask a question, we encourage you to utilize the chat feature to list questions for both doctors. We did receive a number of great questions in advance and we will also reference those. We will start Q and A. At the conclusion of both presentations, Joya will be facilitating Q and a carl Landry and I are monitoring the questions chat box. Finally, just a reminder while we cannot answer personal medical questions, we would love to hear from you with your general questions about epilepsy and the meg. And with that I'm very pleased to introduce our presenters. My script went away from me. Dr Sasha alec Lindstrom is a UT Southwestern triple boarded neurologist and chief neurophysiologist, an epileptic ologists for the MEg program. She specializes in the diagnosis and care of patients with epilepsy using the latest medications and treatments to find the best options for each patient. Dr Elizabeth moody Davenport's serves as a technical director for the magneto and cephalon graffiti or the meg Center of Excellence here at UT Southwestern. She will share about harnessing the power of this technology for diagnosis and treatment with pinpointing patient's seizure originates in their brain gioia is pasting bio links for both doctors into the chat and please click through to read all about them and their amazing, extensive work to you both. Welcome to Science cafe and to Dr alec Lindstrom. The virtual podium is yours awesome. Hello everyone. Thanks for joining us. Bear with me. My voice is not the best tonight. It's those allergies. Um let's see if this will advance. I just needed to switch. There we go. There we go. Perfect. So I will be covering um more of the clinical part of epilepsy. So we'll cover the basics the medications went to seek higher level of care like at a center level four center like our center here at UT Southwestern. Um what other options we have and what the pre surgical process entails and where we can go after that. Either surgery lasers and all the different uh neuro stimulation devices that we have available which are currently three. Let's start with some definitions in terms of an epileptic seizure. So it is basically a transient occurrence or signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. And so epilepsy is a chronic disorder, the Hallmark Hallmark being um recurrent unprovoked seizures. So a person is diagnosed with the epilepsy whenever they have two seizures more than 24 hours apart or a seizure and the higher likelihood of having a subsequent seizure either by E. G. Or suspected syndrome or exam or any lesion in the brain or whatnot. So for the purposes of simplicity and today's talk, we're gonna talk about two major types. We have focal epilepsy which is formally called partial epilepsy. Um and that can be uh focal with retained awareness or focal with impaired awareness, which is formally called complex partial seizures and then the generalized epilepsy. And then the third category would be you know whenever you don't see the onset and you don't know which which could be um unknown. So now you know what epilepsy is right um Not quite. So what else do you have to consider whenever you have somebody in front of you and they say, oh I have epilepsy whatnot. So epilepsy is a lot more than just having seizures, right? It's keeping in mind all the potential triggers. Um You know, a lot of people talk about photosensitivity and like lights and whatnot, but really it's a lot more, you know, like if they miss meds or if they're sleep deprived or even stress or any number of things, everybody's different, right? And then um how about medication? You know, whatever is good for this person is not gonna be good for another person or they can't tolerate it, which means they're not gonna take it. And of course they're gonna have seizures and they could have allergies to the medication or intolerable side effects or you know, if it's gonna sedate you and you can't work or function, you're not gonna take it, right? And for example, there's mess that you have to take, like 23 times a day and you're gonna forget a dose. I know that whenever I'm gonna antibiotics or whatever, I'll forget a dose. So, so I mean, there's like one a day dose thing that you can take in bedtime and whatnot to help that, you know, also financial constraints, there's no point in prescribing a medication that they can't afford, Like I really, really, really dislike it whenever somebody comes to me from someone else and then they're like, oh they prescribed this medication for me and I'm like, oh, yeah, it's the latest and the greatest, but it's very expensive. Of course, you haven't started it, you're not gonna be able to afford it, I wouldn't want to pay for it, you know. Um Another thing would be sleep, not only the duration, but the quality of their sleep, sleep is super important, and in epilepsy, you need need need to cover sleep hygiene, good quality sleep, make sure they don't have sleep apnea because that will lower the seizure threshold and can contribute to poor control of the disorder. Another thing is mood, mood anxiety. Those are huge comorbidities or things that go along with having a seizure disorder and living with, with, with seizures, right? And just mental health in general, it's always good to kind of inquire about that because it's kind of tough, you know, to, you know, just bring it up in a meet in a, in an appointment. So I just like to ask about that and we actually scream for that as well. And we have a good team for that because it's, it's pretty, quite common, you know, we have a specialized team here, right? Exactly, psychiatry. Exactly, yes. Yes. And another thing would be, I mean, personal goals and values been family planning. I mean, we have a lot of young women who have been told, oh, I can't get pregnant or whatnot, or oh, they told me you have to have a hysterectomy when that's really not true. I mean, if you plan in advance, you can get them on the right meds, get them under good control and make sure they're on folic acid and just take the proper steps and and get