1
00:00:06,296 --> 00:00:08,465
>> GOOD AFTERNOON AND
WELCOME TO

2
00:00:08,465 --> 00:00:10,334
TODAY'S CLINICAL CENTER GRAND

3
00:00:10,334 --> 00:00:13,737
ROUNDS THE HOPKINS CME ACTIVITY

4
00:00:13,737 --> 00:00:18,075
CODE FOR GRAND ROUNDS IS 57871.

5
00:00:18,075 --> 00:00:20,544
PLEASE TEXT THIS TO THE NUMBEROT

6
00:00:20,544 --> 00:00:22,679
SLIDE TO RECEIVE CREDIT FOR

7
00:00:22,679 --> 00:00:23,914
TODAY'S LECTURE.

8
00:00:23,914 --> 00:00:31,955
WE KINDLY ASK YOU TO PROVIDE

9
00:00:31,955 --> 00:00:32,389
SURVEY VIA LINK.

10
00:00:32,389 --> 00:00:34,925
IT WILL BE USED TO PROVIDE US

11
00:00:34,925 --> 00:00:37,494
IMPORTANT INFORMATION ABOUT THIS

12
00:00:37,494 --> 00:00:40,364
PRESENTATION AND SUBMIT ANY

13
00:00:40,364 --> 00:00:42,099
SUGGESTIONS FOR FUTURE GRAND

14
00:00:42,099 --> 00:00:43,600
ROUND TOPICS.

15
00:00:43,600 --> 00:00:45,969
FOLLOWING THE SPEAKER, QUESTIONS

16
00:00:45,969 --> 00:00:47,471
WILL BE TAKEN FROM THE

17
00:00:47,471 --> 00:00:50,374
MICROPHONES IN THE AISLES,

18
00:00:50,374 --> 00:00:52,075
ADDITIONALLY, YOU CAN ALSO

19
00:00:52,075 --> 00:00:53,710
SUBMIT QUESTIONS BY CLICKING THE

20
00:00:53,710 --> 00:00:55,813
LIVE FEEDBACK BUTTON ON THE

21
00:00:55,813 --> 00:00:56,380
WEBSITE.

22
00:00:56,380 --> 00:00:57,915
QUESTIONS WILL BE ANSWERED AS

23
00:00:57,915 --> 00:01:00,350
TIME PERMITSA THE CONCLUSION OF

24
00:01:00,350 --> 00:01:01,018
THE PRESENTATION.

25
00:01:01,018 --> 00:01:05,422
OUR SPEAKER TODAY IS D

26
00:01:05,422 --> 00:01:06,256
R. SARA INATI, WITH THE

27
00:01:06,256 --> 00:01:07,958
NATIONAL INSTITUTE OF

28
00:01:07,958 --> 00:01:10,093
NEWOLOGICAL DISORDERS AND

29
00:01:10,093 --> 00:01:11,228
STROKE.

30
00:01:11,228 --> 00:01:12,262
DR. INATI COMPLOATED HER USHED

31
00:01:12,262 --> 00:01:13,764
GRAD STUDIES AT HARVARD

32
00:01:13,764 --> 00:01:17,167
UNIVERSITY AND EARNED HER DEGREE

33
00:01:17,167 --> 00:01:18,602
FROM DARTMOUTH MEDICAL SCHOOL.

34
00:01:18,602 --> 00:01:20,871
SHE COMPLETED HER INTERNSHIP AT

35
00:01:20,871 --> 00:01:25,008
THE LENOIR OX MEDICAL HOSPITAL,

36
00:01:25,008 --> 00:01:27,644
TRAINING AT THE COLUMBIA MEDICAL

37
00:01:27,644 --> 00:01:31,615
INSTITUTE, AND FELLOWSHIP AT THE

38
00:01:31,615 --> 00:01:32,549
EPILEPSY AND COMPREHENSIVE

39
00:01:32,549 --> 00:01:35,953
EPILEPSY CENTER.

40
00:01:35,953 --> 00:01:39,556
IN 2010 DR. INATI JOINED THE NIH

41
00:01:39,556 --> 00:01:41,425
WITH THE NINDS CONSULT SERVICE

42
00:01:41,425 --> 00:01:43,260
AND JOINED THE EEG SECTION THE

43
00:01:43,260 --> 00:01:46,563
FOLLOWING YEAR WHERE SHE SERVED

44
00:01:46,563 --> 00:01:48,398
AS CHIEF FROM 2012-2021.

45
00:01:48,398 --> 00:01:53,437
IN 2021 SHE WAS EMPLOYED AS HEAD

46
00:01:53,437 --> 00:01:54,605
OF NEUROPHYSIOLOGY EPILEPSY

47
00:01:54,605 --> 00:01:55,172
UNIT.

48
00:01:55,172 --> 00:01:57,741
HER INTERESTS INCLUDES SURGICAL

49
00:01:57,741 --> 00:01:59,676
EPILEPSY, TUMOR RELATED EPILEPS

50
00:01:59,676 --> 00:02:01,144
EXPE CHARACTERIZATION OF

51
00:02:01,144 --> 00:02:03,146
EPILEPSY RELATED TO RARE GENETIC

52
00:02:03,146 --> 00:02:06,116
DISORDERS AND WITH HER TEAM SHE

53
00:02:06,116 --> 00:02:07,651
EXPLORES DEEP PHENOTYPES OF

54
00:02:07,651 --> 00:02:09,820
PATIENTS AT THE CLINICAL CENTER

55
00:02:09,820 --> 00:02:12,289
INCLUDING NEWS O PHYSIOLOGIC

56
00:02:12,289 --> 00:02:14,691
EEG, MEG AS WELL AS STRUCTURAL

57
00:02:14,691 --> 00:02:16,426
AND FUNCTIONAL NEURAL IMAGING.

58
00:02:16,426 --> 00:02:19,029
SHE SEEKS TO IMPROVE THE ABILITY

59
00:02:19,029 --> 00:02:21,064
TO IMPROVE SEIZE OUR FON, CI AND

60
00:02:21,064 --> 00:02:22,466
BETTER UNDERSTAND HOW SEIZURE

61
00:02:22,466 --> 00:02:24,401
ACTIVITY SPREAD THROUGHOUT THE

62
00:02:24,401 --> 00:02:29,072
BRAIN TO IMPROVE THE EFFICACY OF

63
00:02:29,072 --> 00:02:32,442
TARGET MEDICATIONS TO INDIVIDUAL

64
00:02:32,442 --> 00:02:34,845
PATIENTS WITH FOCUS BASED

65
00:02:34,845 --> 00:02:35,112
EPILEPSY.

66
00:02:35,112 --> 00:02:37,848
--I JUST GAVE YOU A NEW NAME.

67
00:02:37,848 --> 00:02:40,183
I'LL TAKE CREDIT FOR THAT.

68
00:02:40,183 --> 00:02:42,386
DR. INATI, IS A PASSIONATE

69
00:02:42,386 --> 00:02:43,921
EDUCATOR AND MENTOR SERVING AS

70
00:02:43,921 --> 00:02:46,089
PROGRAM DIRECTOR FOR THE

71
00:02:46,089 --> 00:02:46,890
EPILEPSY FELLOWSHIP PROGRAM

72
00:02:46,890 --> 00:02:48,625
WHICH SHE ESTABLISH INDEED 2015

73
00:02:48,625 --> 00:02:50,861
AND ASSISTANT PROGRAM DIRECTOR

74
00:02:50,861 --> 00:02:53,330
FOR THE CLINICAL NEUROPHYSIOLOGY

75
00:02:53,330 --> 00:02:54,498
FELLOWSHIP, THE PROGRAM HERE AT

76
00:02:54,498 --> 00:02:56,466
NE H.

77
00:02:56,466 --> 00:02:57,834
A PROLIFIC INVESTIGATOR WITH

78
00:02:57,834 --> 00:03:00,370
OVER 60 PEER REVIEW

79
00:03:00,370 --> 00:03:02,439
INVESTIGATORS, DR. INATI IS

80
00:03:02,439 --> 00:03:03,740
BOARD CERTIFIED WITH

81
00:03:03,740 --> 00:03:05,342
QUALIFICATIONS IN EPILEPSY AND

82
00:03:05,342 --> 00:03:06,176
CLINICAL NEUROPHYSIOLOGY AND A

83
00:03:06,176 --> 00:03:09,012
MEMBER OF THE AMERICAN CLINICAL

84
00:03:09,012 --> 00:03:10,414
NEUROPHYSIOLOGY SOCIETY, THE

85
00:03:10,414 --> 00:03:12,115
AMERICAN EPILEPSY SOCIETY, AND

86
00:03:12,115 --> 00:03:13,850
THE AMERICAN ACADEMY OF

87
00:03:13,850 --> 00:03:14,251
NEUROLOGY.

88
00:03:14,251 --> 00:03:16,153
THE TITLE OF TODAY'S

89
00:03:16,153 --> 00:03:17,254
PRESENTATION IS MAPPING EPILEPSY

90
00:03:17,254 --> 00:03:18,255
IN THE HUMAN BRAIN.

91
00:03:18,255 --> 00:03:20,257
NOW PLEASE JOIN ME IN WELCOMING

92
00:03:20,257 --> 00:03:28,131
TODAY'S GRAND ROUND SPEAKERS

93
00:03:28,131 --> 00:03:28,465
DR. EPILEPSY.

94
00:03:28,465 --> 00:03:28,832
[LAUGHTER]

95
00:03:28,832 --> 00:03:32,536
>> IT'S GOING TO STICK
NOW.

96
00:03:32,536 --> 00:03:34,538
>> [LAUGHTER]

97
00:03:34,538 --> 00:03:34,938
>> [ APPLAUSE ]

98
00:03:34,938 --> 00:03:35,572
>> ALL RIGHT.

99
00:03:35,572 --> 00:03:37,107
I THINK THE COMPUTER'S ACTUALLY

100
00:03:37,107 --> 00:03:39,309
WORKING, THIS IS ALL VERY

101
00:03:39,309 --> 00:03:39,576
EXCITING.

102
00:03:39,576 --> 00:03:41,178
THANK YOU SO MUCH FOR THAT KIND

103
00:03:41,178 --> 00:03:42,479
INTRODUCTION AND THANK YOU FOR

104
00:03:42,479 --> 00:03:44,982
THE INVITATION TO SPEAK HERE

105
00:03:44,982 --> 00:03:46,149
TODAY EMPLOY I'M EXCITED TO TALK

106
00:03:46,149 --> 00:03:47,818
TO YOU ABOUT MAPPING EPILEPSY IN

107
00:03:47,818 --> 00:03:49,786
THE HUMAN BRAIN AND TO GET MY

108
00:03:49,786 --> 00:03:52,956
NEW NICKNAME OUT OF ALL THIS.

109
00:03:52,956 --> 00:03:55,158
AND YES, EVERYBODY THAT'S

110
00:03:55,158 --> 00:03:58,795
PICTURED HERE HAS BEEN KNOWN TO

111
00:03:58,795 --> 00:03:59,129
HAVE EPILEPSY.

112
00:03:59,129 --> 00:04:03,233
I HAVE NOTHING TO DISCLOSE, NO

113
00:04:03,233 --> 00:04:04,534
UNAPPROVED OR OFF LABEL DRUGS

114
00:04:04,534 --> 00:04:05,736
WILL BE DISCUSS AND I'M HOPING

115
00:04:05,736 --> 00:04:08,405
BY THE END OF THIS, YOU ALL CAN

116
00:04:08,405 --> 00:04:10,374
IDENTIFY APPROACHES FOR SEIZURES

117
00:04:10,374 --> 00:04:12,709
APPROACHES AND IN PATIENTS

118
00:04:12,709 --> 00:04:13,744
UNDERGOING SURGERY EVALUATION

119
00:04:13,744 --> 00:04:15,712
AND UNDERSTAND IN A BROAD SENSE

120
00:04:15,712 --> 00:04:16,513
HOW PATHOLOGICAL ACTIVITY

121
00:04:16,513 --> 00:04:21,318
SPREADS IN THE BRAIN IN FOCAL

122
00:04:21,318 --> 00:04:21,685
EPILEPSY.

123
00:04:21,685 --> 00:04:24,121
SO TO START OFF, EPILEPSY IS

124
00:04:24,121 --> 00:04:25,522
COMN, AT THE INTRAMURAL PROGRAM,

125
00:04:25,522 --> 00:04:27,491
WE STUDY RARE DISEASES BUT

126
00:04:27,491 --> 00:04:32,029
EPILEPS SE1 OF THE MOST COMMON

127
00:04:32,029 --> 00:04:32,596
DISEASE, ALMOST 3.5 MILLION

128
00:04:32,596 --> 00:04:34,765
PEOPLE IN THE U.S. AND OVER

129
00:04:34,765 --> 00:04:37,501
50 MILLION PEOPLE HAVE ACTIVE

130
00:04:37,501 --> 00:04:39,903
EPILEPSY IN 2021 AND 1 IN 26

131
00:04:39,903 --> 00:04:41,038
PEOPLE WILL DEVELOP EPILEPSY IN

132
00:04:41,038 --> 00:04:41,905
THEIR LIVES.

133
00:04:41,905 --> 00:04:44,074
THAT MEANS IN THIS ROOM HAVE HAD

134
00:04:44,074 --> 00:04:46,143
OR WILL HAVE EPILEPSY.

135
00:04:46,143 --> 00:04:47,077
AND THE INTERESTING THING ABOUT

136
00:04:47,077 --> 00:04:49,279
THAT IS ALTHOUGH THERE'S A TON

137
00:04:49,279 --> 00:04:51,848
OF STIGMA ATTACHED TO EPILEPSY,

138
00:04:51,848 --> 00:04:53,884
MOAF OF WILL NEVER KNOW WHO THEY

139
00:04:53,884 --> 00:04:54,451
ARE, RIGHT?

140
00:04:54,451 --> 00:04:56,887
BECAUSE MOST PEOPLE WILL APPEAR

141
00:04:56,887 --> 00:04:58,522
NORMAL IN BETWEEN THEIR

142
00:04:58,522 --> 00:04:58,789
SEIZURES.

143
00:04:58,789 --> 00:05:01,825
I PUT THIS MAP UP BECAUSE WE'RE

144
00:05:01,825 --> 00:05:02,826
STUDYING THE PSYCHOSIS AND THIS

145
00:05:02,826 --> 00:05:04,995
IS 1 REASON WHY THE PREVALENCE

146
00:05:04,995 --> 00:05:06,129
OF EPILEPSY DIFFERS ACROSS THE

147
00:05:06,129 --> 00:05:08,498
WORLD AND A LOT OF THIS IS IN

148
00:05:08,498 --> 00:05:10,434
DEVELOPING COUNTRIES, SO IT'S A

149
00:05:10,434 --> 00:05:11,601
SIGNIFICANT PUBLIC HEALTH

150
00:05:11,601 --> 00:05:11,835
BURDEN.

151
00:05:11,835 --> 00:05:13,503
I PUT THIS HERE ON THE SIDE TO

152
00:05:13,503 --> 00:05:16,540
SHOW YOU THAT EPILEPSY DOES

153
00:05:16,540 --> 00:05:18,842
CONSIDER ACROSS THE ENIRE AGE

154
00:05:18,842 --> 00:05:19,910
RANGE, FROM THE VERY YOUNG TO

155
00:05:19,910 --> 00:05:22,479
THE VERY OLD AND A LOT OF

156
00:05:22,479 --> 00:05:24,081
EPILEPSY PRESENTS VERY EARLY AND

157
00:05:24,081 --> 00:05:27,918
THESE ARE USUALLY INFANTS

158
00:05:27,918 --> 00:05:29,152
ANDNYONATINGS WITH DISORDERS OF

159
00:05:29,152 --> 00:05:30,687
VARIOUS SORTS AND IN OLD AGE IT

160
00:05:30,687 --> 00:05:35,726
HAPPENS A LOT AND THIS IS DUE TO

161
00:05:35,726 --> 00:05:36,693
ANY INSULT IN THE BRAIN BEING

162
00:05:36,693 --> 00:05:38,261
ABLE TO LEAD TO EPILEPSY IN THE

163
00:05:38,261 --> 00:05:39,629
BREAN IN CERTAIN PEOPLE.

164
00:05:39,629 --> 00:05:43,533
BECAUSE OF THAT, THIS IS RED,

165
00:05:43,533 --> 00:05:45,035
LIVES WITH DISABILITY AND LIVES

166
00:05:45,035 --> 00:05:45,268
LOST.

167
00:05:45,268 --> 00:05:51,174
I SAY THIS BECAUSE PEOPLE WITH

168
00:05:51,174 --> 00:05:52,342
EPILEPSY DO SUFFER DISABILITY

169
00:05:52,342 --> 00:05:54,077
OVER THE COURSE OF THEIR

170
00:05:54,077 --> 00:05:54,344
LIFETIME.

171
00:05:54,344 --> 00:05:55,278
IT STARTS EARLY BUT ALSO WE HAVE

172
00:05:55,278 --> 00:05:57,447
A LOT OF PEOPLE WHERE SEIZURES

173
00:05:57,447 --> 00:06:01,318
DEVELOP IN THEIR LATE TEENS AND

174
00:06:01,318 --> 00:06:01,551
20S.

175
00:06:01,551 --> 00:06:02,619
AND THAT'S TRAJECTORY WHEN THIS

176
00:06:02,619 --> 00:06:03,687
HAPPENS TO THESE PEOPLE.

177
00:06:03,687 --> 00:06:04,621
THEY LIVE WITH DISABILITY AND

178
00:06:04,621 --> 00:06:07,224
THEY LIVE WITH THE FEAR OF

179
00:06:07,224 --> 00:06:07,991
INCREASED MORETALLITY.

180
00:06:07,991 --> 00:06:10,193
THAT CAN BE DUE TO BRAIN TUMORS,

181
00:06:10,193 --> 00:06:11,361
OTHER SYNDROMES BUT EVEN

182
00:06:11,361 --> 00:06:13,430
EPILEPSY ITSELF CAN LEAD TO

183
00:06:13,430 --> 00:06:15,732
DEATH EITHER THROUGH ACCIDENTS

184
00:06:15,732 --> 00:06:16,767
AND INJURIES, SUICIDE IS

185
00:06:16,767 --> 00:06:18,068
INCREASED IN THESE PATIENTS AND

186
00:06:18,068 --> 00:06:22,873
THE OTHER UNEXPLAINED DEATH IN

187
00:06:22,873 --> 00:06:25,275
EPILEPSY AND PATIENTS IN

188
00:06:25,275 --> 00:06:26,877
REFRACTORY EPILEPSY THIS CAN

189
00:06:26,877 --> 00:06:29,179
OCCUR UP TO 1 PERCENT A YEAR

190
00:06:29,179 --> 00:06:30,781
WHICH SOUNDS PRETTY RARE UNTIL

191
00:06:30,781 --> 00:06:32,182
YOU GET DIAGNOSED AT THE AGE OF

192
00:06:32,182 --> 00:06:34,284
20, THE RISK IS PRETTY HIGH IF

193
00:06:34,284 --> 00:06:35,685
YOU ARE PROJECTING YOU ARE GOING

194
00:06:35,685 --> 00:06:37,120
TO LIVE ANOTHER 20 OR 30 YEARS.

195
00:06:37,120 --> 00:06:38,421
SO I THINK YOU START TO GET A

196
00:06:38,421 --> 00:06:41,658
SENSE OF THIS, BUT THE EPILEPSYS

197
00:06:41,658 --> 00:06:42,459
ARE EXTREMELY HETEROGENEOUS SO

198
00:06:42,459 --> 00:06:44,027
WE'RE NOT TALKING ABOUT 1

199
00:06:44,027 --> 00:06:46,663
DISORDER HERE, BUT A FAMILY OF

200
00:06:46,663 --> 00:06:48,465
DISORDERS WITH A COMMON PATHWAY,

201
00:06:48,465 --> 00:06:50,634
I LIKE THIS BECAUSE IT REFLECTS

202
00:06:50,634 --> 00:06:52,969
THAT, IT HAPPENS IN NEOINATES IN

203
00:06:52,969 --> 00:06:54,905
MITTED, AND WHAT HAPPENS IN

204
00:06:54,905 --> 00:06:57,407
ADULTS ON THE OUTSIDE, I'M AN

205
00:06:57,407 --> 00:06:59,075
ADULT NEUROLOGIST SO I'M DEALING

206
00:06:59,075 --> 00:07:00,310
WITH THAT PERIMETER THERE, SO

207
00:07:00,310 --> 00:07:01,978
YOU CAN SEE THAT THIS IS THE

208
00:07:01,978 --> 00:07:03,113
RANGE FROM SEVERE TO BENIGN.

209
00:07:03,113 --> 00:07:06,116
WE HAVE A LOT OF PEOPLE WITH

210
00:07:06,116 --> 00:07:07,184
RELATIVELY BENIGN SEIZURES,

211
00:07:07,184 --> 00:07:10,453
THESE ARE THE 1S THAT PEOPLE

212
00:07:10,453 --> 00:07:12,322
TYPICALLY GROW OUT OF OR HAVE

213
00:07:12,322 --> 00:07:13,557
WELL CONTROLLED MEDICINE.

214
00:07:13,557 --> 00:07:15,892
AND SOME OF OUR PATIENTS RADIOLE

215
00:07:15,892 --> 00:07:17,661
LOAMACYY DO SUFFER FROM

216
00:07:17,661 --> 00:07:18,495
SIGNIFICANT COMPLICATIONS FROM

217
00:07:18,495 --> 00:07:19,095
THEIR EPILEPSY.

218
00:07:19,095 --> 00:07:21,198
IT CAN BE CAUSED BOO I A MILLION

219
00:07:21,198 --> 00:07:23,934
DIFFERENT CAUSES.

220
00:07:23,934 --> 00:07:27,237
TRAUMA, STROKE, TUMORS,

221
00:07:27,237 --> 00:07:30,407
INFECTIONS, CONGENITAL LESIONS,

222
00:07:30,407 --> 00:07:32,442
BIRTH, HIPOXIC ESCHEMIC INJURY,

223
00:07:32,442 --> 00:07:34,110
BUT IN THE VAST MAIORITY OF

224
00:07:34,110 --> 00:07:35,946
PATIENTS WE DON'T HAVE AN ANSWER

225
00:07:35,946 --> 00:07:36,613
FOR THAT QUESTION.

226
00:07:36,613 --> 00:07:38,181
WE STILL DON'T KNOW WHY THEY'RE

227
00:07:38,181 --> 00:07:39,883
HAVING SEIZURES AND THIS IS A

228
00:07:39,883 --> 00:07:42,419
SOURCE OF TURNOVERRED EFFORTS

229
00:07:42,419 --> 00:07:43,320
AND RESEARCH AND OVERTIME WE

230
00:07:43,320 --> 00:07:47,224
THINK WE LABELED A LOT OF THESE

231
00:07:47,224 --> 00:07:48,625
AS GENETIC DISORDERS BUT WE'RE

232
00:07:48,625 --> 00:07:50,727
NOT REALLY FINDING THAT IN OUR

233
00:07:50,727 --> 00:07:52,929
INITIAL STUDIES SO THIS IS STILL

234
00:07:52,929 --> 00:07:56,633
PART OF A POLYMORPHIC AND I

235
00:07:56,633 --> 00:07:58,034
THINK IT'S UNDER SIGNIFICANT

236
00:07:58,034 --> 00:07:58,368
INVESTIGATION.

