Docs to use new method to study epilepsy at cellular level

AIIMS and National Brain Research Centre to collaborate to identify cause of disease at molecular level.

What triggers the electrical process in the cells of the brain that lead to epilepsy? AIIMS is starting a joint project with the National Brain Research Centre (NBRC) in Manesar, to identify the cause of epilepsy at a cellular-level.

For what is understood to be a first for the country, doctors will be inserting electrodes inside brain cells neurons in the brain samples taken from patients who undergo surgery for epilepsy. These electrodes will measure energy levels in abnormal cells and compare them with regular cells.

Dr P Sarat Chandra, senior neurosurgeon at AIIMS and the principal investigator for the project, said: "Epilepsy is a result of hundreds of brain cells producing abnormally high levels of electricity, which results in different manifestations. For the first time, we are trying to understand the neurobiology of the disease scientifically termed as a systems biology approach to help understand the cellular and molecular reasons for epilepsy. This is a very exciting initiative for us, as it may change way in which the disease has been understood and treated so far."

The procedure of inserting electrodes into neurons and measuring the voltage from inside the cell, is an advanced technique known as cellular electrophysiology.

Also helping him is Dr Jyotirmoy Banerjee, who has recently joined AIIMS from the National Institute of Health, School of Medicine, University of Maryland, USA.

He said, "We plan to do this by recording synaptic currents from the slices obtained from dissected brain specimens at the time of surgery. These are the currents generated when the signals are transmitted from one neuron to another, which becomes abnormally high in a patient with epilepsy."

A laboratory, Centre for Excellence in Epilepsy, is under construction at the institute. Here, an advanced diagnostic machine, which detects epilepsy on the basis of functional changes rather than existing structural changes, will be set up with support from the Department of Biotechnology (DBT).

This machine, Magneto Encephalography (MEG), for the first time, will detect abnormalities in the magnetic field of the brain rather than electrical signals, to map the abnormal areas of the brain. This will help doctors to identify functional changes in the brain, that occur before the structural changes are seen or even when the structural changes are absent.

"A magnetic field is always accompanied by an electric field. Techniques like the PET scan and the Electro Encephelography (EEG), which are conventional methods to identify functional changes in the brain, only use the electric fields. The MEG has a sensitivity of 1/10 millionth of the earth's magnetic field, which synchronises perfectly with the magnetic field produced by the brain, and can detect magnetic signals," Dr Manjari Tripathi, co-investigator of the project, said.

An advanced magnetic shielding lab to protect the machine from the earth's magnetic field is being constructed to house the MEG machine and will be operational in six months.

Epilepsy can be detected more appropriately by functional brain mapping techniques, rather than structural techniques like MRI.

Dr Tripathi said, "In such cases, MEG could prove much more useful as it has the capability of being highly sensitive in detecting abnormalities in areas of the brain which may look completely normal in all other investigations."

In the project, every patient who is cleared for surgery will first be subjected to MEG, along with other tests like MRI, to identify the focal points of epilepsy areas where the faulty neurons congregate. These areas will then be removed by surgery and the brain samples will be put through live tissue sampling to test for various characteristics.

Deciphering epilepsy

Epilepsy is a neurological disorder characterised by abnormal energy levels in brain cells

It can have varied manifestations as opposed to the common myth of seizures or "attacks" being the classic

Sign of the disease.

Patients can lose touch with their surroundings, have abnormally heightened sensations of smell, laughing fits, and attention disorders which can actually be the early stages of epileptic attacks.

If left untreated, as the disease advances it can even lead to progressive mental retardation.

The procedure of inserting electrodes into neurons and measuring the voltage from inside the cell is an advanced technique known as cellular electrophysiology.

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