the right medication levels and test them and make sure that everything's in order in order to have a healthy successful pregnancy and whatnot. And some people, which is, it sounds kind of simple, but some people will actually just say, my goal is I want to drive and like something that you take for granted as driving and sometimes, like, I hate driving in traffic here. I mean, some people want to do that. You know, it's independence. Um you also want to ask if they're drinking alcohol or doing any drugs and a lot of people do that to cope with the mental health issues, you know, that they've been encountering, but that also will lead to four seizure control and and other health issues. And then um make sure to cover seizure first aid, make sure that people around them know what to do in case of a seizure, have an education plan or any accommodations at work or in school or whatnot. And also ask them, like, do they feel like a warning sign or nora before they have a seizure blackout because that can always help us determine like where in the brain, the seizures might be coming from and we use that to create the hypothesis of where in the brain they be coming from. And you've seen this in conference. Yeah, it's really interesting, you know, and the other thing is a seizure diary. People come in and I'm like, oh, how have you been since the last appointment? Oh, great. Have you had any seizures? Yep. Um, like how many? And when? I don't know, a handful? Oh, my. How about that seizure diary? It's great. I mean, nowadays there's apps on your phone, you can write it down and like even bring me a little note pad, your phone, anything. Keep a little notebook, we give you like a little seizure diary too. So you can put down like I had a seizure. It was a trigger, any specific kind of details about it, you know, and you start learning if there's a pattern or any triggers or anything and if you're a woman, also, if there's any hormonal influence over the pattern of procedures, because that can also let us know you need to do any hormonal treatment or what not to control your seizure disorder. So There are over 30 seizure medications in the market nowadays. And unfortunately, even though we have all these options, all with their pluses and minuses and side effects and benefits and whatnot. There is no evidence that we've gotten any further in controlling seizure disorders. There's still, like a third of patients that will become refractory to meds meaning they won't respond to meds. So there's a third of patients that meds will not work for. And that's basically what we specialize in here. And this is why I love this team. And the multidisciplinary approach that we take care. So that third of patients is called, they're in a group called er er, a drug resistant epilepsy, right? And the proper thing to do is whenever you fail two or more properly chosen medications that are tolerated and everything and you're still having seizures. I mean, once you go to the third and further meds, the chance that you'll be seizure free alone on meds drops to like under 4% or so. So it's like slim chance. And we like those people to get referred sooner rather than later because we have better odds of controlling their seizures, right? And they don't take a hit like cognitively or memory wise, food wise, whatnot. So you did a very good job jenny and saying epileptic ologists, which is you got both of them right, Which is also known as a seizure specialist like myself and it's basically a neurologist to specialize in the treatment of epilepsy. So all I do all day every day is um care for people with epilepsy and work on research and whatnot. And just basically my life revolves around epilepsy and read studies. Don't forget this. Yeah, Yeah. And so basically it takes a lot of training. You finish what uh school, high school college medical school intern ear neurology. Then you do the neurophysiology. How long is residency again? Four years And then on top of becoming a neurologist then you do clinical neurophysiology and epilepsy. And so we know what we're doing. Yeah. So where can you find this? Where can you find me? Well I wish this was a joke but usually we're really in poorly lit rooms with no windows staring at squiggly lines and uh yeah. Uh That's what my office looks like. Uh But really um you could conduct internet searches. You know, make sure they're board certified and in the field that I said epilepsy foundation website A s. Academic medical centers. Just make sure that if you have failed two or more matter what not that you can be proactive and look for a center like us. So the pre surgical work up. We're gonna go over it. It's really complicated. We're gonna go over it super fast speed. But so E. M. U. The epilepsy monitoring unit. That's the Phase one monitoring. By that point you've already had an e.g. Yeah. And do we want to do the pole and see if they know E. G. S. Let's see. Let's see. Let's see if I can do this. We can start with that one. Yeah. How many of you? So we'll do two polls at once. How many of you know someone with epilepsy. So we'll see what the prevalence in our audience is. We're going to turn into epidemiologists for a second and study prevalence. Very nerdy joke. Yeah. All right. looks like we've got almost 80% coming in now so I'm gonna go ahead and share the results. And so it looks about 62% of the people here know somebody without flopsy. Alright. It always like blows my mind how I mean the stats say like one in 26 people here will develop epilepsy in their lifetime. So it's pretty common. I was really surprised when I first started working with you guys That how like it's not always that onsets of childhood. I always thought it was something you were born with and you always had but no it can onset like even in people in their 40s and 50s, which was surprising to me when I first started learning. Alright so do we want to do, what does E. E. G. Measure? So it can measure electrical activity in the brain? The text hairdressing skills. It's very critical for them to have great ability