237
00:07:58,368 --> 00:08:00,470
TO GIVE YOU BASIC DEFINITIONS,

238
00:08:00,470 --> 00:08:02,572
EPILEPSY IS NOT SUBTLE IN MOST

239
00:08:02,572 --> 00:08:03,940
PATIENTS, IT'S BEEN RECOGNIZED

240
00:08:03,940 --> 00:08:08,945
FOR ALMOST AS  LONG AS WE ARE

241
00:08:08,945 --> 00:08:11,248
TEXT BACK TO THE ANCIENT GREEKS,

242
00:08:11,248 --> 00:08:14,317
ROMANS, THERE'S A LOT OF ART

243
00:08:14,317 --> 00:08:15,352
WORK PORTRAYING THESE DRAMATIC

244
00:08:15,352 --> 00:08:15,619
SEIZURES.

245
00:08:15,619 --> 00:08:18,288
SO WHAT IS AN EPILES SEIZURE?

246
00:08:18,288 --> 00:08:21,057
IT'S A TRANSIENT OCCURRENCE OF

247
00:08:21,057 --> 00:08:23,460
SIGNS SYMPTOMS OF TO SYNCHRONOUS

248
00:08:23,460 --> 00:08:24,661
NEURONAL ACTIVITY IN THE BRAIN,

249
00:08:24,661 --> 00:08:26,296
SO THAT IS COMPLICATED BUT THIS

250
00:08:26,296 --> 00:08:28,565
IS TO GET RID OF ANYTHING THAT'S

251
00:08:28,565 --> 00:08:30,100
CAUSED BY OTHER FUNCTIONS THAT

252
00:08:30,100 --> 00:08:31,167
ARE NOT ELECTRICAL IN ETIOLOGY

253
00:08:31,167 --> 00:08:32,969
AND I THINK IT'S REALLY

254
00:08:32,969 --> 00:08:34,137
IMPORTANT THAT WE RECOGNIZE THAT

255
00:08:34,137 --> 00:08:36,139
THESE SIGNS OR SYMPTOMS ARE

256
00:08:36,139 --> 00:08:37,440
REALLY DIFFERENT ACROSS ALL OF

257
00:08:37,440 --> 00:08:40,310
OUR PATIENTS AND THEY REALLY DO

258
00:08:40,310 --> 00:08:41,378
REPRESENT THIS HIJACKING OF

259
00:08:41,378 --> 00:08:43,680
NORMAL BRAIN FUNCTION BY THIS

260
00:08:43,680 --> 00:08:44,347
PATHOLOGICAL ACTIVITY.

261
00:08:44,347 --> 00:08:45,248
SO I THINK THIS IS THE FIRST

262
00:08:45,248 --> 00:08:48,018
WAVE I WILL TALK ABOUT IN WHICH

263
00:08:48,018 --> 00:08:50,053
EPILEPTIC ACTIVITY AND NORMAL

264
00:08:50,053 --> 00:08:52,022
FUNCTIONAL BRAIN ACTIVITY ARE

265
00:08:52,022 --> 00:08:53,423
REALLY TIED TOGETHER.

266
00:08:53,423 --> 00:08:59,462
EPILEPSY ITSELF ALTHOUGH DEFINED

267
00:08:59,462 --> 00:09:06,403
BY THIS TENDENCY TO SO THERE'S

268
00:09:06,403 --> 00:09:10,407
OTHER AND THE EXPERIENCE OF OUR

269
00:09:10,407 --> 00:09:11,241
PATIENTS WITH EPILEPSY.

270
00:09:11,241 --> 00:09:14,878
WE CALL SOME OF THESE EPILEPSY

271
00:09:14,878 --> 00:09:16,246
AND CO-MORBIDITIES IN THE SENSE

272
00:09:16,246 --> 00:09:19,449
IT'S NOT RELATED TO THE

273
00:09:19,449 --> 00:09:19,783
SEIZURES.

274
00:09:19,783 --> 00:09:21,518
SO THIS IS INTERECTOMYOSINNAL,

275
00:09:21,518 --> 00:09:22,819
THESE ARE THINGS THEY EXPERIENCE

276
00:09:22,819 --> 00:09:24,020
IN BETWEEN SEIZURES AND IT SEEMS

277
00:09:24,020 --> 00:09:26,489
TO BE RELATED TO WHAT BRAIN

278
00:09:26,489 --> 00:09:28,558
SYSTEM IS INVOLVED IN THAT

279
00:09:28,558 --> 00:09:29,059
PATIENT'S EPILEPSY.

280
00:09:29,059 --> 00:09:30,627
SO FOR EXAMPLE, OUR MOOF THE

281
00:09:30,627 --> 00:09:33,263
COMMON TIME IS TEMPORAL LOBE

282
00:09:33,263 --> 00:09:36,533
EPILEPSY AND MANY OF THEM WILL

283
00:09:36,533 --> 00:09:37,167
HAVE CONCOGNITIVE PROBLEMS

284
00:09:37,167 --> 00:09:37,867
PARTICULARLY WITH MEMORY AND

285
00:09:37,867 --> 00:09:40,136
LANGUAGE, A LOT OF THEM SINCE IT

286
00:09:40,136 --> 00:09:41,871
INVOLVES THE EMILY CIBOL SYSTEM

287
00:09:41,871 --> 00:09:43,039
WILL HAVE PROBLEMS WITH

288
00:09:43,039 --> 00:09:44,407
DEPRESSION OR ANXIOUS AND MANY

289
00:09:44,407 --> 00:09:45,809
OF OUR PATIENTS HAVE HEADACHES

290
00:09:45,809 --> 00:09:47,477
AND SLEEP DISORDERS AS WELL, AND

291
00:09:47,477 --> 00:09:49,312
ALL OF THESE COMBINE TO CREATE

292
00:09:49,312 --> 00:09:50,981
THE EXPERIENCE OUR PATIENTS HAVE

293
00:09:50,981 --> 00:09:51,581
LIVING WITH EPILEPSY.

294
00:09:51,581 --> 00:09:54,517
I THINK I CAN'T GIVE A TALK TO A

295
00:09:54,517 --> 00:09:57,754
GENERAL AUDIENCE WITHOUT AT

296
00:09:57,754 --> 00:09:59,789
LEAST MENTIONING STIGMA AND

297
00:09:59,789 --> 00:10:01,057
EPILEPSY BECAUSE THIS 1 OF THE

298
00:10:01,057 --> 00:10:02,826
MOST INTENSE AND DISTRESSING

299
00:10:02,826 --> 00:10:03,860
FEATURES OF THE ILLNESS FOR A

300
00:10:03,860 --> 00:10:05,395
LOT OF OUR PATIENTS AND YOU CAN

301
00:10:05,395 --> 00:10:06,696
IMAGINE ALL OF YOU SITTING HERE,

302
00:10:06,696 --> 00:10:08,798
IF YOU DON'T HAVE EPILEPSY, IF

303
00:10:08,798 --> 00:10:11,468
YOU WERE TO JUST SUDDENLY HAVE A

304
00:10:11,468 --> 00:10:12,268
SEIZURE TODAY OR TOMORROW, JUST

305
00:10:12,268 --> 00:10:12,969
IMAGINE FOR A MEMORY CLONE THAT

306
00:10:12,969 --> 00:10:14,738
HE WENT WOULD MEAN TO YOU AND

307
00:10:14,738 --> 00:10:15,805
YOUR FAMILY, WHAT WOULD THAT

308
00:10:15,805 --> 00:10:16,873
MEAN FOR YOUR JOB, WHAT WOULD

309
00:10:16,873 --> 00:10:18,208
THAT MEAN FOR YOUR SCHOOL, A LOT

310
00:10:18,208 --> 00:10:21,945
OF TIMES IF YOU HAVE A SEIZURE,

311
00:10:21,945 --> 00:10:23,613
YOU CAN'T DRIVE FOR 3-12 MONTHS

312
00:10:23,613 --> 00:10:25,715
SO THIS IS AN EXTREMELY

313
00:10:25,715 --> 00:10:26,516
TROUBLING EVENT FOR PEOPLE.

314
00:10:26,516 --> 00:10:29,753
NOT TO MENTION WE HAD PEOPLE ON

315
00:10:29,753 --> 00:10:31,187
VERY IMPRESSIVE TELECONFERENCES,

316
00:10:31,187 --> 00:10:33,423
VIDEOS WHO ALL OF A SUDDEN WILL

317
00:10:33,423 --> 00:10:35,392
HAVE A SEIZURE IN THE MIDDLE OF

318
00:10:35,392 --> 00:10:36,926
THOSE AND YOU CAN IMAGINE THIS

319
00:10:36,926 --> 00:10:37,994
IS REALLY PROBLEMATIC FOR THEM

320
00:10:37,994 --> 00:10:39,262
IN THEIR PROFESSIONAL CAREERS

321
00:10:39,262 --> 00:10:40,897
EMPLOY BECAUSE IT'S REALLY SCARY

322
00:10:40,897 --> 00:10:42,532
AND IT SCARES PEOPLE THAT SEE

323
00:10:42,532 --> 00:10:42,766
IT.

324
00:10:42,766 --> 00:10:44,734
I PUT THIS UP BECAUSE I FOUND

325
00:10:44,734 --> 00:10:46,036
THIS IN EPILEPS EXPE ME IN THE

326
00:10:46,036 --> 00:10:47,404
WELCOME COLLECTION WHICH IS A

327
00:10:47,404 --> 00:10:48,805
SERIES ONLINE AND THIS IS AN

328
00:10:48,805 --> 00:10:50,673
ARTIST AND SOMEBODY WHO IS

329
00:10:50,673 --> 00:10:52,042
WRITING ABOUT THEIR LIVED

330
00:10:52,042 --> 00:10:52,976
EXPERIENCE WITH EPILEPS EXPE

331
00:10:52,976 --> 00:10:54,511
THIS IS THE ART WORK THEY CAME

332
00:10:54,511 --> 00:10:54,978
UP TO DRIEB.

333
00:10:54,978 --> 00:10:56,846
SO PART OF THIS IS RELATED TO

334
00:10:56,846 --> 00:10:58,181
THEIR INTERACTIONS WITH THE

335
00:10:58,181 --> 00:10:58,648
MEDICAL SYSTEM.

336
00:10:58,648 --> 00:11:01,317
A LOT OF OUR PATIENTS HAVE

337
00:11:01,317 --> 00:11:02,385
RECURRENT SEIZURES AND IF

338
00:11:02,385 --> 00:11:03,920
THEY'RE NOT CONTROLLED THIS

339
00:11:03,920 --> 00:11:05,388
INVOLVES TO WAKING UP PEOPLE

340
00:11:05,388 --> 00:11:07,190
STANDING UP AND STARING AT THEM,

341
00:11:07,190 --> 00:11:08,491
THIS INVOLVES GETTING CARTED OFF

342
00:11:08,491 --> 00:11:10,693
TO EMERGENCY ROOMS OVER AND OVER

343
00:11:10,693 --> 00:11:11,528
AGAIN, SIGNIFICANT COST,

344
00:11:11,528 --> 00:11:12,462
EMBARRASSMENT BUT ALSO THE

345
00:11:12,462 --> 00:11:14,164
MEDICAL SYSTEM CAN BE A BIT

346
00:11:14,164 --> 00:11:15,331
UNKIND TO THESE PATIENTS.

347
00:11:15,331 --> 00:11:19,736
A LOT OF TIMES THEY COME IN THAT

348
00:11:19,736 --> 00:11:20,837
ARE CONFUSED, COMBATIVE, A LOT

349
00:11:20,837 --> 00:11:23,940
OF OUR PATIENTS HAVE HAD

350
00:11:23,940 --> 00:11:26,376
INTERACTIONS WITH POLICE BECAUSE

351
00:11:26,376 --> 00:11:27,343
THEY'RE BEHAVING UNPREDICTABLY.

352
00:11:27,343 --> 00:11:29,579
A LOT OF TIME EMERGENCIES ARE

353
00:11:29,579 --> 00:11:30,547
NOT PARTICULARLY SYMPATHETIC TO

354
00:11:30,547 --> 00:11:32,715
THESE PATIENTS BECAUSE THEY CAN

355
00:11:32,715 --> 00:11:34,617
BE BEHAVIORIALLY DIFFICULT TO

356
00:11:34,617 --> 00:11:36,152
DEAL WITH, THEY HAVE MEMORY

357
00:11:36,152 --> 00:11:38,655
PROBLEMS, CAN'T COME UP WITH

358
00:11:38,655 --> 00:11:39,289
MEDICINES, CAN'T EXPLAIN WHAT'S

359
00:11:39,289 --> 00:11:41,491
GOING ON AND THEY GET EVALUATED

360
00:11:41,491 --> 00:11:43,393
OVER AND OVER AGAIN THIS, IS HER

361
00:11:43,393 --> 00:11:44,994
IMAGES PROJECTING THAT, YOU FEEL

362
00:11:44,994 --> 00:11:50,266
A LITTLE BIT LIKE A ROBOT OR AN

363
00:11:50,266 --> 00:11:52,602
AUTOTOM TON LIKE WE LIKE TO DO

364
00:11:52,602 --> 00:11:54,838
WITH OUR EEGS, THE PROBLEMS WITH

365
00:11:54,838 --> 00:11:56,039
OUR JOBS, MANY OF OUR PATIENTS

366
00:11:56,039 --> 00:11:57,607
HAVE LOST THEIR JOBS WHEN

367
00:11:57,607 --> 00:11:59,375
THEY'VE HAD A SEIZURE ON THEIR

368
00:11:59,375 --> 00:12:00,977
JOBS, IF PEOPLE FIND OUT THEY

369
00:12:00,977 --> 00:12:02,812
WON'T HIRE THEM FOR JOBS AND IN

370
00:12:02,812 --> 00:12:05,715
FACT IF YOU LOOK AT THE ASYLUMS

371
00:12:05,715 --> 00:12:08,785
WE USED TO HAVE IT WAS ASIGNIFY

372
00:12:08,785 --> 00:12:10,453
LEMS FOR THE EPILEPSICS AND THE

373
00:12:10,453 --> 00:12:10,820
INSANE.

374
00:12:10,820 --> 00:12:13,423
SO THAT TELLS YOU A LOT ABOUT

375
00:12:13,423 --> 00:12:14,124
THEIR EXPERIENCE.

376
00:12:14,124 --> 00:12:15,959
A LOT OF THEM TRY AND SUPPRESS

377
00:12:15,959 --> 00:12:17,193
THE KNOWLEDGE THEY HAVE EPILEPSY

378
00:12:17,193 --> 00:12:20,663
FOR FEAR THIS WILL IMPACT THEIR

379
00:12:20,663 --> 00:12:22,832
ABILITY TO HAVE--TO MARRY, HAVE

380
00:12:22,832 --> 00:12:24,534
CHILDREN, AFFECT CHILDREN GOING

381
00:12:24,534 --> 00:12:24,767
FORWARD.

382
00:12:24,767 --> 00:12:26,136
SO THAT'S MY LITTLE PIECE ABOUT

383
00:12:26,136 --> 00:12:28,238
WHAT IT'S LIKE TO LIVE WITH

384
00:12:28,238 --> 00:12:28,605
EPILEPSY.

385
00:12:28,605 --> 00:12:30,373
I'M HAPPY TO TALK WITH ANYBODY

386
00:12:30,373 --> 00:12:31,541
ABOUT WHAT THAT IS.

387
00:12:31,541 --> 00:12:32,742
THE THING I DIDN'T MENTION THERE

388
00:12:32,742 --> 00:12:35,512
IS THE IMPACT ON THEIR FAMILIES,

389
00:12:35,512 --> 00:12:38,014
A LOST THEIR FAMILIES END UP

390
00:12:38,014 --> 00:12:39,816
DRIVING PEOPLE THESE PLACES AND

391
00:12:39,816 --> 00:12:42,252
ARE ALMOST A LOT MORE

392
00:12:42,252 --> 00:12:43,953
TRAUMATIZED THAN THE PATIENTS

393
00:12:43,953 --> 00:12:45,722
BECAUSE THE PATIENTS FOR GET THE

394
00:12:45,722 --> 00:12:46,890
SEIZURES BUT THE FAMILIES HAVE

395
00:12:46,890 --> 00:12:48,191
TO LIVE THROUGH THEM EMPLOY SO

396
00:12:48,191 --> 00:12:50,059
THIS IS A DISORDER THAT AFFECTS

397
00:12:50,059 --> 00:12:52,228
THE FAMILIES SO AS AN

398
00:12:52,228 --> 00:12:53,163
EPIATOLOGYIST WHAT CAN I DO TO

399
00:12:53,163 --> 00:12:53,763
HELP THEM.

400
00:12:53,763 --> 00:12:55,732
THE MAIN STAY IS MEDICATIONS.

401
00:12:55,732 --> 00:12:58,134
WE'VE HAD THIS AMAZING EXPLOSION

402
00:12:58,134 --> 00:13:00,170
IN THE NUMBER OF SEIZURE

403
00:13:00,170 --> 00:13:02,038
MEDICATIONS OVER THE LAST 10 OR

404
00:13:02,038 --> 00:13:02,305
20 YEARS.

405
00:13:02,305 --> 00:13:07,310
WE USED TO HAVE BASICALLY

406
00:13:07,310 --> 00:13:07,911
BROMID, BORAX, AND PHENOBARB

407
00:13:07,911 --> 00:13:09,612
TOLL-LIKE RECEPTOR, AND NOW WE

408
00:13:09,612 --> 00:13:11,681
HAVE A HUGE NUMBER OF MEDICINE

409
00:13:11,681 --> 00:13:13,750
AND THEY HAVE A WHOLE BUNCH OF

410
00:13:13,750 --> 00:13:15,018
MECHANISMS OF ACTION WHICH ARE

411
00:13:15,018 --> 00:13:16,152
SUPER INTERESTING AND WE COULD

412
00:13:16,152 --> 00:13:18,621
TALK ABOUT FOR AN ENTIRE DAY OR

413
00:13:18,621 --> 00:13:20,056
COURSE, MOSTLY AFFECTING, TRYING

414
00:13:20,056 --> 00:13:24,928
TO INCREASE GABBA INHIBITION OR

415
00:13:24,928 --> 00:13:26,629
DECREASE GLUTEA MITTERGIC

416
00:13:26,629 --> 00:13:26,996
EXCITATION.

417
00:13:26,996 --> 00:13:28,598
SADLY, I SAY THE POSITIVE SIDE

418
00:13:28,598 --> 00:13:30,567
IS THESE ARE MUCH BETTER

419
00:13:30,567 --> 00:13:32,368
TOLERATED THAN OLD MEDICINES,

420
00:13:32,368 --> 00:13:33,903
OUR PATIENTS TEND TO HAVE FEWER

421
00:13:33,903 --> 00:13:35,305
SIDE EFFECTS ON THEM.

422
00:13:35,305 --> 00:13:36,906
HOWEVER, NONE OF THEM WORK ANY

423
00:13:36,906 --> 00:13:38,675
BETTER THAN ANY OTHER MEDICINE

424
00:13:38,675 --> 00:13:39,943
IN TREATING THE SEIZURES

425
00:13:39,943 --> 00:13:42,078
THEMSELVES, SO THIS IS SAD AND

426
00:13:42,078 --> 00:13:43,846
IT ACTUALLY DIDN'T AFFECT THE

427
00:13:43,846 --> 00:13:45,982
TRAJECTORY OF THE ILLNESS,

428
00:13:45,982 --> 00:13:46,216
EITHER.

429
00:13:46,216 --> 00:13:50,587
SO IT'S KIND OF LIKE TAKING AN

430
00:13:50,587 --> 00:13:52,555
ADVIL, IT WILL SETTLE THINGS BUT

431
00:13:52,555 --> 00:13:54,724
IT WON'T CHANGE THE UNDERLYING

432
00:13:54,724 --> 00:13:56,292
PREDISPOSITION TO HAVE SEIZURES.

433
00:13:56,292 --> 00:13:57,860
SO SEIZURE CONTROL MEDICATIONS,

434
00:13:57,860 --> 00:13:59,629
YOUR FIRST DRUG, HALF OF OUR

435
00:13:59,629 --> 00:14:01,364
PATIENTS WILL BECOME SEIZURE

436
00:14:01,364 --> 00:14:01,664
FREE.

437
00:14:01,664 --> 00:14:03,800
BY THE TIME YOU'RE TRYING A

438
00:14:03,800 --> 00:14:05,535
THIRD, FOURTH, FIFTH, SIXTH,

439
00:14:05,535 --> 00:14:06,803
SEVENTH DRUG, THE CHANCE THAT

440
00:14:06,803 --> 00:14:10,473
YOU WILL BE SEIZURE FREE ARE

441
00:14:10,473 --> 00:14:10,873
INCREDIBLY SMALL.

442
00:14:10,873 --> 00:14:12,208
ABOUT A THIRD OF OUR PATIENTS

443
00:14:12,208 --> 00:14:13,843
WILL HAVE DRUG RESISTANT

444
00:14:13,843 --> 00:14:15,445
EPILEPSY OR SEIZURES THAT WILL

445
00:14:15,445 --> 00:14:16,379
CONTINUE BASICALLY NO MATTER

446
00:14:16,379 --> 00:14:19,015
WHICH MEDICINE WE TRY TO TREAT

447
00:14:19,015 --> 00:14:21,217
THEM WITH WHICH LEADS ME TO THE

448
00:14:21,217 --> 00:14:22,585
THING I'VE ENDED UP THINK BEING

449
00:14:22,585 --> 00:14:23,786
A LOT WHICH IS SURMLY.

450
00:14:23,786 --> 00:14:25,755
SO WHAT OTHER COPDS EXIST FOR

451
00:14:25,755 --> 00:14:27,790
THIS ONE-THIRD OF PATES WHERE

452
00:14:27,790 --> 00:14:28,491
REALLY THE MEDICINES AREN'T

453
00:14:28,491 --> 00:14:31,294
GOING TO DO THE JOB AND YOU KNOW

454
00:14:31,294 --> 00:14:32,362
THIS AFTER A YEAR OR 2.

455
00:14:32,362 --> 00:14:34,464
SO IF YOU AGGRESSIVELY TRY THESE

456
00:14:34,464 --> 00:14:35,398
MEDICINE, YOU KNOW PRETTY

457
00:14:35,398 --> 00:14:37,467
QUICKLY IN THESE PATIENTS, YOU

458
00:14:37,467 --> 00:14:38,968
ARE NOT A PATIENT WHERE IT'S

459
00:14:38,968 --> 00:14:41,738
GOING TO  WORK.

460
00:14:41,738 --> 00:14:44,140
SO NOBODY WANTS TO THINK ABOUT

461
00:14:44,140 --> 00:14:45,308
BRAIN SURGERY, IT'S NOT

462
00:14:45,308 --> 00:14:46,776
SOMETHING PEOPLE ARE EXCITED

463
00:14:46,776 --> 00:14:47,944
ABOUT YOU BUT OFTEN THE TROUBLE

464
00:14:47,944 --> 00:14:49,379
PEOPLE ARE HAVING IN THEIR LIVES

465
00:14:49,379 --> 00:14:51,047
LEADS THEM TO CONSIDER THIS AS

466
00:14:51,047 --> 00:14:52,782
AN OPTION.

467
00:14:52,782 --> 00:14:54,417
BY FAR THE BIGGEST SURGERY DONE

468
00:14:54,417 --> 00:14:59,656
OVER TIME IS A TEMPORAL

469
00:14:59,656 --> 00:15:02,125
RESECTION OF THE TEMPORAL LOBE,

470
00:15:02,125 --> 00:15:03,926
PLUS THE MEDIAL STRUCTURE CALLED

471
00:15:03,926 --> 00:15:04,360
THE HIPPOCAMPUS.

472
00:15:04,360 --> 00:15:06,896
I THINK MANY OF YOU HAVE HEARD

473
00:15:06,896 --> 00:15:08,431
OF THE HIPPOCAMPUS AS BEING

474
00:15:08,431 --> 00:15:09,365
INCREDIBLE LOAMACYY IMPORTANT

475
00:15:09,365 --> 00:15:10,967
FOR MEMORY, SO CAN YOU IMAGINE

476
00:15:10,967 --> 00:15:12,602
THERE ARE PROBLEMS ASSOCIATE

477
00:15:12,602 --> 00:15:14,237
WIDE RESECTION OF A HYPOCAMPUS.

478
00:15:14,237 --> 00:15:16,639
SO THERE HAVE BEEN EFFORTS TO

479
00:15:16,639 --> 00:15:17,607
MINIMIZE THE COGNITIVE SIDE

480
00:15:17,607 --> 00:15:20,043
EEIVETS OF THESE SURGERIES,

481
00:15:20,043 --> 00:15:20,710
INCLUDING SELECTIVE RESECTIONS,

482
00:15:20,710 --> 00:15:23,179
WE NOW HAVE LASER OBLATIONS

483
00:15:23,179 --> 00:15:26,616
WHERE YOU PUT AN LASER IN, IT'S

484
00:15:26,616 --> 00:15:28,084
ALMOST AN OUTPATIENT PROCEDURE

485
00:15:28,084 --> 00:15:30,720
AND THEY CAN ABLATE THE

486
00:15:30,720 --> 00:15:31,621
HIPPOCAMPUS WITHOUT AFFECTING

487
00:15:31,621 --> 00:15:34,791
THENY O CORTEX AND THERE'S BEEN

488
00:15:34,791 --> 00:15:36,759
AN EXPLOSION IN THE

489
00:15:36,759 --> 00:15:37,460
NEUROMODDULATION OPTIONS, SO

490
00:15:37,460 --> 00:15:39,095
THESE ARE AREAS OF ONGOING WORK

491
00:15:39,095 --> 00:15:42,298
THAT WE'RE REALLY EXCITED ABOUT,

492
00:15:42,298 --> 00:15:44,701
DEFINITELY CAUSING SIDE EFFECTS

493
00:15:44,701 --> 00:15:46,035
BUT THE EFFICACY HAS NEVER

494
00:15:46,035 --> 00:15:50,106
REALLY MATCHED THE EFFICACY OF A

495
00:15:50,106 --> 00:15:51,374
STANDARD ANTERIOR TEMPORAL

496
00:15:51,374 --> 00:15:51,841
LOBECTOMY.

497
00:15:51,841 --> 00:15:55,378
SO THIS IS JUST FOR EPILEPSY

498
00:15:55,378 --> 00:15:56,179
RESECTIVE SURGERIES WHICH IS

499
00:15:56,179 --> 00:15:58,014
STILL THE MOST EFFECTIVE OPTION

500
00:15:58,014 --> 00:15:58,981
WE CAN OFFER OUR PATIENTS.

501
00:15:58,981 --> 00:16:01,417
IF YOU LOOK AT ALL PATIENTS, AND

502
00:16:01,417 --> 00:16:03,219
THIS IS OVER YEARS ON THE

503
00:16:03,219 --> 00:16:05,221
BOTTOMACIS HERE, CAN YOU SEE

504
00:16:05,221 --> 00:16:09,325
THAT THAT A MEAN OF 80-90%

505
00:16:09,325 --> 00:16:10,259
SEIZURE REDUCTION.

506
00:16:10,259 --> 00:16:11,527
SO THESE SURGERIES TEND TO BE

507
00:16:11,527 --> 00:16:11,928
QUITE EFFECTIVE.

508
00:16:11,928 --> 00:16:14,330
SO IF YOU LOCK AT THE 25th

509
00:16:14,330 --> 00:16:15,264
PERCENTILE, THEY DO

510
00:16:15,264 --> 00:16:17,066
EXCEPTIONALLY WELL, HOWEVER WE

511
00:16:17,066 --> 00:16:19,035
HAVE THIS GROUP IN THE TENTH

512
00:16:19,035 --> 00:16:20,536
PERCENTILE THAT DOES MUCH, MUCH

513
00:16:20,536 --> 00:16:22,672
LESS WELL AND ALL COMERS ARE NOT

514
00:16:22,672 --> 00:16:23,606
THE SAME.

515
00:16:23,606 --> 00:16:24,707
PEOPLE WITH TEMPORAL LOBE

516
00:16:24,707 --> 00:16:25,942
EPILEPSY WHICH IS THE BLACK AND

517
00:16:25,942 --> 00:16:27,810
BLUE LINE UP HERE AT 10 YEARS

518
00:16:27,810 --> 00:16:31,581
OUT TEND TO BE OVER 50% ARE

519
00:16:31,581 --> 00:16:33,316
ACTUALLY SEIZURE FREE AFTER

520
00:16:33,316 --> 00:16:35,017
THESE SURGERIES BUT WHEN YOU GET

521
00:16:35,017 --> 00:16:38,354
OUTSIDE THE TEMPORAL LOBE, THE

522
00:16:38,354 --> 00:16:39,489
OUTCOMES ARE HARDER.

523
00:16:39,489 --> 00:16:43,826
SO THIS GREEN LINE IS A TEMPORAL

524
00:16:43,826 --> 00:16:46,763
LOBE EPILEPSY WITH A LESION, AND

525
00:16:46,763 --> 00:16:47,964
TEMPORAL LOBE WITH EPILEPSY

526
00:16:47,964 --> 00:16:48,798
WITHOUT A LESION, CAN YOU SEE WE

527
00:16:48,798 --> 00:16:50,233
HAVE A LOT OF WORK TO DO.

528
00:16:50,233 --> 00:16:52,402
SO THIS IS REALLY WHY THE TITLE

529
00:16:52,402 --> 00:16:54,404
COMES FROM WITH MAPPING EPILEPSY

530
00:16:54,404 --> 00:16:55,972
IN THE HUMAN BRAIN AND SO WHY DO

531
00:16:55,972 --> 00:16:57,373
WE THINK THESE PEOPLE ARE NOT

532
00:16:57,373 --> 00:16:58,875
GETTING THE EFFECT THAT WE'RE

533
00:16:58,875 --> 00:17:00,877
LOOKING FOR, SO 1 IN INCOMPLETE

534
00:17:00,877 --> 00:17:02,478
RESECTION, BUT THIS CAN BE BY

535
00:17:02,478 --> 00:17:04,947
ACCIDENT OR ON PURPOSE, IF

536
00:17:04,947 --> 00:17:06,282
THEY'RE COMING FROM THE ELOQUENT

537
00:17:06,282 --> 00:17:07,683
PART OF THE BRAIN, YOU WE WENT

538
00:17:07,683 --> 00:17:09,085
WANT TO GIVE SOMEBODY A HORRIBLE

539
00:17:09,085 --> 00:17:09,786
DEVELOPMENTAL ENDOCRINOLOGY SILT

540
00:17:09,786 --> 00:17:11,754
SO WE CAN ON PURPOSE NOT RESECT

541
00:17:11,754 --> 00:17:13,823
SOAZ PLACES AND THEY HAVE A

542
00:17:13,823 --> 00:17:15,825
LOWER CHANCE OF BECOMING SEIZURE

543
00:17:15,825 --> 00:17:16,159
FREE.

544
00:17:16,159 --> 00:17:16,926
SOMETIMES WE'RE STILL JUST

545
00:17:16,926 --> 00:17:17,727
GETTING IT WRONG AND THIS IS

546
00:17:17,727 --> 00:17:19,395
WHERE I THINK THAT ALL OF THESE

547
00:17:19,395 --> 00:17:21,364
FANCY NEW TECHNOLOGIES THAT WE

548
00:17:21,364 --> 00:17:23,299
HAVE CAN REALLY HAVE AN IMPACT

549
00:17:23,299 --> 00:17:24,901
ON YOUR CHAIR OF PATIENTS AND

550
00:17:24,901 --> 00:17:27,036
THE LESS IS DIFFUSE FROM

551
00:17:27,036 --> 00:17:28,538
MULTIFOCAL DISEASE, SO SOME

552
00:17:28,538 --> 00:17:31,774
PEOPLE HAVE A NEURODEGENERATIVE

553
00:17:31,774 --> 00:17:33,242
DISORDER OR MULTIFOCAL OR

554
00:17:33,242 --> 00:17:34,143
INFLAMMATORY DISORDER AND TAKING

555
00:17:34,143 --> 00:17:36,145
OUT 1 PLACE MAY NOT TAKE CARE OF

556
00:17:36,145 --> 00:17:38,080
THE WHOLE PROBLEM, THAT'S A

557
00:17:38,080 --> 00:17:39,482
TOPIC FOR THE DIFFERENT DAY.

558
00:17:39,482 --> 00:17:44,153
SO I WILL FOCUS ON THE

559
00:17:44,153 --> 00:17:44,921
INACCURATE LOCALIZATION FOR THE

560
00:17:44,921 --> 00:17:46,055
REST OF THIS.

561
00:17:46,055 --> 00:17:49,258
SO EPILEPSY SURGERY HAS ALWAYS

562
00:17:49,258 --> 00:17:50,860
CLOSELY MIRRORED MAPPING EPILEPS

563
00:17:50,860 --> 00:17:51,561
EXPE MAPPING NORMAL BRAIN

564
00:17:51,561 --> 00:17:54,297
FUNCHES AND I JUST WANT TO TAKE

565
00:17:54,297 --> 00:17:56,532
A MOMENT TO POINT OUT HERE,

566
00:17:56,532 --> 00:17:57,333
JASPER PUBLISHED THE FIRST EEG

567
00:17:57,333 --> 00:17:58,768
IN THE U.S. AND THE BIG IMPACT

568
00:17:58,768 --> 00:18:02,338
HE HAD WAS THAT HE FELT LIKE YOU

569
00:18:02,338 --> 00:18:03,940
COULD ACTUALLY REGIONALIZE WHERE

570
00:18:03,940 --> 00:18:06,509
SEIZURES WERE COMING FROM USING

571
00:18:06,509 --> 00:18:07,777
THIS CRAZY EEG TECHNOLOGY AND

572
00:18:07,777 --> 00:18:09,345
THIS IS THEIR 2 CHANNEL EEG BACK

573
00:18:09,345 --> 00:18:09,912
IN THE DAY.

574
00:18:09,912 --> 00:18:12,348
THIS IS THE FIRST 1 THAT WAS

575
00:18:12,348 --> 00:18:14,317
PUBLISHED AND HE ACTUALLY

576
00:18:14,317 --> 00:18:17,186
EVENTUALLY MET UP WITH PENFIELD

577
00:18:17,186 --> 00:18:19,355
WHO WAS IN MONTREAL AND I HAVE

578
00:18:19,355 --> 00:18:21,824
THIS EEG THAT MAY TELL US WHERE

579
00:18:21,824 --> 00:18:23,659
THE SEIZURES MIGHT BE COMING

580
00:18:23,659 --> 00:18:24,393
FROM.

581
00:18:24,393 --> 00:18:25,061
IT'S A REVOLUTIONARY THING.

582
00:18:25,061 --> 00:18:28,831
I LOVE THE PICTURE, SO I'M THE

583
00:18:28,831 --> 00:18:31,400
EPILEAPTOLOGYIST IN ALL THIS, SO

584
00:18:31,400 --> 00:18:34,270
HERE'S THE DOCTORS AND JASPER'S

585
00:18:34,270 --> 00:18:36,138
BACK HERE DOING OUR SQUIGGLING

586
00:18:36,138 --> 00:18:40,076
LINES SO NOTHING'S CHANGED BUT

587
00:18:40,076 --> 00:18:41,377
TOGETHER THEY PUT OUT THIS BOOK

588
00:18:41,377 --> 00:18:44,113
WHICH I THINK ALL OF YOU AND IF

589
00:18:44,113 --> 00:18:46,849
YOU WENT TO MEDICAL SCHOOL OR

590
00:18:46,849 --> 00:18:48,484
BASIC NEUROSCIENCE CLASSES WE

591
00:18:48,484 --> 00:18:51,387
ALL KNOW THE HOMOCULUS, SO THIS

592
00:18:51,387 --> 00:18:53,322
IS SOMETHING WE LEARNED THROUGH

593
00:18:53,322 --> 00:18:53,823
EPILEPSY SURGERY.

594
00:18:53,823 --> 00:18:55,791
ANOTHER THING YOU MAY HAVE HEARD

595
00:18:55,791 --> 00:18:57,560
ABOUT IS HM OTHERS ANOTHER CASE

596
00:18:57,560 --> 00:18:58,561
OF EPILEPSY SURGERY, TEACHING US

597
00:18:58,561 --> 00:19:01,964
MORE THAN WE WANTED TO KNOW FOR

598
00:19:01,964 --> 00:19:03,366
HIM AT LEAST ABOUT BRAIN

599
00:19:03,366 --> 00:19:03,833
FUNCTION AND MEMORY.

600
00:19:03,833 --> 00:19:06,769
SO WE CONTINUE TO LEARN ABOUT

601
00:19:06,769 --> 00:19:07,937
LANGUAGE ABOUT MOTOR FUNCTION, A

602
00:19:07,937 --> 00:19:09,438
LOT OF THE BRAIN MACHINE

603
00:19:09,438 --> 00:19:10,740
INTERFACE WORK IS COMING OUT OF

604
00:19:10,740 --> 00:19:12,341
OUR PATIENTS WITH EPILEPTSY IS

605
00:19:12,341 --> 00:19:14,110
MOVING INTO OTHER PATIENT

606
00:19:14,110 --> 00:19:15,845
POPULATIONS, SO, THAT'S MY PITCH

607
00:19:15,845 --> 00:19:17,480
FOR EPILEPSY AND NORMAL BRAIN

608
00:19:17,480 --> 00:19:18,781
FUNCTION, THAT IS NOT WHAT I'M

609
00:19:18,781 --> 00:19:19,815
DOING AT ALL.

610
00:19:19,815 --> 00:19:22,218
I AM REALLY INTERESTED IN

611
00:19:22,218 --> 00:19:22,852
UNDERSTANDING EPILEPSY THROUGH

612
00:19:22,852 --> 00:19:24,487
ALL THESE TOOLS AND SO OUR IDEA

613
00:19:24,487 --> 00:19:27,023
OF WHAT EPILEPSY IS, AND HOW IT

614
00:19:27,023 --> 00:19:29,792
FUNCTIONS IN THE BRAIN SO THIS

615
00:19:29,792 --> 00:19:31,260
CONCEPT OF HIJACKING NORMAL

616
00:19:31,260 --> 00:19:32,995
BRAIN FUNCTION HAS BEEN AROUND

617
00:19:32,995 --> 00:19:35,298
FOR A LONG TIME BUT IT HAS

618
00:19:35,298 --> 00:19:35,531
CHANGED.

619
00:19:35,531 --> 00:19:36,732
SO 1950S WE'RE BACK WITH THE

620
00:19:36,732 --> 00:19:39,402
PICTURE I WAS SHOWING YOU OF

621
00:19:39,402 --> 00:19:42,939
JASPER AND PENFIELD DOING INTRA

622
00:19:42,939 --> 00:19:44,440
OPERATIVE RECORDINGS, SO THESE

623
00:19:44,440 --> 00:19:46,309
WOULD BE RELATIVELY BRIEF, SO

624
00:19:46,309 --> 00:19:47,710
MAYBE OVER MINUES TO HOURS AND

625
00:19:47,710 --> 00:19:50,479
YOU WOULD LOOK AT THESE

626
00:19:50,479 --> 00:19:52,982
ACTIVITIES, THE SPIKING AND USE

627
00:19:52,982 --> 00:19:56,252
THAT TO MAP OUT FUNCTION.

628
00:19:56,252 --> 00:19:59,755
SO THEN [INDISCERNIBLE]--THERE'S

629
00:19:59,755 --> 00:20:03,059
A FAMOUS PICTURE I ALMOST PUT IN

630
00:20:03,059 --> 00:20:05,595
HERE, BUT THEY PIONEERED THE USE

631
00:20:05,595 --> 00:20:07,763
OF ELECTRODES, THAT THEY WOULD

632
00:20:07,763 --> 00:20:11,634
ALWAYS PUT SIDE WAYS, THEY

633
00:20:11,634 --> 00:20:12,568
ACTUALLY HAD ANGIOGRAPHYS SO

634
00:20:12,568 --> 00:20:14,870
THEY COULD TELL WHERE THE BLOOD

635
00:20:14,870 --> 00:20:15,838
VESSELS WERE TO AVOID THEM AND

636
00:20:15,838 --> 00:20:17,974
THIS IS WHERE THE

637
00:20:17,974 --> 00:20:18,774
[INDISCERNIBLE] ATLAS CAME FROM

638
00:20:18,774 --> 00:20:19,942
FOR ANY OF YOU.

639
00:20:19,942 --> 00:20:21,777
THEY WOULD PUT THESE DEPTH

640
00:20:21,777 --> 00:20:23,312
ELECTRODES IN AND KEEP THEM IN

641
00:20:23,312 --> 00:20:25,848
LONG ENOUGH TO RECORD SEIZURES,

642
00:20:25,848 --> 00:20:28,150
SO THEY REALLY FOCUSED ON

643
00:20:28,150 --> 00:20:30,653
SEEDSURES AND DEPTH ELECTRODE

644
00:20:30,653 --> 00:20:31,854
RECORDINGS TO SEE HOW SEIZURES

645
00:20:31,854 --> 00:20:32,955
WORKED IN THE BRAIN AND WHAT

646
00:20:32,955 --> 00:20:34,590
AREAINGS THEY WANT TO RESECT TO

647
00:20:34,590 --> 00:20:35,658
MAKE THE SEIZURES BETTER.

648
00:20:35,658 --> 00:20:37,760
BY THE WAY THIS BASICALLY IS

649
00:20:37,760 --> 00:20:39,495
TILL DONE ESSENTIALLY THE SAME

650
00:20:39,495 --> 00:20:43,699
WAY WITH FANCIER TECHNOLOGY BUT

651
00:20:43,699 --> 00:20:44,533
TO THIS DAY.

652
00:20:44,533 --> 00:20:46,669
THE NEXT BIG CHANGES WERE

653
00:20:46,669 --> 00:20:47,436
SEVERAL DECADES LATER WHERE

654
00:20:47,436 --> 00:20:48,371
PARTICULARLY IN THE UNITED

655
00:20:48,371 --> 00:20:51,007
STATES FOR SOME REASON IN

656
00:20:51,007 --> 00:20:52,875
EUROPE, KIND OF CONTINUED THIS

657
00:20:52,875 --> 00:20:53,576
IS NEVER CHANGED.

658
00:20:53,576 --> 00:21:01,017
THE UNITED STATES WENT ALL IN ON

659
00:21:01,017 --> 00:21:01,717
SUBDURANNAL RECORDINGS, SO THE

660
00:21:01,717 --> 00:21:03,352
OTHER THING THAT HAPPENED AROUND

661
00:21:03,352 --> 00:21:05,354
THAT TIME WAS BRAIN IMAGING SO

662
00:21:05,354 --> 00:21:07,990
THE ADVENT OF MRI CHANGED HOW WE

663
00:21:07,990 --> 00:21:09,825
THINK ABOUT SEIZURE FOCUS

664
00:21:09,825 --> 00:21:10,192
LOCALIZATION.

665
00:21:10,192 --> 00:21:13,295
BEFORE WE WERE REALLY RELYING

666
00:21:13,295 --> 00:21:13,929
ENTIRELY ON ELECTROPHYSIOLOGY

667
00:21:13,929 --> 00:21:16,532
BUT NOW WE HAVE BRAIN NRI THAT

668
00:21:16,532 --> 00:21:17,967
JUST SAYS, THERE'S THE PROBLEM,

669
00:21:17,967 --> 00:21:20,002
RIGHT, SO THAT ALLOWED US TO

670
00:21:20,002 --> 00:21:21,303
LEARN A LOT ABOUT EPILEPSY AND

671
00:21:21,303 --> 00:21:26,876
SO THIS WAS PUT TOGETHER BY

672
00:21:26,876 --> 00:21:28,611
LEUTERS AT CLEVELAND CLINIC AND

673
00:21:28,611 --> 00:21:33,649
HE TALKED ABOUT THESE STRECTURAL

674
00:21:33,649 --> 00:21:35,317
LESION, AND THERE WAS A SUBSET

675
00:21:35,317 --> 00:21:37,820
WROAN AND IT WAS A STATIC

676
00:21:37,820 --> 00:21:39,789
DIAGRAM AND THE MORE THEY

677
00:21:39,789 --> 00:21:40,523
OVERLAPPED THE BETTER OUR

678
00:21:40,523 --> 00:21:41,724
SITUATION WAS IN TERMS OF

679
00:21:41,724 --> 00:21:43,659
KNOWING WHAT TO DO TO TRY AND

680
00:21:43,659 --> 00:21:44,994
FIX THE PERSON'S SEIZURES.

681
00:21:44,994 --> 00:21:49,832
OVER TIME THIS IS REALLY EVOLVED

682
00:21:49,832 --> 00:21:52,368
TO A MORE KIND OF DYNAMIC VIEW

683
00:21:52,368 --> 00:21:54,704
OF THINGS WHICH WE LOOSELY REFER

684
00:21:54,704 --> 00:21:56,572
TO AS NETWORKS BUT THAT TERM IS

685
00:21:56,572 --> 00:21:58,174
NONSPECIFIC AND SO TAKING INTO

686
00:21:58,174 --> 00:22:00,810
ACCOUNT BOTH SPACE AND TIME AND

687
00:22:00,810 --> 00:22:02,211
SO I'M GOING TO GIVE YOU AN

688
00:22:02,211 --> 00:22:05,614
EXAMPLE OF WHAT THAT LOOKS LIKE

689
00:22:05,614 --> 00:22:08,784
BY THE WAY WE THINK ABOUT

690
00:22:08,784 --> 00:22:09,952
SCHEMEIOLOGY, IT'S SIGNS AND

691
00:22:09,952 --> 00:22:11,554
SYMPTOMS ANYONE HAS DURING

692
00:22:11,554 --> 00:22:13,923
SEIZURES AND WHEN I STARTED OFF

693
00:22:13,923 --> 00:22:16,559
I WAS EXCITED ABOUT THESE

694
00:22:16,559 --> 00:22:17,326
BASICALLY LOCALIZATIONIST MAPS.