to pretty good and fast. Yeah. Or the patient's aura Looks like we're we're 100%. I know they're too smart. They got our question. Alright so go ahead in polling. So 100% of you guessed correctly. We're doing more new correctly. Uh it measures the electrical activity in the brain. Okay so now we have that established so we can proceed. So in the E. M. U. The epilepsy monitoring unit you'll come in for phase one or scalp monitoring. We usually like to say you join us for 3-5 days. Could be more could be less. We have two of them here that we all rotate through a Parkland and Clements and whatnot and they're fully staffed. You come in we do the E. G. And you're in your own room and you have video on you the whole time and we try to trigger seizures safely right And you have an I. D. And we can stop the seizures and whatnot. And the whole goal is being able to witness firsthand like what your seizures look like what your brain activity is doing during them and and basically study to see where they're coming from to be able to control them. Um There's a lot of tech that goes into that too like as an engineer. I was really excited because it's it's have video that's time locked with the signal from the brain. It's really cool. Yeah and neuropsychology testing. We have a great team of neuropsychologist that help us you know tease out like how their memory is how their cognition is how all the different functions are and and they weigh in whenever we need to discuss each and every case um Just so we make sure that there's concordance and you know like what functions in the brain are intact or which ones are like kind of deficient and make sure that it kind of lines up the functional M. R. I. Which I'll show a picture of it shows basically function in the brain just to keep it simple and we you know, we wanna control the seizures but we don't want to eliminate function so we don't want to touch and open cortex. So this will help us determine, you know for languages, motor and other modalities. So that's gonna be very keen a pack. Um It's been shown that areas that appear hypo metabolic or like down in terms of the uptake are areas that tend to generate seizures. So we kind of just put it all together like all the multi modal imaging and whatnot and what we've seen in the E. M. U. And what we see in the high resolution M. R. I. Within cuts and the bank which you will talk to us about very very soon. And we meet every week one of our many meetings and we put it all together and uh we create a plan. So. Oh I think I broke out of it. I broke it. Okay, so this is just a generic picture. I mean it's on our website, it's kind of what it looks like. There's dr Hayes, our fearless leader. Um One of the 12 of us in our team developed ologists and that's what it kind of looks like the patients, they're bandaged up one of our many great text sets it up. We have a screen there, there's a video whatnot. And you can have a family member stay or not. Things that are a little different now with Covid, but like everything, everything that I can't keep up. And there's kind of like the control station, like everybody's watched day and night, not in the bathroom, but you know, day and night, make sure that we're aware whenever they have seizures, either electrically or clinically or whatnot. And they also give you a push button so you can push it like if you feel like an aura or like you might have had a seizure or whatnot. And people like Russian, they help you and mark to study and it helps us kind of analyze it and they can test you. They can do thorough testing, which kind of helps to see if you're able to talk, follow commands, instructions, that kind of thing. And then we're able to review it. And we'll actually, and you're there, we actually see some videos and kind of break it down piece by piece and and and look at all the ancillary testing we do as well. I think one of my favorite things about the videos is when they have, they asked them to remember a series of words and the words That they come up with are silly and very interesting and but it's pink elephants. Yeah. three Blue Roses. It's but it's good. It's to test memory. Yeah. And we have examples here generic M. R. I. You know, we start off with that, you know, if there's a lesion meaning like a tumor or any area with like scarring or anything that you can go after. You know, the chances of you becoming seizure free or or higher. You know, you have an area if it's an area that you can take out, you do it great. But usually the cases here are not that simple. So we start with that and we do all the rest of the steps that we discussed previously and that's what the F. M. R. I looks like. And here we have the pet on the right side and you can see that area that appears down there you go. That kind of lines up with the area and the system that's lighting up, which is actually the subtraction of the other two superimposed on the M. R. I. But you see how we just, it's like putting together pieces of the puzzle. And I think that's like the challenging but very rewarding part of the job because because I like the team aspect and it's really like a puzzle. So then after that if we determine that we can do surgery or whatnot we do. But many times like I said, our cases are complicated and we may need more So that's when we may proceed to a stage to Phase two. And that means like directly in the brain. Nowadays a lot of it's being done, interpreted li like stereo E. G. And uh dr Legg our neurosurgeon uses a rosa a lot. Think of it like a robotic arm with like GPS to help and guide the electrodes in the brain wherever we hypothesize that they need to be because their seizure generators could be in those areas, right? And you see there were they drove a little holes in the in the skull and where they're placed and then they get connected. They come up to the E. M. U. Reconstructed whatnot. There's a picture of him, tiny picture and our clinical neurophysiologist extraordinaire dr podkoren tova, she's great. And then we do the same thing, bring them to the emu uh