695
00:22:17,326 --> 00:22:18,861
WHERE YOU WOULD BE LIKE A

696
00:22:18,861 --> 00:22:22,064
SEIZURE COMING FROM HERE OR

697
00:22:22,064 --> 00:22:23,466
OLFACTORY OR ICHTALL FEAR, LIKE

698
00:22:23,466 --> 00:22:26,001
A SYMPTOM CAME FROM A SPECIFIC

699
00:22:26,001 --> 00:22:27,269
PLACE, OKAY IN WHAT'S HAPPENED

700
00:22:27,269 --> 00:22:30,573
OVER TIME IS WE REALIZE WE WERE

701
00:22:30,573 --> 00:22:31,407
IGNORING THE RULE OF WHITE

702
00:22:31,407 --> 00:22:34,877
MATTER IN ALL OF THIS SO I THINK

703
00:22:34,877 --> 00:22:37,046
BOTH DTI IMAGING, A LOT OF

704
00:22:37,046 --> 00:22:38,481
ANIMAL WORK FROM FUNCTIONAL MRI

705
00:22:38,481 --> 00:22:41,217
HAS SHOWED US THERE ARE THESE

706
00:22:41,217 --> 00:22:42,585
DISTRIBUTED AND DISTANTLY

707
00:22:42,585 --> 00:22:43,753
LOCATED BRAIN NETWORKS THAT WORK

708
00:22:43,753 --> 00:22:44,820
TOGETHER AND WE NOW THINK THAT

709
00:22:44,820 --> 00:22:46,489
IS ALSO HUGH IT GENERATES THE

710
00:22:46,489 --> 00:22:48,924
SIGNS AND SYMPTOMS THAT WOE SEE

711
00:22:48,924 --> 00:22:50,793
DURING SEIZURES, SO I WILL GIVE

712
00:22:50,793 --> 00:22:54,363
YOU A COUPLE EXAMPLES, SO

713
00:22:54,363 --> 00:22:55,898
AUTONOMICKISM SYMPTOMS, WE WOULD

714
00:22:55,898 --> 00:22:58,734
SAY AMYGDALA BECAUSE IT WAS

715
00:22:58,734 --> 00:23:01,470
MEDIAL LOBE, TEMPORAL LOBE, EPS

716
00:23:01,470 --> 00:23:03,572
LE, BUT NOW WHEN WE THINK ABOUT

717
00:23:03,572 --> 00:23:06,542
IT, WE CAN SEE IT RELEASE

718
00:23:06,542 --> 00:23:07,810
SIGNALS FROM ALL THESE DEFINITE

719
00:23:07,810 --> 00:23:09,612
REGIONS IN THE BRAIN ARE HIGHLY

720
00:23:09,612 --> 00:23:10,980
CONNECTED AND ACTIVATION OF 1

721
00:23:10,980 --> 00:23:11,914
LEADS TO ACTIVATION OF THE REST

722
00:23:11,914 --> 00:23:15,384
AND WE END UP WITH VERY SIMILAR

723
00:23:15,384 --> 00:23:16,552
APPEARING SYMPTOMS.

724
00:23:16,552 --> 00:23:18,521
FRONTAL LOBE EPILEPSY I THINK I

725
00:23:18,521 --> 00:23:19,655
SHOWED YOU EARLIER, WE'RE STILL

726
00:23:19,655 --> 00:23:21,423
NOT GOOD AT DEALING WITH.

727
00:23:21,423 --> 00:23:25,027
IF YOU LOOK AT THE FRONTAL AND

728
00:23:25,027 --> 00:23:26,362
STRUCTURAL CONNECTIVITY OF THE

729
00:23:26,362 --> 00:23:27,963
FRONTAL LOBE, IT'S SMALL WONDER

730
00:23:27,963 --> 00:23:29,131
WE HAVE TROUBLE DEALING WITH

731
00:23:29,131 --> 00:23:30,332
THIS WITH THE RECORRINGS BY

732
00:23:30,332 --> 00:23:31,700
THEMSELVES BECAUSE IF YOU LOOK

733
00:23:31,700 --> 00:23:32,768
THESE ARE BROADLY DRIEWBT

734
00:23:32,768 --> 00:23:35,004
NETWORKS SO IF I SEE SOMETHING

735
00:23:35,004 --> 00:23:37,339
IN THIS DORSAL LATERAL

736
00:23:37,339 --> 00:23:38,941
PREFRONTAL CORTEX, JUST BASED ON

737
00:23:38,941 --> 00:23:42,044
SYMPTOMS IT COULD JUST AS EASILY

738
00:23:42,044 --> 00:23:44,513
BE COMING FROM THE PARIETAL PART

739
00:23:44,513 --> 00:23:45,848
OF THE CORTEX.

740
00:23:45,848 --> 00:23:47,783
SO THIS IS SOMETHING WE GAIN

741
00:23:47,783 --> 00:23:48,851
APPRECIATION FOR AND POSSIBLY

742
00:23:48,851 --> 00:23:50,953
MOVING THIS BACK TO THE EEG

743
00:23:50,953 --> 00:23:53,055
ELECTRODES WHERE YOU SAMPLE VERY

744
00:23:53,055 --> 00:23:54,690
FAR APART PLACES IN THE BRAIN.

745
00:23:54,690 --> 00:23:57,159
MY LAST EXAMPLE IS THE ROLE OF

746
00:23:57,159 --> 00:23:58,894
THE INSULA, WHICH WAS NOT WELL

747
00:23:58,894 --> 00:23:59,595
APPRECIATED PARTICULARLY BY

748
00:23:59,595 --> 00:24:02,965
TRUSTEESS THAT WERE ONLY USING

749
00:24:02,965 --> 00:24:03,766
SUBDURANNAL ELECTRODES SINCE

750
00:24:03,766 --> 00:24:05,568
THOSE DIDN'T SAMPLE THE INSULA

751
00:24:05,568 --> 00:24:06,135
AT ALL.

752
00:24:06,135 --> 00:24:08,103
AND WE KNOW IT'S ANOTHER GREAT

753
00:24:08,103 --> 00:24:09,705
MIMICKER THAT CAN LOOK LIKE

754
00:24:09,705 --> 00:24:13,442
SEIZURES COMING FROM ANY PART OF

755
00:24:13,442 --> 00:24:14,877
THE BRAIN.

756
00:24:14,877 --> 00:24:17,346
SO WHY DID INTRA CRANIAL EEG NOT

757
00:24:17,346 --> 00:24:18,113
SOLVE THIS PROBLEM?

758
00:24:18,113 --> 00:24:19,682
WELL 1 IS WHAT I WAS TELLING YOU

759
00:24:19,682 --> 00:24:21,317
WHICH IS THE ACTIVITY SPREADS

760
00:24:21,317 --> 00:24:22,818
REALLY FAR AND REALLY FAST.

761
00:24:22,818 --> 00:24:24,553
ANOTHER IS THAT EVEN WHEN WE

762
00:24:24,553 --> 00:24:25,354
THINK WE'RE COVERING THIS

763
00:24:25,354 --> 00:24:27,656
MASSIVE PART OF THE BRAIN, THIS

764
00:24:27,656 --> 00:24:29,959
IS AN EXAMPLE OF 4 BY 8 GRID,

765
00:24:29,959 --> 00:24:33,729
PEOPLE HAVE USED EVEN 8 BY 8

766
00:24:33,729 --> 00:24:35,965
GRIDS THAT COVER WHOLE

767
00:24:35,965 --> 00:24:37,566
HEMISPHERES ON THE SURFACE OF

768
00:24:37,566 --> 00:24:38,534
THE BRAIN, THEY PUT THOSE

769
00:24:38,534 --> 00:24:40,336
CERTAINLY--CERTAINLY LECT RODES

770
00:24:40,336 --> 00:24:42,872
ON THE BRAIN SURFACE FOR THE

771
00:24:42,872 --> 00:24:44,373
PATIENT IT ALLOWS YOU TO BLOW

772
00:24:44,373 --> 00:24:46,242
THE BRAIN UP, SO THE BLAINE IS

773
00:24:46,242 --> 00:24:47,743
ALL FOLDED BUT IF YOU THINK OF

774
00:24:47,743 --> 00:24:49,511
PUTTING A STRAW IN AND INFLATING

775
00:24:49,511 --> 00:24:51,180
IT SO IT LOOKS LIKE A BALL, THIS

776
00:24:51,180 --> 00:24:52,581
IS WHERE THOSE ELECTRODES ARE,

777
00:24:52,581 --> 00:24:54,683
SO FOR ME THAT KIND OF

778
00:24:54,683 --> 00:24:56,085
HIGHLIGHTED EXACTLY HOW SPARSE

779
00:24:56,085 --> 00:24:57,586
OUR SAMPLING IS EVEN WHEN IT

780
00:24:57,586 --> 00:25:01,357
LOOKS LIKE WE LIKE COVERED THE

781
00:25:01,357 --> 00:25:02,358
BRAIN WITH ELECTROCOVERRAGE.

782
00:25:02,358 --> 00:25:04,126
SO THERE'S A PAPER THAT CAME OUT

783
00:25:04,126 --> 00:25:06,228
QUANTIFYING THIS AND IF YOU LOOK

784
00:25:06,228 --> 00:25:07,863
AT FOR EXAMPLE, TEMPORAL LOBE

785
00:25:07,863 --> 00:25:09,131
IMPLANT, THIS IS THE COVERAGE OF

786
00:25:09,131 --> 00:25:11,000
THE REGION BY PERCENTAGE, SO

787
00:25:11,000 --> 00:25:14,270
WHEN YOU HAVE STRIPS AND GRIDS

788
00:25:14,270 --> 00:25:16,605
YOU CAN COVER MAYBE

789
00:25:16,605 --> 00:25:19,341
OPTIMISTICALLY, ALMOST 5% OF THE

790
00:25:19,341 --> 00:25:21,644
BRAIN MAXIMUM, EVEN IN THAT

791
00:25:21,644 --> 00:25:22,811
TEMPORAL LOBE, RIGHT?

792
00:25:22,811 --> 00:25:24,713
AND DEPTH ELECTRODES DO NOT FIX

793
00:25:24,713 --> 00:25:26,215
THIS PROBLEM.

794
00:25:26,215 --> 00:25:27,516
THE SPATIAL SAMPLING IS STILL

795
00:25:27,516 --> 00:25:27,783
QUITE LOW.

796
00:25:27,783 --> 00:25:30,085
WHAT I WOULD LIKE TO SAY IS THAT

797
00:25:30,085 --> 00:25:31,353
I THINK PARTICULARLY WHEN WE

798
00:25:31,353 --> 00:25:34,256
TALK ABOUT THESE BROADLY

799
00:25:34,256 --> 00:25:35,424
DRIEWBTED BRAIN NETWORKS, INTRA

800
00:25:35,424 --> 00:25:36,592
CRANIAL EEKB SIN BY ITSELF I

801
00:25:36,592 --> 00:25:38,861
THINK CANNOT BE THE ANSWER.

802
00:25:38,861 --> 00:25:41,764
SO THAT IS WHAT LED ME BACK IN

803
00:25:41,764 --> 00:25:43,732
2014, I STARTED THIS, BUT WE

804
00:25:43,732 --> 00:25:46,035
STARTED COLLECTING DATA IN 2015

805
00:25:46,035 --> 00:25:50,172
TO HAVE A STANDARDIZED

806
00:25:50,172 --> 00:25:50,873
MULTIMODAL NONINVASIVE IMAGING

807
00:25:50,873 --> 00:25:52,541
COHORT THAT ALL OF OUR PATIENTS

808
00:25:52,541 --> 00:25:53,676
UNDERGO THE SAME SET OF STUDIES

809
00:25:53,676 --> 00:25:54,977
WITH THE IDEA THAT WE COULD AT

810
00:25:54,977 --> 00:25:56,745
LEAST HAVE A STANDARDIZED DAILY

811
00:25:56,745 --> 00:25:58,580
BASIS THEA SET WE COULD COLLECT

812
00:25:58,580 --> 00:26:00,182
OVERTIME AND GO BACK AND TRY TO

813
00:26:00,182 --> 00:26:02,584
SAY HOW CAN THESE OTHER

814
00:26:02,584 --> 00:26:05,888
MODALITIES HELP US MAKE BETTER

815
00:26:05,888 --> 00:26:07,056
HYPOTHESIS SO THAT WE CAN PUT

816
00:26:07,056 --> 00:26:07,756
THESE CERTAINLY--CERTAINLY LECT

817
00:26:07,756 --> 00:26:08,857
RODES IN THE MOST PLACES THAT

818
00:26:08,857 --> 00:26:10,159
WILL BE THE MOST INFORMAIVE IT

819
00:26:10,159 --> 00:26:10,459
FOR US.

820
00:26:10,459 --> 00:26:12,161
THIS IS WHAT I HAD BEFORE IS

821
00:26:12,161 --> 00:26:15,064
JUST THE STANDARD SET UP THAT

822
00:26:15,064 --> 00:26:15,998
MOST EPILEPSY CENTERS HAVE FOR

823
00:26:15,998 --> 00:26:20,502
TESTING THAT YOU DO ON A PATIENT

824
00:26:20,502 --> 00:26:21,236
UPDATER GOING PRESURGICAL

825
00:26:21,236 --> 00:26:24,173
EVALUATION, TO THAT WE HAVE

826
00:26:24,173 --> 00:26:29,244
ADDED 7 T IMAGING AND ALSO GET

827
00:26:29,244 --> 00:26:32,114
DIFFUSER IMAGING, ASL, CEREBRAL

828
00:26:32,114 --> 00:26:34,950
BLOOD FLOW ESTIMATES, WE DO OUR

829
00:26:34,950 --> 00:26:36,018
MAPPING FOR FMRI LANGUAGE, BUT

830
00:26:36,018 --> 00:26:37,920
WE ALSO GET RESTING STATE FMRI

831
00:26:37,920 --> 00:26:40,122
AND THEN IN PATIENTS WHERE IT'S

832
00:26:40,122 --> 00:26:44,526
RELEVANT WHERE THEY WILL GET

833
00:26:44,526 --> 00:26:46,528
INTRA CRANIAL RECORDINGS IN

834
00:26:46,528 --> 00:26:48,664
CLOSE COLLABORATION WITH THE

835
00:26:48,664 --> 00:26:53,302
NEUROLOGY BRANCH AND DR. ZAGULL.

836
00:26:53,302 --> 00:26:55,571
SO THE WAY WE HAVE INDIVIDUAL

837
00:26:55,571 --> 00:26:56,472
PATIENT HYPOTHESIS, RIGHT?

838
00:26:56,472 --> 00:26:58,440
AND WE TEST THEM WITH OUR

839
00:26:58,440 --> 00:27:00,409
RESECTION, SO, IF THE PATIENT

840
00:27:00,409 --> 00:27:02,177
BECOMES SEIZURE FREE, WE ASSUME

841
00:27:02,177 --> 00:27:03,078
THE SEIZURES WERE COMING FROM

842
00:27:03,078 --> 00:27:06,582
SOMEWHERE IN THE AREA OF

843
00:27:06,582 --> 00:27:07,649
RESECTION, IF THE PATIENT

844
00:27:07,649 --> 00:27:09,184
DOESN'T BECOME SEIZURE FREE, WE

845
00:27:09,184 --> 00:27:10,419
ASSUME THE PROBLEM WAS NOT IN

846
00:27:10,419 --> 00:27:10,919
THAT REGION.

847
00:27:10,919 --> 00:27:13,155
SO I WILL TELL YOU ABOUT A

848
00:27:13,155 --> 00:27:13,856
COUPLE PROGECS WOO EVALUATION

849
00:27:13,856 --> 00:27:19,328
PROCESS DONE TRYING TO MAP

850
00:27:19,328 --> 00:27:19,595
EPILEPSY.

851
00:27:19,595 --> 00:27:24,666
IN OUR PATIENT COHORT USING THAT

852
00:27:24,666 --> 00:27:25,401
EPILEPSY IMAGING PROTOCOL, SO

853
00:27:25,401 --> 00:27:26,402
I'M GOING STOCK EXCHANGE START

854
00:27:26,402 --> 00:27:28,604
OFF BY TALKING ABOUT THE

855
00:27:28,604 --> 00:27:29,304
STRUCTURAL ABNORMALITIES.

856
00:27:29,304 --> 00:27:30,672
SO 1 OF THE THINGS THAT WHEN I

857
00:27:30,672 --> 00:27:32,174
STARTED I KNEW COULD MAKE AN

858
00:27:32,174 --> 00:27:34,343
IMMEDIATE DIFFERENCE FOR OUR

859
00:27:34,343 --> 00:27:36,078
PATIENTS, WAS TRYING TO FIND

860
00:27:36,078 --> 00:27:37,346
LESIONS THAT WEREN'T IMMEDIATELY

861
00:27:37,346 --> 00:27:38,547
OBVIOUS WHEN WE LOOK THROUGH THE

862
00:27:38,547 --> 00:27:40,883
IMAGE, SO IF YOU LOOK OVERALL AT

863
00:27:40,883 --> 00:27:44,053
TEMPORAL AND EXTRA TEMPORAL LOBE

864
00:27:44,053 --> 00:27:45,020
EPILEPSY, IN LESIONIONAL

865
00:27:45,020 --> 00:27:48,824
PATIENTS, THEY WERE ACHIEVING

866
00:27:48,824 --> 00:27:51,660
APPROXIMATELY 68% SEIZURE

867
00:27:51,660 --> 00:27:51,927
FREEDOM.

868
00:27:51,927 --> 00:27:54,997
IN NONLESIONAL PATIENTS WE HAD

869
00:27:54,997 --> 00:27:55,564
40%, RIGHT?

870
00:27:55,564 --> 00:27:57,299
BECAUSE THESE PEOPLE HAVE

871
00:27:57,299 --> 00:27:58,534
MULTIFOCAL DISEASE OR DIDN'T

872
00:27:58,534 --> 00:27:59,668
FIND THE LESION AND DIDN'T

873
00:27:59,668 --> 00:28:02,204
THEREFORE HAVE THE RIGHT ANSWER.

874
00:28:02,204 --> 00:28:04,139
SO HERE'S AN EXAMPLE OF AN

875
00:28:04,139 --> 00:28:05,407
EPILEPTIC LESION THAT I DON'T

876
00:28:05,407 --> 00:28:07,643
THINK YOU NEED THE RED ARROW

877
00:28:07,643 --> 00:28:12,614
FOR, CAN YOU SEE THAT, THE

878
00:28:12,614 --> 00:28:15,317
PATIENTS GET SEIZURES IN THESE

879
00:28:15,317 --> 00:28:18,187
CABER NOAMAS, THIS IS NOT A

880
00:28:18,187 --> 00:28:18,520
MYSTERY.

881
00:28:18,520 --> 00:28:28,831
THE PATH OF LESION FOR

882
00:28:28,831 --> 00:28:31,133
CAVERNOMA, THEY EXIST ON A

883
00:28:31,133 --> 00:28:31,934
SPECTRUM, THEIR BRAIN

884
00:28:31,934 --> 00:28:33,902
MALFORMATIONS THAT HAPPEN DURING

885
00:28:33,902 --> 00:28:35,504
BRAIN DEVELOPMENT, SOME OF THEM

886
00:28:35,504 --> 00:28:36,572
ARE REALLY, REALLY OBVIOUS, I

887
00:28:36,572 --> 00:28:38,874
THINK YOU CAN SEE HERE THE

888
00:28:38,874 --> 00:28:40,042
BRIGHT LESIONOT FLAIR IMAGE WITH

889
00:28:40,042 --> 00:28:42,878
THE TAIL GOING BACK TOWARDS THE

890
00:28:42,878 --> 00:28:44,179
VENTRICLE, IT LOOKS THICK AND

891
00:28:44,179 --> 00:28:46,281
BLURRY AND YOU CAN SEE IT ON

892
00:28:46,281 --> 00:28:46,949
THESE IMAGES.

893
00:28:46,949 --> 00:28:49,051
I PUT THE ARROW THERE IN CASE

894
00:28:49,051 --> 00:28:49,751
YOU COULDN'T SEE IT.

895
00:28:49,751 --> 00:28:52,588
AND THEN THERE ARE MORE SUBTLE

896
00:28:52,588 --> 00:28:54,923
TYPES OF FOCAL CORDICLE

897
00:28:54,923 --> 00:28:56,859
DISPLASSIAS THAT PEOPLE MISS AND

898
00:28:56,859 --> 00:28:58,627
SO, IF YOU LOOK AT THIS PATIENT,

899
00:28:58,627 --> 00:29:00,229
THIS PATIENT WAS SEEN IN

900
00:29:00,229 --> 00:29:02,698
MULTIPLE DEFINITE CENTERS, ALL

901
00:29:02,698 --> 00:29:03,232
IS CONSIDERED NONLESIONAL

902
00:29:03,232 --> 00:29:04,933
PATIENT AND I'M NOT SURE IF IT

903
00:29:04,933 --> 00:29:06,735
WAS JUST THAT WE HAD A BETTER

904
00:29:06,735 --> 00:29:08,670
HYPOTHESIS OR THAT IMAGES WERE

905
00:29:08,670 --> 00:29:10,339
GETTING BETTER OVER TIME BUT WE

906
00:29:10,339 --> 00:29:11,173
WERE ABLE TO IDENTIFY LESION AND

907
00:29:11,173 --> 00:29:13,142
WHAT YOU CAN SEE IS THAT IT'S

908
00:29:13,142 --> 00:29:16,612
SIMILAR TO THIS LESION UP HERE

909
00:29:16,612 --> 00:29:18,547
BUT IT'S JUST MORE SUBTLE BUT

910
00:29:18,547 --> 00:29:20,115
THERE'S A LITTLE BIT OF LEARNING

911
00:29:20,115 --> 00:29:22,184
AND SIGNAL CHANGES AND HYPER

912
00:29:22,184 --> 00:29:23,919
INTENSITY BUT THIS IS A THING

913
00:29:23,919 --> 00:29:26,522
THAT A PARTICULAR PERIOD OF

914
00:29:26,522 --> 00:29:27,923
RADIOLOGISTS AND IT'S REALLY

915
00:29:27,923 --> 00:29:32,161
EASY TO MISS THESE, AND YOU CAN

916
00:29:32,161 --> 00:29:34,096
SEE THERE'S 1 WHERE THERE ISN'T

917
00:29:34,096 --> 00:29:38,800
SO, SO THAT'S AN IMPORTANT

918
00:29:38,800 --> 00:29:39,234
CONSIDERATION, ALSO.