taper win off meds record seizure safely. But this time it's more precise because it's in the brain and then once again we meet and we discuss it and we try to put it together, right? I have not discussed the meg because even though we work together, I want to leave it to the expert and dr Davenport will take over. But this is a tiny picture. We haven't taken a recent picture because pandemic. Yeah. But this is like an old picture of like most of our village uh the epileptic ologists and I love it. But a lot of us aren't there like the technologist and the nurse practitioners and whatnot. But when I see yeah when I started going to conference I was amazed at the number of different disciplines that come in to help and like you know every case gets like scrutinized a lot of attention to every case meaning every patient is very scrutinized, every detail. I love I love working with you know like your ideology, your there um neuropsychology, uh neurosurgery psychiatry, all the trainees, I mean everybody's there. Yeah it's really great. It's like great meeting of the minds. Alright so I'm going to talk about meg. Um and so well here we go. So I'm gonna give you a tour. So we're actually sitting in the meg sweet right now. Um And this is what it looks like. So normally we would maybe have you here and give you a little tour. Um The other uh doctor there with me is dr Prosky bec she's another one of our meg scientists that works with the team. She's fantastic and she just joined us um as faculty two months ago I think that seems like it seems like forever. Yeah. Time is weird uh in the pandemic at least. Um So first I'm going to talk about um magnetic versus electric fields. So what you heard about was any G earlier or sorry E e g. Earlier E E. G. Is like we said measures the electrical conductivity and so here you get the electrical signal and it goes through all these different tissues. But it can it can be misleading because it can come out of the different tissues further away than it is from the source. So but you don't have a good precision with where it's gonna come out and so but those electrical fields also make magnetic fields. And this is true if you remember from high school physics if you have an electrical current you have a magnetic field that wraps around it. So here's this example where they're turning on the electricity and this wire and you can see the iron shavings making a circle around it showing you visualizing that magnetic field. Well that also happens in the brain when the neurons fire. They have these ionic currents that go through these electrochemical gradients. Your synapses are firing. And it also produces this magnetic field. Um And that's what we want to measure. Um And so it can actually come outside of the head and it travels really cleanly. So you have all of your neurons line up together and they all send a signal all at once. They're all thinking as a so to speak. And they also ended this very nice magnetic signal. And if we go back to our other example this magnetic field travels really cleanly through the different tissues. So we don't have to worry about it getting skewed or bouncing around and coming out at a misleading location. We know that where it's coming from better. Um So what I'm telling you is that telepathy is real. If you stand close enough you can't sorry we won't get close it's pandemic. If you stand close enough you can talk to someone with With magnetic fields, but that's not true. Um so the brain's magnetic field is on the Tesla scale. This is 10 to the negative. 15, the trillion times smaller than a frat a magnet you're gonna use on your fridge. And additionally the magnetic field decays at an exponential rate. So the further away you get from the brain, the less and less field you're gonna have and it's just gonna plummet exponentially. Uh This is kind of like trying to find a needle in a haystack, trying to find the signal. Another good example is trying to find a submarine in the ocean. Uh So in World War Two and during the Cold War, uh we always wanted to find the submarines in the ocean, right? Because they were kind of these hidden missiles that might attack the navy ships. So the earth has its natural magnetic field, the north pole and the south pole. And as the planes would fly along, they would actually have these magnetometers uh meters that would measure the magnetic field. And as they wrote, flew over the ocean, they would see this very nice magnetic field. But then when they flew over a submarine you would actually see this this abnormality in the magnetic field, telling you that there was a submarine there and their military still uses them today. And so the brain scientist had a meeting with these actually geophysicists and the military and said okay you're measuring these magnetic fields from way up. And it's this tiny signal by the time you get up into the sky where the planes are flying, we want to do something similar but in the brain which is just an odd meeting of different disciplines that made this. And so what they came up with was the superconducting quantum interference device for very informally known as the squid. And that is what Dr Cohen put into His new device that he called a meg. And they made the first measurement in 1971. It was I think it was actually 1968 but they published it in 1971. Um And here you can see this is somebody with their eyes open and then when you close your eyes your your amplitude goes up. It's a yeah, just like E. G. And so um this is now we have a non invasive technique for measuring the brain activity at a millisecond time scale with a lot of precision. Um So my next question for you guys is gonna be why is there this weird steel room around the sensor? Uh So we're gonna do a poll um What is the metal room for? To keep out noise? So the patients can sleep To keep out magnetic and electric noise or to keep the ghosts from interfering with the signal which is actually a real problem in our meg suite. We always joke that the ghost, there's something in here that makes the computers go