919
00:29:39,234 --> 00:29:39,902
HERE'S HISTOLOGIC LOAMACYY WHAT

920
00:29:39,902 --> 00:29:41,803
WE KNOW IS HAPPENING, THIS IS A

921
00:29:41,803 --> 00:29:43,705
NORMAL HAPPY 6 LAYEREDNY O

922
00:29:43,705 --> 00:29:45,374
CORTEX, WHAT HAPPENS OVER HERE

923
00:29:45,374 --> 00:29:46,775
IS IN THE MOST SEVERE FORM IS

924
00:29:46,775 --> 00:29:49,678
YOU HAVE LOSS OF THAT 6 LAYERED

925
00:29:49,678 --> 00:29:50,946
STRUCTURES, YOU HAVE DISLAM

926
00:29:50,946 --> 00:29:52,781
NATION, UNDER IT YOU HAVE LOCAL

927
00:29:52,781 --> 00:29:55,317
INFLAMMATION SO THERE ARE A LOT

928
00:29:55,317 --> 00:29:56,351
OF HISTOLOGIC CHANGES THAT WE

929
00:29:56,351 --> 00:29:57,853
KNOW ABOUT THAT ARE VERY WELL

930
00:29:57,853 --> 00:30:02,591
DESCRIBED THAT WE CAN DETECT.

931
00:30:02,591 --> 00:30:05,260
SO MY LAY MAN'S SUMMARY IS

932
00:30:05,260 --> 00:30:07,529
HERE'S THE WHERE'S WALDO

933
00:30:07,529 --> 00:30:08,897
PROBLEM.

934
00:30:08,897 --> 00:30:10,866
IF SOMEBODY SAYS, OH, LOOK,

935
00:30:10,866 --> 00:30:12,401
WALDO, YES, I SEE HIM BUT I

936
00:30:12,401 --> 00:30:13,235
CAN'T FIND HIM OVER HERE.

937
00:30:13,235 --> 00:30:14,870
SO OUR JOB IS CAN WE USE ALL

938
00:30:14,870 --> 00:30:17,306
THIS NEW MACHINE LEARNING,

939
00:30:17,306 --> 00:30:18,807
IMAGING, ALL THESE THINGS TO

940
00:30:18,807 --> 00:30:20,275
BASICALLY POINT OUT EYE TO A

941
00:30:20,275 --> 00:30:21,476
PLACE WHERE WE WOULD HAVE SEEN

942
00:30:21,476 --> 00:30:23,078
IT IF WE HAD ALREADY LOOKED.

943
00:30:23,078 --> 00:30:25,581
SO THERE ARE OTHER PEOPLE THAT

944
00:30:25,581 --> 00:30:27,115
HAVE OBVIOUSLY DONE THIS ALSO,

945
00:30:27,115 --> 00:30:34,723
WE CAME UP WITH THE  NORMATIVE

946
00:30:34,723 --> 00:30:35,290
MODELING THIS YEAR.

947
00:30:35,290 --> 00:30:37,526
IT'S A LOT MORE ROBUST, REQUIRES

948
00:30:37,526 --> 00:30:39,928
LESS TRAINING, WE DEFINITELY

949
00:30:39,928 --> 00:30:41,830
BENEFITED FROM RESOURCESSA THE

950
00:30:41,830 --> 00:30:42,831
NIH CLINICAL CENTER, INCLUDING

951
00:30:42,831 --> 00:30:43,966
OUR COLLEAGUES AND SOME OF THE

952
00:30:43,966 --> 00:30:45,701
PEOPLE IN THE OTHER IMAGING

953
00:30:45,701 --> 00:30:47,002
CORES HERE, SO THIS WAS

954
00:30:47,002 --> 00:30:48,036
DEFINITELY A GROUP EFFORT AND

955
00:30:48,036 --> 00:30:50,239
NOT JUST FROM ME AS THE

956
00:30:50,239 --> 00:30:51,373
EPILEAPTOLOGYIST BUT WHAT YOU

957
00:30:51,373 --> 00:30:52,908
CAN SEE AT THE END OF THIS IS

958
00:30:52,908 --> 00:30:54,643
THAT WE END UP WITH SIMILARITY

959
00:30:54,643 --> 00:30:56,178
MAPS AND WE CAN ACTUALLY POINT

960
00:30:56,178 --> 00:30:57,579
OUR EYE, THIS IS THE SAME

961
00:30:57,579 --> 00:30:59,181
PATIENT, THIS IS THEIR LESION

962
00:30:59,181 --> 00:31:01,083
LOCATION AND IT ACTUALLY SAYS,

963
00:31:01,083 --> 00:31:03,318
HEY, JUST LOOK HERE WHICH TURNS

964
00:31:03,318 --> 00:31:05,220
OUT TO BE VERY USEFUL IN OUR

965
00:31:05,220 --> 00:31:06,722
PATIENTS, SO THIS THE OTHER MORE

966
00:31:06,722 --> 00:31:07,990
OBVIOUS PATIENT I SHOWED YOU.

967
00:31:07,990 --> 00:31:09,224
ONE THING WE LEARNED ABOUT THIS

968
00:31:09,224 --> 00:31:11,059
IS THAT THERE'S AREAS OF THE

969
00:31:11,059 --> 00:31:14,596
BRAIN THAT REALLY LOOK A LOT

970
00:31:14,596 --> 00:31:16,865
LIKE FOCAL DISPLASSIA, O THIS

971
00:31:16,865 --> 00:31:18,233
HAS HELPED US AVOID

972
00:31:18,233 --> 00:31:18,967
FALSE-POSITIVES IN THOSE AREAS

973
00:31:18,967 --> 00:31:21,603
WHEN WE LOOK AT IMAGES.

974
00:31:21,603 --> 00:31:23,338
HERE'S ANOTHER PATIENT WHERE

975
00:31:23,338 --> 00:31:24,206
THIS ABNORMALITY, WHEN YOU LOOK

976
00:31:24,206 --> 00:31:26,875
BACK IT WAS MISSED ON MULTIPLE

977
00:31:26,875 --> 00:31:28,143
PREVIOUS EVALUATIONS BUT OF

978
00:31:28,143 --> 00:31:31,013
COURSE, NOW THAT I POINTED TO,

979
00:31:31,013 --> 00:31:32,981
YOU'RE LIKE, OH YEAH, THERE IT

980
00:31:32,981 --> 00:31:33,148
IS.

981
00:31:33,148 --> 00:31:34,950
SO THIS HAS BEEN A HELPFUL TOOL

982
00:31:34,950 --> 00:31:37,252
FOR US, WE ARE TRYING TO FIGURE

983
00:31:37,252 --> 00:31:41,223
OUT THE ROLE OF 7 T IMAGING IS

984
00:31:41,223 --> 00:31:44,192
IN HELPING FIND THESE

985
00:31:44,192 --> 00:31:46,228
DYSPLASIAS, WE GET A BEAUTIFUL

986
00:31:46,228 --> 00:31:47,562
POINT AT THIS PART WITH THE

987
00:31:47,562 --> 00:31:49,398
DETAIL BUT AGAIN IT'S THE

988
00:31:49,398 --> 00:31:50,565
WHERE'S WALDO PROBLEM, WHERE

989
00:31:50,565 --> 00:31:51,733
THIS LOOKS ABNORMAL TO ME MAYBE

990
00:31:51,733 --> 00:31:53,402
BECAUSE I LOOK AT THESE IMAGE IT

991
00:31:53,402 --> 00:31:56,571
IS MORE ON THE 3 T MRI, THIS IS

992
00:31:56,571 --> 00:31:59,775
THE SAMEOT 7 T MRI, BUT COMPARE

993
00:31:59,775 --> 00:32:02,444
IT IT'S HARDER IF ARE ME TO TELL

994
00:32:02,444 --> 00:32:03,378
WHAT'S NORMAL AND ABNORMAL SO I

995
00:32:03,378 --> 00:32:05,914
THINK THIS IS AN ONGOING PROJECT

996
00:32:05,914 --> 00:32:09,217
IN TERMS OF HOW THE 7 T IMAGES

997
00:32:09,217 --> 00:32:11,286
FIT INTO THIS WHOLE STRUCTURAL

998
00:32:11,286 --> 00:32:11,653
IMAGING PICTURE.

999
00:32:11,653 --> 00:32:12,788
BUT I THINK WE'RE ALL VERY

1000
00:32:12,788 --> 00:32:14,690
EXCITED ABOUT THE POSSIBILITIES

1001
00:32:14,690 --> 00:32:16,925
OF IT AND SO THAT'S DEFINITELY A

1002
00:32:16,925 --> 00:32:17,993
FUTURE DIRECTION GOING FORWARD.

1003
00:32:17,993 --> 00:32:19,361
ALL RIGHT, SO I WILL TAKE A

1004
00:32:19,361 --> 00:32:21,463
BRIEF MOMENT TO TALK ABOUT

1005
00:32:21,463 --> 00:32:22,297
FUNCTIONAL ABNORMALITIES, I

1006
00:32:22,297 --> 00:32:25,033
THINK THESE CAN TELL US A LOT

1007
00:32:25,033 --> 00:32:26,301
ABOUT LOCAL PATHOLOGY IN THE

1008
00:32:26,301 --> 00:32:28,170
AREA OF THE EPILEPTOGENIC REGION

1009
00:32:28,170 --> 00:32:31,540
BUT THEY CAN ALSO BE USED TO

1010
00:32:31,540 --> 00:32:32,941
FIND EPILEPTIC REGION AND THIS

1011
00:32:32,941 --> 00:32:34,009
IS COMMONLY DONE.

1012
00:32:34,009 --> 00:32:36,278
WE KNOW THAT THERE ARE HUGE

1013
00:32:36,278 --> 00:32:36,978
CHANGES THAT HAPPEN AROUND THE

1014
00:32:36,978 --> 00:32:39,381
TIME OF THE SEIZURE VERY

1015
00:32:39,381 --> 00:32:41,350
ELEGANTLY HERE AS MY RED STAR

1016
00:32:41,350 --> 00:32:42,017
THING.

1017
00:32:42,017 --> 00:32:43,352
SO WHEN YOU LOOK AROUND THE TIME

1018
00:32:43,352 --> 00:32:45,153
OF A SEIZURE, THERE'S DEFINITELY

1019
00:32:45,153 --> 00:32:47,255
HUGE LOCAL CHANGES IN THE

1020
00:32:47,255 --> 00:32:47,489
TISSUE.

1021
00:32:47,489 --> 00:32:50,058
SO THERE'S HYPER ACTIVATION OF

1022
00:32:50,058 --> 00:32:54,029
NEURONS, THERE'S VASE O

1023
00:32:54,029 --> 00:32:54,996
DILATION, INCREASED CEREBRAL

1024
00:32:54,996 --> 00:32:57,332
BLOOD FLOW, INFLATION, BLOOD

1025
00:32:57,332 --> 00:32:58,834
BRAIN BARRIER BREAK DOWN,

1026
00:32:58,834 --> 00:33:00,702
THERE'S A WHOLE LOT WHEN THESE

1027
00:33:00,702 --> 00:33:03,672
COME TOGETHER AND A HUGE

1028
00:33:03,672 --> 00:33:05,073
SYNCHRONOUS FIRING EVENT.

1029
00:33:05,073 --> 00:33:07,642
WE KNOW THIS THROUGH ROUTINE

1030
00:33:07,642 --> 00:33:08,410
CLINICAL PRACTICE USING IMCANCER

1031
00:33:08,410 --> 00:33:09,978
CENTERING SO THIS LOOKS AT

1032
00:33:09,978 --> 00:33:11,613
PROFUSION AND YOU CAN SEE THAT

1033
00:33:11,613 --> 00:33:13,014
IN BETWEEN SEIZURES AND THIS

1034
00:33:13,014 --> 00:33:15,117
PATIENT, THAT'S AN EXAMPLE,

1035
00:33:15,117 --> 00:33:21,890
THERE'S HYPOPROFUSION, SO

1036
00:33:21,890 --> 00:33:22,691
THERE'S THIS INTER-ICTAL,

1037
00:33:22,691 --> 00:33:25,127
PERIOD, AND WHEN YOU DO THE

1038
00:33:25,127 --> 00:33:26,528
SUBTRAPGZ IMAGES YOU CAN

1039
00:33:26,528 --> 00:33:29,030
LOCALIZE THE AREA OF SEIZURES

1040
00:33:29,030 --> 00:33:34,970
ASK IT REQUIRES SOMEBODY SITTING

1041
00:33:34,970 --> 00:33:36,905
AND PATIENTS WE WAIT DAYS OR

1042
00:33:36,905 --> 00:33:38,940
WEEKS TO SEE A SEIZURE SO WE

1043
00:33:38,940 --> 00:33:42,110
REALLY, THE USE OF

1044
00:33:42,110 --> 00:33:42,978
THIS--ALTHOUGH IT'S AMAZING THIS

1045
00:33:42,978 --> 00:33:44,479
IS LIMITED TO CENTERS WITH A

1046
00:33:44,479 --> 00:33:47,582
VERY WELL TRAINED STAFF, WHO CAN

1047
00:33:47,582 --> 00:33:50,852
GET THIS INJECTION IN AND IN

1048
00:33:50,852 --> 00:33:52,954
PATIENTS WHO HAVING FREQUENT

1049
00:33:52,954 --> 00:33:53,221
SEIZURES.

1050
00:33:53,221 --> 00:34:00,896
PET IMAGES WE ALSO DO

1051
00:34:00,896 --> 00:34:01,930
INTERICTALLY, WE SEE

1052
00:34:01,930 --> 00:34:03,799
HYPOMETABOLISM, SO WE USE FTG

1053
00:34:03,799 --> 00:34:05,500
PET, AND ACTUALLY IN WORK HERE

1054
00:34:05,500 --> 00:34:07,269
WITH BILL AND BOB AND PETER,

1055
00:34:07,269 --> 00:34:09,571
THERE'S BEEN A WHOLE BUVEN OF

1056
00:34:09,571 --> 00:34:11,206
PET LIGANDS THAT HAVE BEEN USED

1057
00:34:11,206 --> 00:34:12,641
THAT FOUND INTERESTING MARKERS

1058
00:34:12,641 --> 00:34:14,309
OF INFLAMMATION AND OTHER

1059
00:34:14,309 --> 00:34:15,877
MARKERS, HOWEVER, THE STANDARD

1060
00:34:15,877 --> 00:34:18,847
CLINICAL USE IS FTG PET AND

1061
00:34:18,847 --> 00:34:21,383
USUALLY THIS IS HOPE O METABOLIC

1062
00:34:21,383 --> 00:34:23,251
IN BETWEEN SEIZURES AND HYPER

1063
00:34:23,251 --> 00:34:25,787
METABOLIC AROUND THE TIME OF

1064
00:34:25,787 --> 00:34:27,155
SEIZURES.

1065
00:34:27,155 --> 00:34:29,191
ANYWAYS, SO OUR HYPOTHESIS WAS

1066
00:34:29,191 --> 00:34:34,095
CAN WE USE ASL WHICH IS AN MRI

1067
00:34:34,095 --> 00:34:35,163
ABOUT 6 MINUTE SEQUENCE,

1068
00:34:35,163 --> 00:34:37,332
NONINVASIVE TO AT LEAST

1069
00:34:37,332 --> 00:34:38,166
LATERALIZE EPILEPSY BETWEEN

1070
00:34:38,166 --> 00:34:40,001
SEIZURES ISSUES SO WHY DO WE DO

1071
00:34:40,001 --> 00:34:41,870
THAT WHEN WE KNEW IT WOULD WORK

1072
00:34:41,870 --> 00:34:43,939
WAY BETTER, WELL IT'S NOT REALLY

1073
00:34:43,939 --> 00:34:44,906
EASY TO IMAGE PEOPLE RIGHT

1074
00:34:44,906 --> 00:34:46,575
AROUND THE TIME OF SEIZURES,

1075
00:34:46,575 --> 00:34:49,010
TURNS OUT MOST OF THE TIME WHEN

1076
00:34:49,010 --> 00:34:50,712
WE KNOW THAT'S' HAPPENING MOST

1077
00:34:50,712 --> 00:34:52,614
OF THEM HAVE ELECTRODES ON THEIR

1078
00:34:52,614 --> 00:34:54,483
HEAD, THOAR MEAOF THELY NOT MRI

1079
00:34:54,483 --> 00:34:55,684
COMPATIBLE, SO IT'S DIFFICULT TO

1080
00:34:55,684 --> 00:34:56,885
GET THE IMAGES SO WE WANTED TO

1081
00:34:56,885 --> 00:35:00,655
KNOW IF WE COULD FIND A SIGNAL

1082
00:35:00,655 --> 00:35:01,089
INTERICTLY.

1083
00:35:01,089 --> 00:35:03,892
AND WE FOUND THIS IN TEMPORAL

1084
00:35:03,892 --> 00:35:06,928
LOBE EPILEPSY. 

1085
00:35:06,928 --> 00:35:17,072
WHEN WE LOOK AT PATIENTS WITH

1086
00:35:17,072 --> 00:35:17,572
MEDIALIZE.

1087
00:35:17,572 --> 00:35:18,773
THE PROBLEM IS ALREADY KNEW THE

1088
00:35:18,773 --> 00:35:19,608
ANSWER, RIGHT?

1089
00:35:19,608 --> 00:35:22,043
BECAUSE THEY ALREADY HAD MEDIAL

1090
00:35:22,043 --> 00:35:23,411
TEMPORAL SCLEROSIS, SO WE FOUND

1091
00:35:23,411 --> 00:35:26,414
OUT IN TERMS OF PATHOPHYSIOLOGY

1092
00:35:26,414 --> 00:35:29,784
THAT YES, THERE IS INTERICTAL

1093
00:35:29,784 --> 00:35:31,753
HYPOPROFUSION ON THE SIDE OF THE

1094
00:35:31,753 --> 00:35:33,722
LESION BUT IN OUR NONLESIONAL

1095
00:35:33,722 --> 00:35:35,156
PATIENTS WHICH ARE THESE GREEN

1096
00:35:35,156 --> 00:35:39,561
PATIENTS, IT WAS ACTUALLY

1097
00:35:39,561 --> 00:35:40,061
COMPLETELY CEMET RICK.

1098
00:35:40,061 --> 00:35:42,531
IF YOU LOOK AT THE RAW SCORES ON

1099
00:35:42,531 --> 00:35:45,066
EACH SIDE ISSUES THE DARKER

1100
00:35:45,066 --> 00:35:53,041
COLOR ON THE SIDE, THE THIS IS

1101
00:35:53,041 --> 00:35:56,545
THE TEMPORAL LOBE, YOU CAN SEE A

1102
00:35:56,545 --> 00:35:58,947
HUGE DIFFERENT IN OUR PATIENTS

1103
00:35:58,947 --> 00:36:00,582
WITH THE SCLEROSIS, SHOWING

1104
00:36:00,582 --> 00:36:01,850
THERE ARE BLOOD FLOW CHANGES BUT

1105
00:36:01,850 --> 00:36:05,153
WHEN YOU LOOK AT OUR NONLESIONAL

1106
00:36:05,153 --> 00:36:07,088
PATIENTS, YOU CAN SEE THEY'RE

1107
00:36:07,088 --> 00:36:10,158
NEARLY IDENTICAL FROM SIDE TO

1108
00:36:10,158 --> 00:36:10,759
SIDE.

1109
00:36:10,759 --> 00:36:12,727
SO AGAIN, HYPOPROFUSE COMPARED

1110
00:36:12,727 --> 00:36:13,562
TO HEALTHY VOLUNTEERS BUT NOT

1111
00:36:13,562 --> 00:36:15,163
SOMETHING THAT WILL HELP US IN

1112
00:36:15,163 --> 00:36:16,765
AN INDIVIDUAL PATIENT TO TELL

1113
00:36:16,765 --> 00:36:18,300
WHICH SIDE THE SEIZURES ARE

1114
00:36:18,300 --> 00:36:21,236
COMING FROM IN THESE NONLESIONAL

1115
00:36:21,236 --> 00:36:21,503
PATIENTS.

1116
00:36:21,503 --> 00:36:23,171
SO WE'RE STILL LOOKING AT THAT,

1117
00:36:23,171 --> 00:36:25,006
WE THINK THERE'S SOME INITIAL

1118
00:36:25,006 --> 00:36:27,976
SUGGESTION THAT MAY BE AN

1119
00:36:27,976 --> 00:36:30,612
FCDs, THERE'S ALSO PROFUSION

1120
00:36:30,612 --> 00:36:31,680
CHAIVENLGS INTERICTALLY BUT

1121
00:36:31,680 --> 00:36:32,614
THAT'S ONGOING WORK WE'RE DOING

1122
00:36:32,614 --> 00:36:33,582
AND THEN I WILL SPEND THE REST

1123
00:36:33,582 --> 00:36:35,216
OF THE TIME I HAVE HERE, TALKING

1124
00:36:35,216 --> 00:36:37,185
TO YOU ABOUT SOME OF THE

1125
00:36:37,185 --> 00:36:37,886
NEUROPHYSIOLOGY WORK THAT WE'VE

1126
00:36:37,886 --> 00:36:42,123
BEEN TRYING TO DO AND TRYING TO

1127
00:36:42,123 --> 00:36:43,124
UNDERSTAND INTERICTAL EPILEPTIC

1128
00:36:43,124 --> 00:36:44,526
FORM ACTIVITY AND TO MAP IT IN

1129
00:36:44,526 --> 00:36:46,261
THE BRAIN WHICH MAKES SENSE

1130
00:36:46,261 --> 00:36:48,029
WHICH I WAS ACTUALLY AN EEG

1131
00:36:48,029 --> 00:36:48,730
PERSON BY TRAINING.

1132
00:36:48,730 --> 00:36:51,066
SO THERE'S A LOT OF WAYS THAT WE

1133
00:36:51,066 --> 00:36:54,502
HAVE IN HUMANS OF MAPPING

1134
00:36:54,502 --> 00:36:54,936
INTERICTAL ACTIVITY.

1135
00:36:54,936 --> 00:36:57,472
I LIKE THIS BECAUSE IT HAS

1136
00:36:57,472 --> 00:36:58,974
SPATIAL RESOLUTION COMPARED TO

1137
00:36:58,974 --> 00:37:00,675
TEMPORAL RESOLUTION, MANY OF YOU

1138
00:37:00,675 --> 00:37:02,911
WHO HAVE DONE NEURAL IMAGING

1139
00:37:02,911 --> 00:37:04,546
UNDERSTAND THAT ECOG, MEG AND

1140
00:37:04,546 --> 00:37:06,715
EEG ALL HAVE REALLY GOOD

1141
00:37:06,715 --> 00:37:07,549
TEMPORAL RESOLUTION, BUT THEY

1142
00:37:07,549 --> 00:37:10,986
DIFFER A LOT IN TERMS OF THEIR

1143
00:37:10,986 --> 00:37:12,687
SPATIAL RESOLUTION.