wacky sometimes when something won't work. That's are excuses. Probably. Yeah, that's you. All right. Like we got about 60 getting there. I like that. Some people are voting for the ghost. It's a real it's a real problem. All right. So 93% of you are correct. It keeps out the magnetic and electric noise. An additional bonus is that it kind of keeps it quiet in here in the machine so that the patients can sleep while we're doing their test. Um Alright, so stop share and like out of that. Okay, so this is called a magnetically shielded room. It's made up of new metal that it diverts the lower frequencies and then aluminum that diverts the higher frequencies. So there is actually some basis to putting a tin foil hat on your head to keep the aliens out. I wouldn't recommend it though. I'm not sure how well that actually works. Um So that's actually what this is made of and this looks a little bit Star Wars. Just a little bit scary. The first one that they used um ours today looks a lot nicer. Um It's very white. The door is extremely heavy because it's made up of a couple tons of these different metals. Nu metal is actually only produced two places in the world. So you have to special order it from Germany. Um And the Germans were very excited when they came to try brisket, they loved it. They loved it. They were they were thrilled. They deliberate. And yeah, they were like anytime there needs to be another installation in texas, they were going to be here. Um So so our modern meg looks a lot nicer too. So we have 306 squids, not the animal, but the sensor and they sit around the head and like this kind of in a dark Vader shaped helmet. And then each of those sensors give us a tracing and that is what dr alec reads. Um And so when she reads through or she'll come to a spot in the in the study that there is an epileptic spike. Um something that an abnormal firing in the brain essentially. And so she will highlight that for me. Um and say, okay, I want to know where this is coming from in the brain. And so what we're gonna do is we're going to do something similar to what the gps locators do when you're trying to navigate your way around Dallas uh your phone is gonna send a pig. Nall being a signal. I can, I'm not, I'm not having historical promise, your phone is going to pick a signal up to the satellites and then those satellites are gonna all talk together. And geolocation where you came from. So if it tells you that there's bad traffic at 32.8 degrees north and 90 negative 96.8 degrees west. Sorry I don't know how to read gps coordinates. I should look that up beforehand. Um It's gonna be a little confusing. Right? You're you're going to say okay great there's there's there's traffic there but what does that mean? So you wanna know the structures that you're around as well? So now that I've overlaid it with the ST max I can tell you that the oh it's on I. 35 east near the inward exit. Um And so we're gonna do the same thing but with an M. R. I. And so this is my M. R. I. Scrolling through from top to bottom to brain. That's my brain. She's gonna read it now. There's gonna be some concerns so and then we have we can actually reconstruct it in three D. So this is my self portrait. Um And when now we know the shape of not only the patient's exterior of their skull but the brain as well. And so then what we're gonna do when they come in for the meg is we're gonna digitize the shape of their head. And so they wear these really cool glasses. The machine was designed in the 80s. It's been upgraded since then but the fashion has not yet been upgraded. So you get these really nice glasses. And then our lovely tech jennifer is going to go through and make a shape of your head? And it's gonna look something like this. So those are my brain. And so that's me. And then we're gonna overlay all of that together. So we have this three D picture of your head. We know where the brain is. We now know where the sensors are because we plug those wires into the machine and we can put it all together. So now I know where the satellites are, I know where my streets are and I can tell you where the traffic is coming from. And so we do that using a very advanced mathematical algorithm. It's also known as being forming or source localization. I would love love to tell you all about this. But for the purposes of tonight's presentation uh forever and over its magic. It is computer magic right now. So you'll have to trust me that I did enough training to know what I'm talking about there. Um and so the end result is uh this is that same spike that we saw earlier. It's a and this is the one that was in the picture for the event. And here you can see that there's this activity right here in the brain and we can watch that one more time really quick. Um and this is actually half a second of data displayed over 10 seconds. And so you can see that red, that's that extra activity. And so now we have a fun another poll question and oh and somebody else already got it for me. So what area of the brain is this localizing to? So this is actually the most common area for focal epilepsy. We have the lisa loop, the foramen magnum or the temporal lobe. Nobody picks mine. Yeah, we were when we were making the questions, Dr Alex suggested the lisa Loeb. Uh Alright, it was late at night, it was, we're doing our night shift um not a single, not a single one for years. That's okay, that's alright, alright, so we've got 91%. Uh so the temporal lobe, that's correct, the frame and magnum is actually latin for big hole and that's the whole the whole at the base of your skull that the spinal cord goes through. Um and then there is the lisa Loeb which is a celebrity of some kind. I'm an engineer, I don't I don't I don't get out, I'm not that much older than I am. Um She was, I just, I didn't get out studying. So this is what it looks like on a real patient. So this is an example of one of our recent cases where a patient came in, they actually had a seizure in the meg and here you can see the localization of that seizure and as you can tell, it's a very small area of the brain that had a huge impact on this patient's life. Um And we were able, so dr alec went through, read the whole study was able to locate and we were able to localize this to a very small area of the brain which was really exciting for this patient for the idea that it's there. And so then you know, we take this back to the team and and dr Alex and they plan the S. E. E. G. So here you can see this is for this patient and they really concentrated the scG in that area where we saw that meg activity. Uh It just really helps I guess to better better informed yeah to better uh pinpoint or target those areas that we kind of let them know like lit up whenever we did the meg and analyze the meg. And also, you know if we saw anything in any of the other testing and whatnot and that's how we create the maps and that's how we know we're in research. It needs to place the electrodes and whatnot. So and one of the things that we I skipped in this presentation but we also can have them do language tests or have them tap their fingers while they're in the machine and map those areas back as well. Um So it's kind of a map for the neurosurgeon that says don't cut here. These are very important locations. Um You know, here's the area that is is sending a lot of signal ah And so that is about it for what we're doing currently and I'm gonna give you guys a sneak peek. Uh 10 years in the future. Probably we are one of the only locations in the United States that have uh optically pumped magnetometer room. So I told you about the squids earlier, that was a very cool advancement in science in the last five years. They've made even more advancements and we are able to miniaturize the meg into very small sensors that are mobile. And so this is great for kids. We can give them a little helmet and they can kind of where you still have to be inside of a shielded room, but you don't have to be in this big scary machine. And yeah, they're very wiggly. That's one thing that I've learned is that with our texts are fantastic. The wiggly kids. Um and getting them to lay still for this exam. But hopefully with this new technology in the future, um as we do trials with it and we learn more about its capabilities, we'll be able to use it on patients maybe in 5 to 10 years. And that's another thing we didn't mention, like we, we scanned kids here too. It's not just about yeah, yeah. Usually on Mondays for anybody who's curious. Um Yeah, and then I think at this point we're, we're ready for those questions I know and hopefully we haven't lost any of you, I don't think we've lost anyone, but I just want to say, first of all, thank you both so much. That was A fantastic and informative presentation. I for one learned quite a bit, so I'm just gonna jump into questions because we've received quite a few. Um one of the questions I'm going to start off with was submitted for someone who register when they registered. The question is, can a child outgrow seizures? And if so, how can a parent help the child outgrow naturally. So yes, I'm gonna start with. Yes, there's sometimes that a child Canada grow seizures, I would say the most common examples are whenever they have like simple federal seizures that they can have seizures in the settings of fevers are usually around five months to six years old or so, and they don't necessarily need to be on meds and they'll remit fine or if they have benign epilepsy was sent to temporal spikes, like atlantic epilepsy and we know those syndromes, uh, you cannot grow and don't necessarily treatment. Uh and yeah, I would say those naturally, I would say just general, you know, health health. Exactly. I don't think there's anything that you should add to any regimen or vitamin or whatnot, as long as everything has been looked into and the diagnosis confirmed that it's one of the syndromes that you cannot grow and the neurologist should know. Um but if it's not one of those, you still have to be careful because not all you don't necessarily outgrow seizure disorders. It's just in some cases it depends on, like, the hand of them. The brand. The brand. Um Yeah, and I like she talked about earlier when you were talking about like, general health, like sleep, all of those things, you know, that's one of the things that we ask our patients to do is to be mean, go to your PCP, take good care of yourself, good nutrition, good sleep, physical activity, take care of your mental and physical health. Yeah. You know, all the goodies, so great, thank you. Our next question comes from to joseph. E is there any relation between mental health and epileptic seizures? Yeah. Yes, absolutely bi directional. I would sing um like I mentioned earlier and there's a reason why I mentioned it and I tell patients like this um a lot of people or most people that have seizure disorders will have uh a mental health co morbidity mostly, you know, a mood disorder, anxiety, whatnot. And I like to bring it up because if we don't address it, not only is it bad for quality of life, but it can negatively impact seizure control. They might not be as compliant with the treatment. Um That kind of thing. And also poor mental health can also affect, you know, seizure control and make it worse and more seizures can lead to worse, you know, mental health than vice versa. I hope that makes sense. Bad cycle. Yeah. You, because this is one of your areas of recent, right, is into mental health and and seizures, I feel it's been long enough that that hasn't been more of the focus and it's like huge. So yeah, thank you. Our next question comes from Zach Is a computer program monitoring and successfully detecting Caesar's as soon as they start and alerting the staff. Or do the staff have to visually monitor continuously? 