1144
00:37:12,687 --> 00:37:17,192
SO, THEORETICALLY ECOG HAS

1145
00:37:17,192 --> 00:37:19,194
BETTER SPATIAL RESOLUTION BUT

1146
00:37:19,194 --> 00:37:21,162
LESS COVERAGE WHEREAS EEG AND

1147
00:37:21,162 --> 00:37:23,498
MEG HAVE LESS SPATIAL RESOLUTION

1148
00:37:23,498 --> 00:37:25,734
BIEW WHOLE BRAIN COVERAGE SO

1149
00:37:25,734 --> 00:37:27,502
THERE'S A DEFINITE TRADE-OFF

1150
00:37:27,502 --> 00:37:30,839
THERE IN CASE YOU CAN ASK

1151
00:37:30,839 --> 00:37:33,642
SOMETHING THAT WAS USING EEG,

1152
00:37:33,642 --> 00:37:36,144
FMRI HAS THE BEST SPATIAL

1153
00:37:36,144 --> 00:37:36,845
RESOLUTION BUT THE TEMPORAL

1154
00:37:36,845 --> 00:37:38,313
RESOLUTION AND NOT THAT GOOD AND

1155
00:37:38,313 --> 00:37:41,049
PET IS A LITTLE WORSE ALSO,

1156
00:37:41,049 --> 00:37:43,284
OBVIOUSLY STRUCTURAL MRI HAS NO

1157
00:37:43,284 --> 00:37:43,918
TEMPORAL RESOLUTION.

1158
00:37:43,918 --> 00:37:45,020
SO WHAT DOES THIS LOOK LIKE?

1159
00:37:45,020 --> 00:37:46,755
I WANT TO GIVE YOU AN IMAGE SO

1160
00:37:46,755 --> 00:37:48,857
THAT YOU CAN SEE KIND OF WHAT IT

1161
00:37:48,857 --> 00:37:52,761
LOOKS LIKE ON EEG, SO THIS IS

1162
00:37:52,761 --> 00:37:56,331
SCALP EEG, WE HAVE STANDARDIZED

1163
00:37:56,331 --> 00:37:57,365
ELECTRODE PLACEMENTS.

1164
00:37:57,365 --> 00:37:58,667
THIS IS STANDARD MEDICAL STUDENT

1165
00:37:58,667 --> 00:38:01,836
KNOWLEDGE RIGHT, AND SO, IN

1166
00:38:01,836 --> 00:38:02,537
BETWEEN SEIZURES WHEN THE

1167
00:38:02,537 --> 00:38:05,106
PATIENT IS AT LEAST TO ALL

1168
00:38:05,106 --> 00:38:06,608
INTENTS AND PURPOSES,

1169
00:38:06,608 --> 00:38:09,210
SYMPTOMATIC WILL SEE THESE

1170
00:38:09,210 --> 00:38:11,212
MARKERS OF CORTICAL IRRITABILITY

1171
00:38:11,212 --> 00:38:12,847
APPEARS THROUGHOUT THE RECORD.

1172
00:38:12,847 --> 00:38:14,015
DURING THE SEIZURE, WE WILL SEE

1173
00:38:14,015 --> 00:38:15,984
THIS WHICH IS AN ACTUAL SEIZURE

1174
00:38:15,984 --> 00:38:17,719
ON EEG SO HAVE YOU THIS

1175
00:38:17,719 --> 00:38:18,386
INCREASING RHYTHMIC ACTIVITY IN

1176
00:38:18,386 --> 00:38:19,654
THE BRAIN SO THIS IS WHAT THAT

1177
00:38:19,654 --> 00:38:21,823
LOOKS LIKE IN A SCALP EEG.

1178
00:38:21,823 --> 00:38:24,092
WHAT DOES THAT LIKE LIKE ON

1179
00:38:24,092 --> 00:38:24,659
INTRA CRANIAL EEG.

1180
00:38:24,659 --> 00:38:26,728
I THINK YOU WILL SEE IT LOOKS

1181
00:38:26,728 --> 00:38:28,163
NOT THAT DIFFERENT ISSUES RIGHT?

1182
00:38:28,163 --> 00:38:30,265
SO ON INTRA CRANIAL EEG

1183
00:38:30,265 --> 00:38:32,967
RECORDINGS, THIS IS FOR DEPTHS

1184
00:38:32,967 --> 00:38:33,968
AND SUBDURANNAL ELECTRODES AND

1185
00:38:33,968 --> 00:38:35,470
YOU SEE IT'S VERY SIMILAR TO

1186
00:38:35,470 --> 00:38:38,139
WHAT WE SEE ON SCALP, EEG,

1187
00:38:38,139 --> 00:38:39,674
ALTHOUGH EACH OF THOSE IS ONLY

1188
00:38:39,674 --> 00:38:41,976
LOOKING AT THE VERY LOCAL AREA

1189
00:38:41,976 --> 00:38:43,511
AROUND ITS LOCATION, SIMILARLY,

1190
00:38:43,511 --> 00:38:45,113
SEIZURES DON'T LOOK THAT

1191
00:38:45,113 --> 00:38:45,580
DIFFERENT, EITHER.

1192
00:38:45,580 --> 00:38:48,149
WE KNOW THAT TO SEE IT ON SCALP

1193
00:38:48,149 --> 00:38:50,518
EEG, WE NEED ABOUT SOMEWHERE

1194
00:38:50,518 --> 00:38:52,587
BETWEEN 6 AND 20 SQUARE

1195
00:38:52,587 --> 00:38:55,090
CENTIMETERS OF OF THE INTRA

1196
00:38:55,090 --> 00:38:56,391
CRANIAL ELECTRODES TO EVEN TURN

1197
00:38:56,391 --> 00:38:58,493
UP ON THE SCALP SO WE DO HAVE

1198
00:38:58,493 --> 00:38:59,527
THAT BETTER SPATIAL RESOLUTION,

1199
00:38:59,527 --> 00:39:01,963
BUT YOU CAN SEE THE ACTIVITY

1200
00:39:01,963 --> 00:39:04,332
ITSELF REALLY DOESN'T LOOK THAT

1201
00:39:04,332 --> 00:39:04,599
DIFFERENT.

1202
00:39:04,599 --> 00:39:05,667
AND MEG WHICH I WILL TALK ABOUT

1203
00:39:05,667 --> 00:39:08,269
THE END OF THIS, WE GEAP HAVE

1204
00:39:08,269 --> 00:39:09,804
WHOLE BRAIN COVERAGE LIKE WE DO

1205
00:39:09,804 --> 00:39:12,340
WITH THE SCALP EEG AND AGAIN,

1206
00:39:12,340 --> 00:39:13,475
YOU SEE MOSTLY INTERICTAL

1207
00:39:13,475 --> 00:39:15,777
ACTIVITY BECAUSE OUR PATIENTS

1208
00:39:15,777 --> 00:39:17,378
USUALLY TOLERATE MEGS LASTING

1209
00:39:17,378 --> 00:39:19,914
ABOUT AN HOUR OR SO BUT NOT MUCH

1210
00:39:19,914 --> 00:39:22,684
LONGER SO WE VERY RARELY RECORD

1211
00:39:22,684 --> 00:39:23,084
SEIZURES.

1212
00:39:23,084 --> 00:39:25,720
AND IN OUR MEG, AGAIN WE HAVE

1213
00:39:25,720 --> 00:39:27,122
WAY MORE SENSORS BUT AGAIN YOU

1214
00:39:27,122 --> 00:39:30,091
SEE THE SPIKE IN WAVE ACTIVITY.

1215
00:39:30,091 --> 00:39:32,627
SO NO MATTER WHICH WAY WE RECORD

1216
00:39:32,627 --> 00:39:34,596
IT, THE ACTIVITY LOAMACY BEINGS

1217
00:39:34,596 --> 00:39:37,098
SIMILAR AND GOING BACK TO THAT

1218
00:39:37,098 --> 00:39:38,399
LIEWTERS MODEL OF THINKING ABOUT

1219
00:39:38,399 --> 00:39:40,702
THIS, WHY DON'T WE JUST USE

1220
00:39:40,702 --> 00:39:44,205
INTERICTAL ACTIVITY ALL THE

1221
00:39:44,205 --> 00:39:44,806
TIME?

1222
00:39:44,806 --> 00:39:46,207
SO USUALLY INTERICTAL ACTIVITY,

1223
00:39:46,207 --> 00:39:48,176
INVOLVES THE SAME AREA AS WHERE

1224
00:39:48,176 --> 00:39:49,711
THE SEIZURES START BUT OFTEN

1225
00:39:49,711 --> 00:39:51,212
TIMES INVOLVES A MUCH BROADER

1226
00:39:51,212 --> 00:39:52,747
REGION AND THEY CAN ALSO BE

1227
00:39:52,747 --> 00:39:53,548
MULTIPLE POPULATIONS SOME OF

1228
00:39:53,548 --> 00:39:56,117
WHICH NEVER GO ON TOEN GENERATE

1229
00:39:56,117 --> 00:39:59,921
SEIZURES, SO THE IRRITATED ZONE,

1230
00:39:59,921 --> 00:40:01,589
AND CAN BE CONSIDERED A

1231
00:40:01,589 --> 00:40:03,324
RELATIVELY LESS SPECIFIC MARKER

1232
00:40:03,324 --> 00:40:04,726
OF THE SEIZURES ARE COMING FROM

1233
00:40:04,726 --> 00:40:06,694
AND THAT'S WHY WE STILL BOTHER

1234
00:40:06,694 --> 00:40:09,130
TO TRY TO RECORD SEIZURES.

1235
00:40:09,130 --> 00:40:11,599
SO WHY IS IT A NONSPECIFIC

1236
00:40:11,599 --> 00:40:11,833
MARKER?

1237
00:40:11,833 --> 00:40:13,768
SO 1 REASON THAT IT'S

1238
00:40:13,768 --> 00:40:15,303
NONSPECIFIC IS BECAUSE WE CAN

1239
00:40:15,303 --> 00:40:16,805
HAVE MULTIPLE POPULATIONS OF

1240
00:40:16,805 --> 00:40:17,105
DISCHARGES.

1241
00:40:17,105 --> 00:40:19,340
THE OTHER REASON THAT IT'S A

1242
00:40:19,340 --> 00:40:22,210
NONSPECIFIC MARKER IS BECAUSE

1243
00:40:22,210 --> 00:40:23,978
THIS EPILET ACTIVITY PROPAGATES,

1244
00:40:23,978 --> 00:40:24,379
RIGHT?

1245
00:40:24,379 --> 00:40:25,480
SO IT PRES FROM WHEREVER THE

1246
00:40:25,480 --> 00:40:27,215
SOURCE IS TO OTHER AREAS OF THE

1247
00:40:27,215 --> 00:40:27,415
BRAIN.

1248
00:40:27,415 --> 00:40:29,184
THE PROBLEM THAT WE HAVE WHEN

1249
00:40:29,184 --> 00:40:30,351
STUDYING PEOPLE IS THAT WE DON'T

1250
00:40:30,351 --> 00:40:31,853
KNOW WHAT AREA IT IS THAT WAS

1251
00:40:31,853 --> 00:40:32,954
STARTING OFF THIS ACTIVITY,

1252
00:40:32,954 --> 00:40:34,589
RIGHT IN SO WE LOOK BACK TO

1253
00:40:34,589 --> 00:40:36,558
ANIMAL MODELS AND WHEN YOU LOOK

1254
00:40:36,558 --> 00:40:37,826
AT AN ANIMAL MODEL WHERE THEY

1255
00:40:37,826 --> 00:40:39,394
KNOW THEY SET OFF THE SEIZURE,

1256
00:40:39,394 --> 00:40:41,329
RIGHT IN THAT WHAT THEY SEE IS

1257
00:40:41,329 --> 00:40:43,031
THAT THIS ACTIVITY DOES INFACT

1258
00:40:43,031 --> 00:40:44,799
SPREAD, AND IT SPREADS IF THEY

1259
00:40:44,799 --> 00:40:47,235
STARTED THE SEIZURE HERE, IT

1260
00:40:47,235 --> 00:40:49,304
SPREADS RADIALLY, SO LONG THE

1261
00:40:49,304 --> 00:40:50,505
CORTICALE SURFACE WHICH ISN'T

1262
00:40:50,505 --> 00:40:51,906
SURPRISING, THAT'S KIND OF THE

1263
00:40:51,906 --> 00:40:53,942
MENTAL MODEL MOST OF US HAVE BUT

1264
00:40:53,942 --> 00:40:56,044
GOING BACK TO THIS NETWORK IDEA,

1265
00:40:56,044 --> 00:40:57,679
IT ALSO SPREADS ALONG WHITE

1266
00:40:57,679 --> 00:40:59,047
MATTER PATHWAYS, AND THOSE CAN

1267
00:40:59,047 --> 00:41:02,750
BE VERY DISTANT, RIGHT?

1268
00:41:02,750 --> 00:41:06,287
SO WE CAN GET THESE

1269
00:41:06,287 --> 00:41:09,257
DISCONTIGUOUS AND TIMES OF

1270
00:41:09,257 --> 00:41:10,325
ACTIVATION DURING INTERICTAL

1271
00:41:10,325 --> 00:41:12,694
ACTIVITY AND SEIZURE ACTIVITY.

1272
00:41:12,694 --> 00:41:16,331
SO THEY BOTH FOLLOW SIMILAR

1273
00:41:16,331 --> 00:41:17,498
SPREAD PATTERNS, HERE'S MY

1274
00:41:17,498 --> 00:41:18,466
BEAUTIFUL CIRCLE DIAGRAM THAT

1275
00:41:18,466 --> 00:41:19,868
KEEPS IT SIMPLE FOR MYSELF, SO

1276
00:41:19,868 --> 00:41:21,736
IF THERE'S A SEIZURE FOCUS IT

1277
00:41:21,736 --> 00:41:23,671
CAN TRAVEL ALONG THIS GRAY

1278
00:41:23,671 --> 00:41:25,273
MATTER SURFACE, IT CAN TRAVEL TO

1279
00:41:25,273 --> 00:41:27,442
WHITE MATTER AND THE THING THE

1280
00:41:27,442 --> 00:41:28,610
MOUSE MODEL DOESN'T ADDRESS IS

1281
00:41:28,610 --> 00:41:30,311
WE STILL DON'T UNDERSTAND THE

1282
00:41:30,311 --> 00:41:32,146
ROLE OF THE SUBCORTICALE

1283
00:41:32,146 --> 00:41:33,314
STRUCTURES EITHER WHICH ARE

1284
00:41:33,314 --> 00:41:34,816
INTERESTING AND BECOMING

1285
00:41:34,816 --> 00:41:36,718
INCREASINGLY OF INTEREST AS WE

1286
00:41:36,718 --> 00:41:37,518
TALK ABOUT NEUROMODDULATION.

1287
00:41:37,518 --> 00:41:38,519
ALL RIGHT, SO AGAIN I MENTION

1288
00:41:38,519 --> 00:41:39,954
THIS BUT I WANT TO BRING IT UP

1289
00:41:39,954 --> 00:41:42,357
AGAIN, SO IF WE THINK OF THE

1290
00:41:42,357 --> 00:41:44,559
SEIZURE ACTIVITY AS SPREADING

1291
00:41:44,559 --> 00:41:46,060
LOCALLY AND DISTANTLY OVER WHITE

1292
00:41:46,060 --> 00:41:46,995
MATTER PATHWAYS, CAN YOU SEE

1293
00:41:46,995 --> 00:41:50,131
THIS IS WHERE THE SPARSE SPATIAL

1294
00:41:50,131 --> 00:41:50,732
SAMPLING, BECOMES PROBLEMATIC

1295
00:41:50,732 --> 00:41:53,468
FOR US AND WHERE THIS INITIAL

1296
00:41:53,468 --> 00:41:54,469
HYPOTHESIS IS SUPER IMPORTANT.

1297
00:41:54,469 --> 00:41:55,670
THE OTHER THING WE'RE THINKING

1298
00:41:55,670 --> 00:41:57,105
ABOUT AS WE THOUGHT ABOUT WHY

1299
00:41:57,105 --> 00:41:58,606
WE'RE SEEING THE SPIKE IN

1300
00:41:58,606 --> 00:41:59,674
ACTIVITY ALL OVER THE PLACE IS

1301
00:41:59,674 --> 00:42:01,309
HOW CAN THIS HAPPEN SO FAST AND

1302
00:42:01,309 --> 00:42:03,678
WHY CAN'T WE TELL THE

1303
00:42:03,678 --> 00:42:04,145
DIFFERENCE?

1304
00:42:04,145 --> 00:42:05,313
AND SOMETHING THAT'S IMPORTANT

1305
00:42:05,313 --> 00:42:07,515
TO RECOGNIZE IS EEG ACTIVITY WE

1306
00:42:07,515 --> 00:42:08,983
SEE, REALLY DOESN'T REPRESENT

1307
00:42:08,983 --> 00:42:10,218
ACTION POETIC TEBTIALS WHICH ARE

1308
00:42:10,218 --> 00:42:12,053
THE ACTUAL FIRING AND ACTIVE

1309
00:42:12,053 --> 00:42:13,788
PART WHEN IT REALLY REPRESENT

1310
00:42:13,788 --> 00:42:15,490
SYSTEM RECEIPT OF SIGNATURES NOX

1311
00:42:15,490 --> 00:42:16,658
FAMILY ACTIVATOR, SO, EVERY

1312
00:42:16,658 --> 00:42:18,393
NEURON, SO THE ACTION POTENTIAL

1313
00:42:18,393 --> 00:42:19,794
WOULD COME DOWN FROM HERE,

1314
00:42:19,794 --> 00:42:21,596
RIGHT, BUT THEY'RE ALL RECEIVING

1315
00:42:21,596 --> 00:42:22,997
SIGNALS FROM EVERYWHERE IN THE

1316
00:42:22,997 --> 00:42:23,564
BRAIN, ALL THE TIME.

1317
00:42:23,564 --> 00:42:26,434
RIGHT IN AND THIS IS HOW IT

1318
00:42:26,434 --> 00:42:27,969
INTEGRATES AND THEN FIRES IF YOU

1319
00:42:27,969 --> 00:42:29,370
REMEMBER THAT, SO THIS IS THE

1320
00:42:29,370 --> 00:42:31,105
INTEGRATION IS HAPPENING WITH

1321
00:42:31,105 --> 00:42:32,307
THESE POST SYNAPTIC POTENTIALS

1322
00:42:32,307 --> 00:42:35,443
WHERE YOU HAVE INHIBITORY AND

1323
00:42:35,443 --> 00:42:36,477
POST EXCITALLORY POTENTIALS THAT

1324
00:42:36,477 --> 00:42:37,912
SPREAD LOCALLY AND DISTANTLY AND

1325
00:42:37,912 --> 00:42:39,113
EACH NEURON GETS TONS OF THESE

1326
00:42:39,113 --> 00:42:42,016
AND SO WHEN THEY GET SYNCHRONOUS

1327
00:42:42,016 --> 00:42:46,421
ENOUGH, THEN WE SEE IT

1328
00:42:46,421 --> 00:42:47,188
NEUROPHYSIOLOGICALLY,

1329
00:42:47,188 --> 00:42:47,522
INTERACTIVITY.

1330
00:42:47,522 --> 00:42:50,458
SO, IN KEEPING WITH THAT, A

1331
00:42:50,458 --> 00:42:53,127
NUMBER OF GROUPS HAVE NOW BEEN

1332
00:42:53,127 --> 00:42:54,595
THINKING ABOUT MAPPING

1333
00:42:54,595 --> 00:42:55,229
INTERECTOMYOSINNAL DISCHARGES

1334
00:42:55,229 --> 00:42:57,432
USING THE IDEA THAT IT'S RECEIPT

1335
00:42:57,432 --> 00:42:59,033
OF SIGNAL, NOT GENERATED SIGNAL.

1336
00:42:59,033 --> 00:43:01,669
AND SO IN [INDISCERNIBLE] LAB

1337
00:43:01,669 --> 00:43:03,104
HERE, WE WORK CLOSELY WITH THEM

1338
00:43:03,104 --> 00:43:04,038
BUT THEY DEVELOPED THIS MODEL

1339
00:43:04,038 --> 00:43:07,542
WHERE YOU COULD TELL THE SOURCE

1340
00:43:07,542 --> 00:43:09,877
OF BOTH INTERICTAL ANDICTAL

1341
00:43:09,877 --> 00:43:12,013
ACTIVITY BY LOOK BEING AT TIME

1342
00:43:12,013 --> 00:43:14,482
DELAYS ACROSS SENSORS SO THIS

1343
00:43:14,482 --> 00:43:15,850
CAME FROM EARTHQUAKE DETENTION

1344
00:43:15,850 --> 00:43:18,419
IF THEY HAVE THEIR SENSORS

1345
00:43:18,419 --> 00:43:20,021
STATICALLY PLACED AROUND THE

1346
00:43:20,021 --> 00:43:20,888
COUNTRY, WHICHEVER SEES IT FIRST

1347
00:43:20,888 --> 00:43:22,490
IS THE CLOSEST BUT NOT

1348
00:43:22,490 --> 00:43:23,558
NECESSARILY WHERE THE EARTHQUAKE

1349
00:43:23,558 --> 00:43:26,094
STARTED SO WE CAN USE A SIMILAR

1350
00:43:26,094 --> 00:43:27,395
APPROACH TO LOCALIZE, OKAY, EVEN

1351
00:43:27,395 --> 00:43:29,364
THOUGH WE ONLY HAVE ELECTRODES

1352
00:43:29,364 --> 00:43:31,099
HERE AND HERE, WE CAN PUT ALL

1353
00:43:31,099 --> 00:43:31,899
THE INFORMATION TOGETHER ACROSS

1354
00:43:31,899 --> 00:43:33,234
THESE PATES TO REALIZE THE

1355
00:43:33,234 --> 00:43:35,703
SEIZURES ARE COMING FROM THIS

1356
00:43:35,703 --> 00:43:37,338
LOCATION EMPLOY THIS IS A WAY OF

1357
00:43:37,338 --> 00:43:38,840
DEALING WITH THE SPARSE SPATIAL

1358
00:43:38,840 --> 00:43:41,175
SAMPLING PROBLEM WE HAVE WITH

1359
00:43:41,175 --> 00:43:43,344
OUR INTRA CRANIAL EEGs AND WE

1360
00:43:43,344 --> 00:43:46,481
DID THIS WITH THEICTAL ACTIVITY

1361
00:43:46,481 --> 00:43:49,851
AND FOUND OUT YOU HAD SIMILAR

1362
00:43:49,851 --> 00:43:51,085
CASES IN BOTH REGIONS.

1363
00:43:51,085 --> 00:43:52,587
THE PROBLEM IS THIS IS A LOCAL

1364
00:43:52,587 --> 00:43:52,820
THING.

1365
00:43:52,820 --> 00:43:55,256
THEY CAN LOOK AT A REGION RIGHT

1366
00:43:55,256 --> 00:43:56,624
AROUND THE PLACE WHERE THEY'RE

1367
00:43:56,624 --> 00:43:58,259
SAMPLING BUT THEY CAN'T ACCOUNT

1368
00:43:58,259 --> 00:44:00,561
FOR PLACES WHERE WE'RE NOT

1369
00:44:00,561 --> 00:44:00,795
LOOKING.