24, I wish there are programs persist and whatnot. They're not great. You can fine tune them and whatnot, but a lot of them pick up a lot of noise. So I still prefer visual inspection and maybe using the F. F. D. And whatnot, but they in no way are superior to actually read by an epileptic. Ologists. You know, there's always E g tech watching the monitors just to make sure, oh, is that movement? Is that actually something epileptic? And then um whenever the files get downloaded and we're not there and if it's during the night, then whenever we review, we actually go through every second, it's pretty time comes to the main, but I mean it makes all the difference in the person's life, right? So that's what motivates us to do everything we do. You know, it's many people working together, so it is an area of research that we're yeah, working, but definitely not. Yeah, we're not there yet by any means time consuming, but very worth the time. Um Next question comes from Melinda. If someone has a stroke is it assumed that they are at a higher risk of having a seizure. Absolutely especially um And they're in the adult population and elderly. It's one of the most common reasons for a person to develop epilepsy. Any injury to the brain will put a person at higher risk of developing a seizure disorder because it acts as a substrate for abnormal electrical activity. So yes definitely. Thank you. Next question. Can CBD or marijuana help with controlling seizures. I knew that was coming. Absolutely. Um You could never like finish talk without the C. B. D. Um. Yes. Yes it has been shown to help what I always saying is that it's best if we prescribe it because there is a medication that's pure CBD oil that we know the exact concentration and that we can titrate and know exactly what you're getting so that it's not adulterated or like other stuff in it. And it's been shown to help in certain seizure syndromes such as Dr A. Atlantic gasto syndrome L. G. S. So it's approved for those and I've been used for others but basically approved for those and I mean it does help in some cases some other times people are not able to tolerate them. Um And plus um I just it's a little um I get a little nervous because a lot of people just think they can just get it off the street and whatnot. Not everybody can go like to a babe store and get CBD and what you don't know what you're getting and you don't want to put anything in your body. And plus it's natural, but it'll hurt your liver and if you're on medications like Depakote, um, clubs and whatnot are that, that'll hurt your delivery and that'll lead to bigger, bigger problems and it'll make the levels of the medication hard to control. And I would rather, you know, people be forthcoming with the information and let me help with that. But yes, CBD oil has been proven to help in some cases and it doesn't make you high because it has to be really, really, really low. Tetrahydrocannabinol, the THC, THC and the delta nine THC, and its higher CBD, which doesn't get you high. Next question that was submitted ahead of time. How helpful are traditional oral medications? They are very helpful. They are very helpful. They, like I mentioned, there's over 30 medications on the market right now. Um like everything, I mean, even Tylenol has side effects, Everybody responds differently. The big thing is to identify the person has a focal seizure disorder, or generalized seizure disorder because if you put somebody on a uh that has an underlying generalized seizure disorder on a very narrow spectrum medication, you can actually make it worse and that's why especially that first visit are like, being really, really specific and like get all the details and subsequent ones too. But especially that one to kind of like formulate in the back of my mind, like what I could be dealing with. Uh So I don't treat them with the wrong medication. But yeah I know you can do it monotherapy and drive up the dose or use it in combination or whatnot. But like I mentioned before, there's still a third of patients that will not respond and that's why we do all we do. So um jumping back to the chat. A question from Andy while patients are not actively seizing. Can any imaging technique differentiate a person with a seizure disorder from a person without a seizure disorder? Uh Yes. So if you count meg as an imaging technique because some people consider it like a recording. If there's there's these things called inter little spikes which is between seizures that you and that's what we see in E. G two. Right? Yeah. So I don't want to answer for the position. I just don't know if I understood the question clearly. Can you repeat it again? I'm a little hard of hearing too. Yes. Let me find it. Okay, while patients are not actively seizing, can any imaging technique differentiate a person with a seizure disorder from a person without a seizure disorder? Well imaging, not really um that's what I wanted to clarify um neuro physiologic studies may help because like after that important mentioned E. G. Make whatnot can pick up. you know any kind of regional focal slowing with slowing spikes, sharp waves, whatnot that you may see in between seizures. That may point to readability that may generate seizures. But in like structural imaging like MRI and whatnot. Unless there's an obvious lesion. I mean a lot of our patients have unremarkable normal MRI's and they still have the seizure disorder. So no it doesn't really eliminate the possibility somebody can have seizures even if it's normal. Those are what we call non legion. Yeah the non regional and then that's why they come to see the I said that meg is that it's looking in and putting that all together with the structural, how many meg machines are in texas and how many are in the US. So texas is actually special. There's uh it's always it's just everything's bigger in texas. Uh So there are five M. E. G. Machines in texas. There's two in Houston, one in Austin. One important worth that cook's Children's and then one here we are actually one of the only centers that specializes in adults as well as Children. The other centers tend to cater more to Children which is great. Um And then in the United States there's about 35 maybe 40 now that there's been a couple of new installations over the last year um because some of them are researching some clinical and whatnot. So