1370
00:44:00,795 --> 00:44:02,964
SO ANOTHER GROUP TRIED TO DO

1371
00:44:02,964 --> 00:44:04,399
THIS WITH DTI AND WHITE MATTER

1372
00:44:04,399 --> 00:44:07,735
PATHWAYS AND SAID IF WE HAVE

1373
00:44:07,735 --> 00:44:09,904
THESE 3 AREAS AND THEY'RE

1374
00:44:09,904 --> 00:44:11,072
CONNEBBED ALONG WHITE MATTER

1375
00:44:11,072 --> 00:44:13,074
PATHWAYS CAN WE USE THIS FOR

1376
00:44:13,074 --> 00:44:15,143
WHITE MATTER FIBERS, SO THIS HAS

1377
00:44:15,143 --> 00:44:16,310
FUNDAMENTAL FLAWS IN IT, BECAUSE

1378
00:44:16,310 --> 00:44:17,512
I DON'T THINK THIS IS COMING

1379
00:44:17,512 --> 00:44:18,546
FROM THE JUNCTION OF WHITE

1380
00:44:18,546 --> 00:44:20,848
MATTER TRACKS IN THE MIDDLE OF

1381
00:44:20,848 --> 00:44:22,717
THE BRAIN BUT IT WAS 1 OF THE

1382
00:44:22,717 --> 00:44:25,086
FIRST TIMES HISEEN SOMEBODY TRY

1383
00:44:25,086 --> 00:44:25,920
AND INCORPORATE WHITE MATTER

1384
00:44:25,920 --> 00:44:32,060
INTO THIS LEADING AND LAGGING

1385
00:44:32,060 --> 00:44:32,260
THING.

1386
00:44:32,260 --> 00:44:33,928
SO SOMETHING WE DID IN OUR LAB

1387
00:44:33,928 --> 00:44:37,231
IS CAN WE USE OUR MULTIMODAL

1388
00:44:37,231 --> 00:44:38,766
DATABASE HERE AND TRY TO

1389
00:44:38,766 --> 00:44:40,134
INCORPORATE WHITE MATTER AND

1390
00:44:40,134 --> 00:44:40,968
GRAY MATTER PROPAGATION AND SO

1391
00:44:40,968 --> 00:44:42,703
THE WAY THAT THIS IS

1392
00:44:42,703 --> 00:44:43,738
TRADITIONALLY BEEN DONE AND THE

1393
00:44:43,738 --> 00:44:45,873
WAY I WAS TAUGHT TO DO IT AND

1394
00:44:45,873 --> 00:44:48,176
CLINICALLY WHEN WE'RE LOOKING

1395
00:44:48,176 --> 00:44:50,378
VISUALLY AT EEG, WHEN YOU SEE 3

1396
00:44:50,378 --> 00:44:52,413
ELET RODES HAVING SPIKES, YOU,A

1397
00:44:52,413 --> 00:44:53,815
SIEWM THE FIRST 1 IS THE SOURCE

1398
00:44:53,815 --> 00:44:55,383
OF THE ACTIVITY, PRETTY LOGICAL,

1399
00:44:55,383 --> 00:44:56,617
RIGHT, KIND OF LIKE THE ERGT

1400
00:44:56,617 --> 00:44:57,919
QUAKE THING WHERE THE FIRST 1

1401
00:44:57,919 --> 00:44:59,554
SHOULD BE CLOSER TO THE SOURCE

1402
00:44:59,554 --> 00:45:02,290
THAN THE FARTHER AWAY 1INGS BUT

1403
00:45:02,290 --> 00:45:04,192
WHAT WE FOUND IS LIEUSING

1404
00:45:04,192 --> 00:45:05,693
LITERALLURE FROM EVOKED

1405
00:45:05,693 --> 00:45:06,994
POTENTIALS AND INTRA CRANIAL

1406
00:45:06,994 --> 00:45:09,430
RECORDINGS AS WELL AS OTHER

1407
00:45:09,430 --> 00:45:13,034
LITERATURE, GRAY MATTER

1408
00:45:13,034 --> 00:45:15,269
CONDUCTION VELOCITIES ARE IN THE

1409
00:45:15,269 --> 00:45:16,771
RANGE AND WHITE MATTER

1410
00:45:16,771 --> 00:45:18,739
CONDUCTION IS MUCH, MUCH FASTER,

1411
00:45:18,739 --> 00:45:20,741
OKAY IN AND SO WHAT WE SAID IS,

1412
00:45:20,741 --> 00:45:22,176
OKAY, WELL, IF THE SOURCE IS

1413
00:45:22,176 --> 00:45:24,145
HERE, AND WE KNOW THERE ARE TIME

1414
00:45:24,145 --> 00:45:26,114
DELAYS AND WE KNOW OUR DISTANCES

1415
00:45:26,114 --> 00:45:27,181
ALONG THE CORTICALE SURFACE WE

1416
00:45:27,181 --> 00:45:28,716
SHOULD BE ABLE TO EXPLAIN ALL

1417
00:45:28,716 --> 00:45:31,819
THIS TIMES, RIGHT IN SO IF YOU

1418
00:45:31,819 --> 00:45:33,454
USE THAT LEADING ELECT ROAD

1419
00:45:33,454 --> 00:45:35,123
THEORY AND THIS IS AN EXAMPLE OF

1420
00:45:35,123 --> 00:45:36,357
PATIENTS THAT WERE INVOLVED IN

1421
00:45:36,357 --> 00:45:37,892
THE DISCHARGE, WHAT WE FOUND IF

1422
00:45:37,892 --> 00:45:40,661
YOU ASSUME THE SOURCES AT THIS

1423
00:45:40,661 --> 00:45:42,063
FIRST ELECTRODE, YOU COULD

1424
00:45:42,063 --> 00:45:43,798
EXPLAIN PROPAGATION TO 1 OF THE

1425
00:45:43,798 --> 00:45:45,333
OTHER EELECTRODE RODES WITH THE

1426
00:45:45,333 --> 00:45:45,933
TIMES WE OBSERVED.

1427
00:45:45,933 --> 00:45:50,404
THIS IS KIND OF THE HERTZ UNIT

1428
00:45:50,404 --> 00:45:50,905
MODEL.

1429
00:45:50,905 --> 00:45:52,173
WE SAID LET'S ASSUME THE SOURCE

1430
00:45:52,173 --> 00:45:53,608
COULD BE ANYWHERE AND WE'RE

1431
00:45:53,608 --> 00:45:55,443
RECEIVING SIGNAL, BUT WE WANT IT

1432
00:45:55,443 --> 00:45:56,978
TO SAY INSTEAD OF JUST RECEIVING

1433
00:45:56,978 --> 00:45:59,013
SIGNAL THROUGH THIS CORTICALE

1434
00:45:59,013 --> 00:46:00,882
TRAVELING WAY OF PROPAGATION,

1435
00:46:00,882 --> 00:46:02,483
LET'S SAY WHITE MATTER

1436
00:46:02,483 --> 00:46:04,018
PROPAGATION CAN ALSO HAPPEN, SO

1437
00:46:04,018 --> 00:46:05,520
SOUNDS LOGICAL SO FAR, RIGHT IN

1438
00:46:05,520 --> 00:46:08,089
SO WHEN WE DID THAT JUST LOOKING

1439
00:46:08,089 --> 00:46:09,490
FOR TRAVELING WAVE PROPAGATION,

1440
00:46:09,490 --> 00:46:14,362
YOU CAN HARDLY SEE IT BURIED IN

1441
00:46:14,362 --> 00:46:15,263
THE [INDISCERNIBLE] HERE, BUT

1442
00:46:15,263 --> 00:46:17,932
THIS IS THE SOURCE THAT BEST

1443
00:46:17,932 --> 00:46:20,568
EXPLAINED TIMING OF EACH OF

1444
00:46:20,568 --> 00:46:22,503
THESE 3 ELECTRODES, BUT WE

1445
00:46:22,503 --> 00:46:24,405
COULDN'T EXPLAIN WHERE WE WERE

1446
00:46:24,405 --> 00:46:25,907
SEEING A SPIKE IN THE FOURTH

1447
00:46:25,907 --> 00:46:27,241
ELECTRODE, BECAUSE IT WAS TOO

1448
00:46:27,241 --> 00:46:28,442
FAR AWAY.

1449
00:46:28,442 --> 00:46:30,178
LET'S SAY IT'S WHITE MATTER,

1450
00:46:30,178 --> 00:46:33,714
WHAT ANSWER DO WE GET WITH THESE

1451
00:46:33,714 --> 00:46:36,217
VELOCITIES AND ANSWERS WITH THE

1452
00:46:36,217 --> 00:46:39,520
D FI AND WE FOUND AGAIN WE

1453
00:46:39,520 --> 00:46:40,955
COULDN'T EXPLAIN THE LAST SPIKE

1454
00:46:40,955 --> 00:46:42,156
THAT WAS INVOLVED.

1455
00:46:42,156 --> 00:46:43,324
SO WHAT WE FOUND AND THIS IS

1456
00:46:43,324 --> 00:46:46,294
TRUE ACROSS ALL OF OUR PATIENTS

1457
00:46:46,294 --> 00:46:48,362
IS IF YOU ALLOW FOR WHITE MATTER

1458
00:46:48,362 --> 00:46:50,431
CONDUCTION AND/OR TRAVELING WAVE

1459
00:46:50,431 --> 00:46:52,366
CONDUCTION AND THIS ISN'T REALLY

1460
00:46:52,366 --> 00:46:53,768
A SURPRISE BUT HADN'T REALLY

1461
00:46:53,768 --> 00:46:54,936
BEEN DONE, YOU CAN FIND THAT

1462
00:46:54,936 --> 00:46:57,705
WILL EXPLAIN THE TIMING OF BY

1463
00:46:57,705 --> 00:46:58,773
FAR THE MOST SEQUENCES SO WHAT

1464
00:46:58,773 --> 00:47:00,208
WE THINK IS THIS GOES WITH WHAT

1465
00:47:00,208 --> 00:47:01,375
THE ANIMAL WORK SHOWED US IS

1466
00:47:01,375 --> 00:47:03,444
THAT WE SHOULD BE EXPECTING TO

1467
00:47:03,444 --> 00:47:06,080
SEE GRAY MATTER AND WHITE MATTER

1468
00:47:06,080 --> 00:47:07,782
PROPAGATION AND THAT SHOULD HELP

1469
00:47:07,782 --> 00:47:09,083
TO EXPLAIN, ALSO MAYBE EXPLAIN

1470
00:47:09,083 --> 00:47:12,053
WHY WE MISSED SOME OF THESE

1471
00:47:12,053 --> 00:47:12,620
LOCALIZATIONS.

1472
00:47:12,620 --> 00:47:14,155
SO IF WE'RE ASSUMING THE

1473
00:47:14,155 --> 00:47:15,122
LOCALIZATIONS ARE COMING FROM

1474
00:47:15,122 --> 00:47:16,657
WHERE WE PUT ELECTRODES, THAT'S

1475
00:47:16,657 --> 00:47:20,061
PROBABLY NOT A GOOD ASSUMPTION,

1476
00:47:20,061 --> 00:47:20,328
RIGHT?

1477
00:47:20,328 --> 00:47:21,629
AND THEN ALSO THE SURPRISING

1478
00:47:21,629 --> 00:47:22,530
THING THAT WE FOUND FROM THIS,

1479
00:47:22,530 --> 00:47:24,632
SO THIS IS THE COMBINED GRAY

1480
00:47:24,632 --> 00:47:27,602
MATTER AND WHITE MATTER ANSWER.

1481
00:47:27,602 --> 00:47:29,737
AND WE ALWAYS THOUGHT THAT THE

1482
00:47:29,737 --> 00:47:31,339
LEADING EELECTRODE RODE WILL BE

1483
00:47:31,339 --> 00:47:33,307
THE BEST ESTIMATE AND THAT'S

1484
00:47:33,307 --> 00:47:35,243
BECAUSE EVEN LOGICALLY WE WERE

1485
00:47:35,243 --> 00:47:36,077
TRAVELING ONLY WAVE

1486
00:47:36,077 --> 00:47:37,678
PROVEIGATION, SO IT TURNS OUT IF

1487
00:47:37,678 --> 00:47:39,280
YOU HAVE THESE COMBINED GRAY

1488
00:47:39,280 --> 00:47:40,615
MATTER AND WHITE MATTER

1489
00:47:40,615 --> 00:47:41,449
PATHWAYS, ACTUALLY THE WHEAT

1490
00:47:41,449 --> 00:47:43,284
MATTER IS SO MUCH FASTER THAT

1491
00:47:43,284 --> 00:47:44,819
THOSE SPIKES CAN TURN UP MUCH

1492
00:47:44,819 --> 00:47:46,087
EARLIER THAN THE 1S THAT ARE

1493
00:47:46,087 --> 00:47:47,655
MOVING KIND OF MORE SLOWLY AND

1494
00:47:47,655 --> 00:47:48,256
LOCALLY.

1495
00:47:48,256 --> 00:47:50,725
SO THIS IS ACTUALLY I THINK 1 OF

1496
00:47:50,725 --> 00:47:53,127
THE REASONS WHY WE SOMETIMES

1497
00:47:53,127 --> 00:47:54,729
HAVE MISS LOCALIZATION,

1498
00:47:54,729 --> 00:47:55,930
BASICALLY RELATED TO POOR

1499
00:47:55,930 --> 00:47:58,099
SAMPLING OF OUR ELECTRODES, WHEN

1500
00:47:58,099 --> 00:47:59,200
WE HAD DISTANT SOURCES LIKE

1501
00:47:59,200 --> 00:48:02,403
THIS, WE FOUND A LOT OF TIMES

1502
00:48:02,403 --> 00:48:04,038
THERE WERE 0 ELECTRODES IN THE

1503
00:48:04,038 --> 00:48:05,439
AREA WHERE THAT SOURCE WAS SO I

1504
00:48:05,439 --> 00:48:06,974
CAN'T PROVE THAT THESE ARE TRUE

1505
00:48:06,974 --> 00:48:08,242
BECAUSE WE ACTUALLY DIDN'T LOOK

1506
00:48:08,242 --> 00:48:09,543
THERE, AND IT TURNS OUT THIS

1507
00:48:09,543 --> 00:48:11,779
PATIENT HAD A RESECTION OF THEIR

1508
00:48:11,779 --> 00:48:12,947
ANTERIOR TEMPORAL REGION THAT

1509
00:48:12,947 --> 00:48:14,415
INCLUDE ALL THE SPIKING

1510
00:48:14,415 --> 00:48:15,249
CERTAINLY--CERTAINLY LECT RODES

1511
00:48:15,249 --> 00:48:16,284
AND DIDN'T BECOME SEIZURE FREE,

1512
00:48:16,284 --> 00:48:18,219
SO CAN YOU IMAGINE THAT THIS

1513
00:48:18,219 --> 00:48:27,795
WOULD HAVE A DIRECT IMPACT ON

1514
00:48:27,795 --> 00:48:28,562
OUR APPROACH.

1515
00:48:28,562 --> 00:48:30,431
SO WE SAID LET'S GO BACK TO OUR

1516
00:48:30,431 --> 00:48:31,599
RECORDINGS IN THESE PATES AND

1517
00:48:31,599 --> 00:48:38,973
SEE IF WE CAN SEE WHAT WE EXPECT

1518
00:48:38,973 --> 00:48:41,042
WHICH IS AND PROPAGATION AND

1519
00:48:41,042 --> 00:48:42,209
WHITE MATTER PROPAGATION, WHEN I

1520
00:48:42,209 --> 00:48:43,844
LOOK AT THIS, I ALREADY SHOWED

1521
00:48:43,844 --> 00:48:45,946
YOU THIS WHEN YOU LOOK AT IT,

1522
00:48:45,946 --> 00:48:49,884
THEY LOOK REALLY SIMILAR, WE

1523
00:48:49,884 --> 00:48:52,486
HAVE A WAY OF LOCALIZING THEM

1524
00:48:52,486 --> 00:48:54,221
WITH A DISCIPLINARY POLE MODEL

1525
00:48:54,221 --> 00:48:56,590
WHERE YOU EXPECT THE SOURCE IS

1526
00:48:56,590 --> 00:48:58,693
THE ACTUAL SOURCE, SOMEWHERE

1527
00:48:58,693 --> 00:49:06,767
BETWEEN THE AREAS OF NEGATIVE

1528
00:49:06,767 --> 00:49:07,668
AND POSITIVE APPLICATION.

1529
00:49:07,668 --> 00:49:09,503
SO THE CURRENT GOLD STANDARD IN

1530
00:49:09,503 --> 00:49:11,806
THIS PATIENT, I PUT IN THIS

1531
00:49:11,806 --> 00:49:13,140
VIDEO AND LET'S SEE IF IT WORKS

1532
00:49:13,140 --> 00:49:14,875
BUT WHAT I WANTED YOU TO SEE IS

1533
00:49:14,875 --> 00:49:16,977
WHEN WE DID A DRIEWBTED SOURCE

1534
00:49:16,977 --> 00:49:18,579
MODEL, SO WHEN MEG, IT'S

1535
00:49:18,579 --> 00:49:21,215
DIFFERENT THAN IN EEG, AND

1536
00:49:21,215 --> 00:49:22,616
DIFFERENT THAN INTRA CRANIAL EEG

1537
00:49:22,616 --> 00:49:24,685
AND YOU KNOW EXACTLY WHAT PART

1538
00:49:24,685 --> 00:49:26,153
OF CORTEX YOU ARE SAMPLING, ON

1539
00:49:26,153 --> 00:49:27,655
MEG, YOU HAVE THE OUTSIDE AND

1540
00:49:27,655 --> 00:49:29,657
YOU ARE USING MATHEMATICAL

1541
00:49:29,657 --> 00:49:30,858
MODELS TO INFER WHAT BRAIN

1542
00:49:30,858 --> 00:49:31,792
ACTIVITY IS GENERATING THAT

1543
00:49:31,792 --> 00:49:32,760
LOCATION, I THINK WE'RE ABOUT TO

1544
00:49:32,760 --> 00:49:37,031
GET TO THE SPIKE, SO DON'T

1545
00:49:37,031 --> 00:49:37,264
BLINK.

1546
00:49:37,264 --> 00:49:39,100
SO IT'S VERY QUIET AND THIS

1547
00:49:39,100 --> 00:49:41,435
SHOWS YOU HOW BIG AN OUTLIER

1548
00:49:41,435 --> 00:49:42,503
THIS SPIKING ACTIVITY IS, BUT

1549
00:49:42,503 --> 00:49:43,437
HERE IT IS, OKAY?

1550
00:49:43,437 --> 00:49:45,506
SO YOU CAN SEE THAT THE

1551
00:49:45,506 --> 00:49:46,674
DISCIPLINARY POLE MODEL WAS NOT

1552
00:49:46,674 --> 00:49:50,511
WRONG BUT IT WASN'T ENTIRELY

1553
00:49:50,511 --> 00:49:51,212
CORRECT, EITHER BECAUSE THIS

1554
00:49:51,212 --> 00:49:53,013
HIEWNL AREA OF BRAIN IS GETTING

1555
00:49:53,013 --> 00:49:54,048
INVOLVED IN THIS DISCHARGE AND

1556
00:49:54,048 --> 00:49:56,150
THIS IS WHAT WE TEND TO SEE, AND

1557
00:49:56,150 --> 00:49:57,885
YOU CAN SEE HOW THIS DOES GO

1558
00:49:57,885 --> 00:49:59,553
ALONG WITH THE TRAVELING WAVE WE

1559
00:49:59,553 --> 00:50:01,822
ARE TALKING ABOUT SO HAVE YOU

1560
00:50:01,822 --> 00:50:03,290
THIS BIG AREA OF ACTIVATION

1561
00:50:03,290 --> 00:50:04,625
THAT'S GROWING BUT IT'S A HUGE

1562
00:50:04,625 --> 00:50:06,694
AREA WHICH IS WHY WE THINK IT'S

1563
00:50:06,694 --> 00:50:07,862
NONSPECIFIC BUT IF YOU LOOK, THE

1564
00:50:07,862 --> 00:50:09,397
THING IEMG NOT SHOWING YOU FROM

1565
00:50:09,397 --> 00:50:12,032
THE MOVE SETHIS IS WHAT'S

1566
00:50:12,032 --> 00:50:13,067
HAPPENING IN THE

1567
00:50:13,067 --> 00:50:14,235
INTERHEMISPHERIC PART OF BRAIN.

1568
00:50:14,235 --> 00:50:16,470
SO THIS IS JUST AS BIG AN AREA

1569
00:50:16,470 --> 00:50:18,572
OF ACTIVATION HAPPENING SOME

1570
00:50:18,572 --> 00:50:20,107
PLACE WE WEREN'T EVEN LOOKING SO

1571
00:50:20,107 --> 00:50:23,411
IT'S TRUE THAT THIS ACTIVITY IS

1572
00:50:23,411 --> 00:50:23,844
NONSPECIFIC.

1573
00:50:23,844 --> 00:50:25,579
THIS PATIENT ACTUALLY GOT THIS

1574
00:50:25,579 --> 00:50:26,981
RESECTION AND BECAME SEIZURE

1575
00:50:26,981 --> 00:50:30,484
FREE AFTERWARDS SO IN FACT THE

1576
00:50:30,484 --> 00:50:32,286
DIPOLE WAS CORRECT BUT MAYBE NOT

1577
00:50:32,286 --> 00:50:33,721
A COMPLETE REPRESENTATION OF THE

1578
00:50:33,721 --> 00:50:34,288
ACTIVITY THAT'S HAPPENING.

1579
00:50:34,288 --> 00:50:36,157
SO 1 OF THE THINGS THAT WE'VE

1580
00:50:36,157 --> 00:50:37,458
BEEN DOING CAN THIS IS WORK

1581
00:50:37,458 --> 00:50:40,795
THAT'S HAPPENING IN MY LAB RIGHT

1582
00:50:40,795 --> 00:50:42,263
NOW WITH [INDISCERNIBLE], WE ARE

1583
00:50:42,263 --> 00:50:43,898
TRYING TO SEE CAN WE SEE THIS

1584
00:50:43,898 --> 00:50:45,933
GRAY MATTER AND WHITE MATTER

1585
00:50:45,933 --> 00:50:48,302
PROPAGATION, SO WHAT WE DID IS

1586
00:50:48,302 --> 00:50:50,037
WE SOURCE LOCAL EYATION TO GET

1587
00:50:50,037 --> 00:50:51,105
THESE DISTRIBUTED SOURCES AND

1588
00:50:51,105 --> 00:50:54,108
THEN JUST LOOKED OVER THE WHEEL

1589
00:50:54,108 --> 00:50:55,476
TIME COURSE OF THE SPIKE, IF YOU

1590
00:50:55,476 --> 00:50:56,877
ADD UP THE ACTIVITIES TO LOOK AT

1591
00:50:56,877 --> 00:50:58,412
THE AREA UNDER THE CURVE AND

1592
00:50:58,412 --> 00:51:00,114
PICK THE AREAS WITH THE BIGGEST

1593
00:51:00,114 --> 00:51:01,315
AREA UNDER THE CURVE SO WE'RE

1594
00:51:01,315 --> 00:51:02,483
NOT LOOKING AT LEADING OR

1595
00:51:02,483 --> 00:51:03,784
LAGGING OR ANYTHING ELSE, JUST

1596
00:51:03,784 --> 00:51:05,719
SAID WHERE'S THE MOST ACTIVATION

1597
00:51:05,719 --> 00:51:07,121
HAPPENING IN THIS GENERAL TIME

1598
00:51:07,121 --> 00:51:08,689
REGION AND YOU CAN SEE THIS IS A

1599
00:51:08,689 --> 00:51:09,089
DIFFERENT PATIENT.