yeah there's there's a little map online at the A. C meg's american clinical meg. But so we also will get patients from Oklahoma and Arkansas will will come and see us. So it's a that's another thing that's exciting about the new realm of meg these smaller energies because this actually takes quite a lot of space at the university which is a hot commodity. Um And it was expensive. It was a lot to install. Um So we're hoping to make the technology more available in the future, portable portable data paul asked is the meg ever recommended when medicine is working? Not really. I mean it is a lengthy study, expensive study and it's not really indicated unless you have drug resistant epilepsy. There is no reason to really do it clinically unless you're trying to find the seizure focus. So because it's a it's only it's approved for pre surgical mapping. So if you're not planning on surgery. Right. Yeah. Yeah. Just a couple more questions Peg a asks how long is the minimum duration of acquiring the meg signal. So for epilepsy we typically do around an hour. Um and that's because some people will have these interactive spikes all the time. Um and then sometimes they will have one or two an hour. And so we want to capture as many of those as possible. Um In terms of research we can we want to capture sleep. True. That's important. Yes. Thank you And research and for research we do um as short as six minutes. So we're looking at using this technology to um maybe do an earlier detection of Alzheimer's disease? Uh to better treat concussion to better diagnosed concussions. So it can be treated in different ways as well as autism diagnosis and testing Treatments for autism. So there's a lot of different research going on. And so that is about those scans can be as shortest. 5, 6 minutes. Nice. Yeah. Our seems like an eternity. But dr alec when she reads the hour long studies, I know she's she's, I get antsy, but it's worth it. Right. I'm gonna ask one last question because you just mentioned sleep. Alice asked, can a sleeping person have a dream while they're having a seizure? Interesting. Can a person have a dream while they're having a seizure? I mean, I Don't know the answer. 100% for sure. But I don't see why a person can imagine something while they're seizing and they have altered consciousness. So I don't know if anybody could be able to answer that. A 100% certainty. Nine. It's interesting. Yeah. Yes. Thank you both for tackling all those questions so quickly. There were many more that we didn't get to to address, but thank you both so much. Oh, actually wait one last one. Um let's see jenny jenny. Do you see this question? Yes. Have there been clinical trials with meg? And what is the advantage of meg over some other seizure medications or treatments? Mhm. Okay. So so the first part of it was is there what is, sorry what are there any clinical trials? There were clinical trials. This was FDA approved in 1993. Um And so now we are fully approved to use this for pre surgical mapping in terms of clinical trials. We are doing research in terms of other indications but not on epilepsy. It's fully approved and fully tested for for uh informing surgical mapping and then I'll let you tackle the next part. It's the only approved indication right now. And one thing that I want you all to leave this talk with is that please remember that the mega modality, a neuro physiologic test to add to the pre surgical work up of intractable drug resistant epilepsy. It is not a treatment. Okay so it's whenever all of their treatments fail it helps us um come up with a management plan whether that be an open surgery or or laser or if we can't do that, maybe we can do a nurse stimulation device like B. N. S. R. N. S. D. B. S. Or a combination or whatnot. After doing an intracranial monitoring it needed. So I mean there's topics to discuss. The meg meg isn't gonna do anything to you. It's actually completely passive. It's just listening to the brain. So it's FDA approved for pregnant women Children. We scan babies as young as a newborn sometimes for research studies. Um it's very safe. It's not doing anything. It's just it's really close to no limitations or exclusions. Yeah. Yeah. There's no there's no risk for doing a meg. Um Did that help? That is perfect. Thank you. And I think that's a great place to to conclude and I want to thank you doctors alec Lindstrom and Davenport's. This was fascinating to learn about how the, how the magazine diagnose diagnostic treatment, how it's transforming lives um and helping you improve epilepsy surgery, outcomes. Uh and I think it's really inspiring to consider how health care is going to continue to be impacted by such innovative treatments and technology tools. Thank you to care. Alondra and Gioia for helping run our event this evening and everyone. It is so good to be back with you. We hope you'll join us in two weeks on thursday september 9th for the science of food allergies and the impact on Children with dr Christopher perish following that will be another cafe on thursday, september 23rd about prostate cancer biomarkers, prevention strategies and treatment, innovations with dr Yair Lotan. And before we adjourn as you know, we must employ you implore you and your friends and family to get a Covid vaccine Vaccines protect you from severe illness and death from COVID-19 and experience for information on Covid including vaccine appointments from UT Southwestern click on the yellow Covid information bar at U. T. S. W. Med dot org and if you're an existing patient who received your vaccine from us, check your my chart account soon for booster shot information. And finally, even if you are fully vaccinated, please continue to help us by wearing masks, social distancing and being vigilant with your hand hygiene. Let's put a stop to the variants and the breakthrough infections as much as we can. Thank you for doing your part to contribute to good public health. And for now we wish you good health, good spirits and a good rest of your evening. We are adjourned. Thanks for joining us.