1600
00:51:09,089 --> 00:51:11,625
CAN YOU SEE THE AREA UNDER THE

1601
00:51:11,625 --> 00:51:13,027
CURVE ALMOST FOLLOWS THE SAME

1602
00:51:13,027 --> 00:51:14,428
PATTERN WHERE THERE'S A BIG AREA

1603
00:51:14,428 --> 00:51:16,630
IN THE CURVE AND IT FALLS OFF,

1604
00:51:16,630 --> 00:51:21,268
THIS THRESHOLD SO THIS ACTIVITY

1605
00:51:21,268 --> 00:51:22,436
KEEPS GOING FOR QUITE A BIT.

1606
00:51:22,436 --> 00:51:23,771
THIS IS WHAT THEY LOOK LEAK.

1607
00:51:23,771 --> 00:51:26,207
YOU CAN SEE THIS IS THE AREA

1608
00:51:26,207 --> 00:51:27,274
WITH THE LARGEST--THIS IS THE

1609
00:51:27,274 --> 00:51:28,642
SENSOR WITH THE LARGEST AREA

1610
00:51:28,642 --> 00:51:30,478
UNDER THE CURVE BUT THESE OTHER

1611
00:51:30,478 --> 00:51:31,679
1S ALSO ARE FOLLOWING AND YOU

1612
00:51:31,679 --> 00:51:33,647
CAN KIND OF SEE THIS TIME DELAY

1613
00:51:33,647 --> 00:51:37,585
THAT WE'RE EXPECTING TO SEE.

1614
00:51:37,585 --> 00:51:39,286
WHEN WE TAKE THE AREA OF THE

1615
00:51:39,286 --> 00:51:41,155
CURVE AND GO OUTWARD FROM THE

1616
00:51:41,155 --> 00:51:43,424
VIRTUAL SENSOR WITH THE MAXIMUM

1617
00:51:43,424 --> 00:51:44,625
AREA IN THE CURVE, CAN YOU SEE

1618
00:51:44,625 --> 00:51:47,161
THE AREA IN THE CURVE IS FALLING

1619
00:51:47,161 --> 00:51:48,596
OFF, WHICH MATCHES WHAT YOU SEE,

1620
00:51:48,596 --> 00:51:52,933
WHERE THE END OF THE CURVE IS

1621
00:51:52,933 --> 00:51:54,735
GOING BACK TO THE YELLOW THINGS

1622
00:51:54,735 --> 00:51:57,338
AND WE SEE THIS PROPERIGATION IN

1623
00:51:57,338 --> 00:51:58,839
OUR MEG RECORRINGS WHICH IS

1624
00:51:58,839 --> 00:52:00,674
PRETTY COOL BECAUSE I DON'T

1625
00:52:00,674 --> 00:52:01,842
THINK ANYBODY'S TRIED TO TIE

1626
00:52:01,842 --> 00:52:03,043
THESE 2 THINS TOGETHER, THE

1627
00:52:03,043 --> 00:52:04,812
OTHER THING WE SAW THAT THE

1628
00:52:04,812 --> 00:52:05,646
PRIMARY CLUSTERS OVERLAP THE

1629
00:52:05,646 --> 00:52:07,381
RESECTION IN OUR ANGLE 1 PATIENT

1630
00:52:07,381 --> 00:52:09,250
WHO IS ARE SEIZURE FREE PATIENTS

1631
00:52:09,250 --> 00:52:10,885
IN ALMOST ALL OF OUR PATIENTS WE

1632
00:52:10,885 --> 00:52:12,853
LOOKED AT AND MOST OF THEM HAVE

1633
00:52:12,853 --> 00:52:14,455
THIS CORRELATION AT LEAST IN

1634
00:52:14,455 --> 00:52:17,892
THEIR PRIMARY OR LARGEST

1635
00:52:17,892 --> 00:52:18,125
CLUSTER.

1636
00:52:18,125 --> 00:52:20,361
AND THEN WHAT ABOUT THAT WHITE

1637
00:52:20,361 --> 00:52:21,629
MATTER PROPAGATION, SO I SHOWED

1638
00:52:21,629 --> 00:52:23,230
NUCLEOTIDES THE PATIENT WE SAW A

1639
00:52:23,230 --> 00:52:25,466
HUGE AREA OF ACTIVATION

1640
00:52:25,466 --> 00:52:29,169
LATERALLY AND HUGE AREA OF

1641
00:52:29,169 --> 00:52:29,703
ACTIVATION DISCONTIGUOUSLY

1642
00:52:29,703 --> 00:52:30,571
IMMEDIATELY, SO DOES THIS MAKE

1643
00:52:30,571 --> 00:52:32,773
SENSE THIS, IS WORK THAT'S JUST

1644
00:52:32,773 --> 00:52:33,240
HAPPENING RIGHT NOW.

1645
00:52:33,240 --> 00:52:35,242
AND WHAT YOU CAN SEE, IS THAT WE

1646
00:52:35,242 --> 00:52:37,177
ACTUALLY USE THIS THRESHOLD TO

1647
00:52:37,177 --> 00:52:39,813
SEE AT WHAT POINT THESE AREAS

1648
00:52:39,813 --> 00:52:42,349
BECAME ACTIVATED, IF YOU USE

1649
00:52:42,349 --> 00:52:43,484
THAT THRESHOLD TIME, WHAT YOU

1650
00:52:43,484 --> 00:52:46,820
CAN SEE ACROSS CLUSTERS IS THAT

1651
00:52:46,820 --> 00:52:48,822
THERE--THAT YOU'RE SEEING THE

1652
00:52:48,822 --> 00:52:50,024
GRAY MATTER TRACHING CAN

1653
00:52:50,024 --> 00:52:51,625
PROPAGATION LATER AND LATER WITH

1654
00:52:51,625 --> 00:52:52,593
ACTIVATION WITH EACH CLUSTER AND

1655
00:52:52,593 --> 00:52:55,362
YOU ARE ALSO SEEING SUBSEQUENT

1656
00:52:55,362 --> 00:52:57,064
CLUSTERS ACTIVATE AT LATER TIME

1657
00:52:57,064 --> 00:52:58,699
PERIODS RIGHT?

1658
00:52:58,699 --> 00:53:00,467
SO THIS SUGJEFFS THEY ARE MOST

1659
00:53:00,467 --> 00:53:04,038
LIKELY COMING FROM THE EARLIER

1660
00:53:04,038 --> 00:53:06,173
CLUSTER AND SPREADING ACROSS AND

1661
00:53:06,173 --> 00:53:07,341
WE SUSPECT IT'S CONTIGER

1662
00:53:07,341 --> 00:53:09,043
DATABASE USOUS, SO AGAIN, KIND

1663
00:53:09,043 --> 00:53:10,778
OF FOLLOWING WITH THE EPITHELIAL

1664
00:53:10,778 --> 00:53:11,879
RACRANIAL ACTIVITY, IF YOU LOOK

1665
00:53:11,879 --> 00:53:13,981
AT THE TIMING AND THE DISTANCES,

1666
00:53:13,981 --> 00:53:17,017
WE ACTUALLY SAW THAT SEVERAL OF

1667
00:53:17,017 --> 00:53:19,086
THESE AREAS IN THE PRIMARY

1668
00:53:19,086 --> 00:53:20,454
EARLIEST CLUSTER COULD EXPLAIN

1669
00:53:20,454 --> 00:53:22,423
BY DISTANCE AND TIMING

1670
00:53:22,423 --> 00:53:23,457
PROPAGATION TO THIS LARGER

1671
00:53:23,457 --> 00:53:23,824
CLUSTER.

1672
00:53:23,824 --> 00:53:25,359
SO WE THINK WE'RE SEEING

1673
00:53:25,359 --> 00:53:26,160
SOMETHING REALLY SIMILAR IN THE

1674
00:53:26,160 --> 00:53:27,795
MEG DATA WHICH IS KIND OF

1675
00:53:27,795 --> 00:53:29,763
SUPPORTING OUR THOUGHTS FROM THE

1676
00:53:29,763 --> 00:53:30,598
INTRA CRANIAL DATA.

1677
00:53:30,598 --> 00:53:31,332
OBVIOUSLY THERE'S MORE WORK TO

1678
00:53:31,332 --> 00:53:32,566
DO HERE AND I THINK IT'S

1679
00:53:32,566 --> 00:53:33,300
INTERESTING TO COMPARE WHAT

1680
00:53:33,300 --> 00:53:35,970
WE'RE SEEING IN THE MEG AND

1681
00:53:35,970 --> 00:53:38,138
INTRA CRANIAL DATA BUT I'M

1682
00:53:38,138 --> 00:53:39,073
HOPING THAT SOME DAY THAT WILL

1683
00:53:39,073 --> 00:53:39,907
HELP US TO PUT

1684
00:53:39,907 --> 00:53:40,608
CERTAINLY--CERTAINLY LET RODES

1685
00:53:40,608 --> 00:53:41,542
IN THESE AREAS OF PARTICULAR

1686
00:53:41,542 --> 00:53:44,945
INTEREST AND SO THAT WE WILL NO

1687
00:53:44,945 --> 00:53:46,580
LONGER BE HAVING THIS POTENTIAL

1688
00:53:46,580 --> 00:53:47,781
SOURCE WITH NO ELECTRODE THERE.

1689
00:53:47,781 --> 00:53:52,052
SO AS YOU CAN SEE HOW THAT WOULD

1690
00:53:52,052 --> 00:53:56,023
DIRECTLY LEAD TO MORE UTILITY IN

1691
00:53:56,023 --> 00:53:57,091
OUR INTRA CRANEICALRIA CORDINGS.

1692
00:53:57,091 --> 00:53:58,492
I WILL SAY THE MAIN PROBLEM WE

1693
00:53:58,492 --> 00:53:59,793
HAVE IS THAT IF WE'RE CORRECT

1694
00:53:59,793 --> 00:54:01,528
AND IF WE ACTUALLY IMPLANT THESE

1695
00:54:01,528 --> 00:54:04,765
AREAS THAT ARE SEPARATE, YOU

1696
00:54:04,765 --> 00:54:06,867
COULD IMAGINE WE WILL HAVE

1697
00:54:06,867 --> 00:54:07,568
ACTIVITY THAT'S SPREADING REALLY

1698
00:54:07,568 --> 00:54:08,669
FAST BETWEEN THEM AND SO THEN WE

1699
00:54:08,669 --> 00:54:11,472
WILL HAVE TO USE ALL THE FUN

1700
00:54:11,472 --> 00:54:14,875
TOOLS FOR THE PEOPLE WHO USE

1701
00:54:14,875 --> 00:54:15,576
EPITHELIAL RACRANIAL EEG CAN

1702
00:54:15,576 --> 00:54:17,211
GIVE US BECAUSE I THINK IT'S

1703
00:54:17,211 --> 00:54:19,046
GOING TO BE DIFFICULT TO

1704
00:54:19,046 --> 00:54:19,747
DISTINGUISH WHERE IT'S COMING

1705
00:54:19,747 --> 00:54:20,848
FROM AND WHERE IT'S GOING TO.

1706
00:54:20,848 --> 00:54:22,916
SO I THINK WE HAVE A LOT OF WORK

1707
00:54:22,916 --> 00:54:27,655
LEFT TO DO BUT I THINK THIS IS A

1708
00:54:27,655 --> 00:54:36,230
REALLY EXCITING AREA AND I'M

1709
00:54:36,230 --> 00:54:37,531
HOPING AND LOOK FORWARD TO

1710
00:54:37,531 --> 00:54:41,235
CONTINUING THIS AND I WANT TO

1711
00:54:41,235 --> 00:54:43,103
ACKNOWLEDGE ALL MY PEOPLE IN THE

1712
00:54:43,103 --> 00:54:44,371
GROUP AND COLLEAGUES WHO WE

1713
00:54:44,371 --> 00:54:47,975
WORKED WITH AND EVERYBODY IN THE

1714
00:54:47,975 --> 00:54:50,577
BRANCHES AND THE PATIENTS,

1715
00:54:50,577 --> 00:54:52,980
FAMILIES, MECH CORFACILLITY, MRI

1716
00:54:52,980 --> 00:54:54,715
CORE FACILITY AND ALL THE NURSES

1717
00:54:54,715 --> 00:54:55,816
WHO HELP TO TAKE WEAR OF THESE

1718
00:54:55,816 --> 00:54:59,586
PATIENT WHO IS CAN BE VERY

1719
00:54:59,586 --> 00:55:00,554
CHALLENGING, SO THANK YOU AND

1720
00:55:00,554 --> 00:55:03,290
HAPPY TO ANSWER ANY QUESTIONS.

1721
00:55:03,290 --> 00:55:13,500
[ APPLAUSE ]

1722
00:55:15,502 --> 00:55:16,503
>> IF ANYBODY HAS ANY
QUESTIONS

1723
00:55:16,503 --> 00:55:18,472
YOU MAY APPROACH THE MICROPHONES

1724
00:55:18,472 --> 00:55:20,040
BUT 1 QUESTION I WANT TO START

1725
00:55:20,040 --> 00:55:21,341
OFF WITH BECAUSE I THINK IT'S

1726
00:55:21,341 --> 00:55:22,876
BECOMING MORE AND MORE PART OF

1727
00:55:22,876 --> 00:55:23,811
OUR CONVERSATIONS IS ESPECIALLY

1728
00:55:23,811 --> 00:55:26,947
WITH YOUR WORK INVOLVING

1729
00:55:26,947 --> 00:55:27,748
MULTIMODALITY, PHENOTYPING HOW

1730
00:55:27,748 --> 00:55:30,651
AI CAN COME INTO PLAY TO HELP

1731
00:55:30,651 --> 00:55:31,218
WITH THIS LOCALIZATION?

1732
00:55:31,218 --> 00:55:33,520
IT SEEMS LOAMACYIC IT WOULD BE

1733
00:55:33,520 --> 00:55:34,354
RIPE FOR THAT.

1734
00:55:34,354 --> 00:55:36,657
I DON'T UNDERSTAND IT BUT YOU

1735
00:55:36,657 --> 00:55:36,890
KNOW.

1736
00:55:36,890 --> 00:55:38,058
>> I THINK WE WERE TALKING
ABOUT

1737
00:55:38,058 --> 00:55:40,194
AI IN SOME OF THESE THINGS SO AI

1738
00:55:40,194 --> 00:55:42,162
IS DEFINITELY PLAYING A ROLE

1739
00:55:42,162 --> 00:55:43,464
ALREADY, I THINK AI RIGHT NOW IS

1740
00:55:43,464 --> 00:55:44,698
REALLY GOOD AT TELLING PATIENTS

1741
00:55:44,698 --> 00:55:50,771
WHO ARE NOT GOING TO DO WELL AT

1742
00:55:50,771 --> 00:55:51,305
SURGERY.

1743
00:55:51,305 --> 00:55:53,741
BUT OUR FCU DETECTION WAS A

1744
00:55:53,741 --> 00:55:54,908
MACHINE LEARNING ALGORITHM

1745
00:55:54,908 --> 00:55:58,045
ALREADY, RIGHT, SO IMAGING AI IS

1746
00:55:58,045 --> 00:55:58,879
DEFINITELY ALREADY PLAYING A

1747
00:55:58,879 --> 00:56:00,681
ROLE AND THEN THE INTRA CRANIAL

1748
00:56:00,681 --> 00:56:03,550
EEG, A LOT OF PEOPLE ARE ALSO

1749
00:56:03,550 --> 00:56:05,252
DOING AI APPROACHES WITH IT BUT

1750
00:56:05,252 --> 00:56:07,421
MY WHOLE STILL HYPOTHESIS IS IF

1751
00:56:07,421 --> 00:56:10,290
WE DON'T PUT THE ELECTRODES IN

1752
00:56:10,290 --> 00:56:11,925
THE RIGHT PLACE IT'S GOING TO BE

1753
00:56:11,925 --> 00:56:13,227
HARD FOR AI TO FIND THE ANSWER

1754
00:56:13,227 --> 00:56:14,294
BECAUSE WE DON'T KNOW THE

1755
00:56:14,294 --> 00:56:14,528
ANSWER.

1756
00:56:14,528 --> 00:56:15,729
SO YOU HAVE TO TRAIN ON

1757
00:56:15,729 --> 00:56:17,531
SOMETHING, SO CAN YOU TRAIN ON

1758
00:56:17,531 --> 00:56:19,199
ANIMAL MODELS BUT APPROXIMATE

1759
00:56:19,199 --> 00:56:21,802
YOU DON'T NOT ANSWER IT BECOMES

1760
00:56:21,802 --> 00:56:22,903
REALLY HARD.

1761
00:56:22,903 --> 00:56:24,772
BUT WE'RE TRYING TO IMLESM AI

1762
00:56:24,772 --> 00:56:28,609
FOR A LOT OF REALLY MEG

1763
00:56:28,609 --> 00:56:31,245
APPROACHES AND USING INTRA

1764
00:56:31,245 --> 00:56:33,213
CRANIALLY EEG AND AI IS HERE AND

1765
00:56:33,213 --> 00:56:34,815
WILL CONTINUE TO BE HERE.

1766
00:56:34,815 --> 00:56:37,117
>> YOU MENTIONED AT THE

1767
00:56:37,117 --> 00:56:38,952
BEGINNING, YOU CAN CAN OFTEN SEE

1768
00:56:38,952 --> 00:56:41,588
WITHIN A YEAR IF A PATIENT IS

1769
00:56:41,588 --> 00:56:49,062
NOT GOING RESPOND TO FOLLOWING

1770
00:56:49,062 --> 00:56:52,366
AND QUALITY OF LIFE, SO?

1771
00:56:52,366 --> 00:56:54,468
>> YEAH, SO THIS IS I
TOPIC NEAR

1772
00:56:54,468 --> 00:56:56,203
AND DAILY BASISSER TO MY HEART.

1773
00:56:56,203 --> 00:56:57,604
THE AVERAGE TIME I BELIEVE LAST

1774
00:56:57,604 --> 00:56:59,840
TIME I LOOKED FOR PEOPLE TO GET

1775
00:56:59,840 --> 00:57:01,175
REFER FOR EPILEPSY SURGERY IS

1776
00:57:01,175 --> 00:57:02,476
STILL BETWEEN THE TENT AND 20

1777
00:57:02,476 --> 00:57:04,411
YEARS SO IT'S A HUGE EFFORT THAT

1778
00:57:04,411 --> 00:57:05,712
WE'RE ALL MAKING TO EDUCATE

1779
00:57:05,712 --> 00:57:07,915
PEOPLE TO SAY, YOU DON'T NEED TO

1780
00:57:07,915 --> 00:57:09,216
WAIT 10 OR 20 YEARS.

1781
00:57:09,216 --> 00:57:10,584
PEOPLE SAY OH WELL THERE'S

1782
00:57:10,584 --> 00:57:11,852
ANOTHER MEDICINE THEY HAVEN'T

1783
00:57:11,852 --> 00:57:13,854
TRIED YET, BUT THERE CHANCE IS

1784
00:57:13,854 --> 00:57:14,421
SO LOW, RIGHT?

1785
00:57:14,421 --> 00:57:15,956
SO I THINK PEOPLE ARE GETTING

1786
00:57:15,956 --> 00:57:18,125
BETTER AT DOING THE TRIALS OF 2

1787
00:57:18,125 --> 00:57:19,193
MEDICINE AND THEN REFERRING

1788
00:57:19,193 --> 00:57:21,261
PEOPLE WHO HAVE CLEAR LESIONS

1789
00:57:21,261 --> 00:57:23,230
THAT THEY THINK ARE SAFE, OKAY?

1790
00:57:23,230 --> 00:57:27,734
SO I THINK THE NONLESIONAL

1791
00:57:27,734 --> 00:57:28,101
PATIENTS.

1792
00:57:28,101 --> 00:57:30,037
THEY'RE STILL RELUCTANT TO

1793
00:57:30,037 --> 00:57:32,005
REFER, WE A LOT OF PATIENTS THAT

1794
00:57:32,005 --> 00:57:33,407
TOLD US THEY'RE HUNDRED PERCENT

1795
00:57:33,407 --> 00:57:34,775
NOT A SURGICAL CANDIDATE IF

1796
00:57:34,775 --> 00:57:36,076
ANYBODY TRIES TO DO SURGERY,

1797
00:57:36,076 --> 00:57:37,711
THEY WILL BE A VEGETABLE,

1798
00:57:37,711 --> 00:57:41,148
THERE'S A LOT OF FEAR OF

1799
00:57:41,148 --> 00:57:42,182
NEUROSURGERY OUT THERE, SO THIS

1800
00:57:42,182 --> 00:57:43,450
IS SOMETHING WE'RE STILL

1801
00:57:43,450 --> 00:57:45,419
OVERCOMING TO A LARGE EXTEND AND

1802
00:57:45,419 --> 00:57:46,486
WE'RE HOPING THAT LECTURES LIKE

1803
00:57:46,486 --> 00:57:47,788
THIS AND OTHER LECTURES OUT IN

1804
00:57:47,788 --> 00:57:49,556
THE COMMUNITY WILL HELP PEOPLE

1805
00:57:49,556 --> 00:57:50,724
BE AWARE OF WHAT THEIR OPTIONS

1806
00:57:50,724 --> 00:57:52,492
ARE AND I THINK NEURAL

1807
00:57:52,492 --> 00:57:53,660
MODULATION IS PLAYING A HUGE

1808
00:57:53,660 --> 00:57:55,629
ROLE IN THIS, TOO, BECAUSE A LOT

1809
00:57:55,629 --> 00:57:57,231
OF PEOPLE FEEL SAFER WITH THE

1810
00:57:57,231 --> 00:57:58,432
IDEA OF A DEVICE THAN THEY DO

1811
00:57:58,432 --> 00:58:00,300
WITH THE IDEA OF A SURGEON

1812
00:58:00,300 --> 00:58:01,235
REMOVING SOME PART OF THEIR

1813
00:58:01,235 --> 00:58:03,036
BRAIN SO I THINK THAT'S KIND OF

1814
00:58:03,036 --> 00:58:04,504
OPENING PEOPLE'S EYES TO MAYBE

1815
00:58:04,504 --> 00:58:05,439
THE POSSIBILITIES AND THE HOPE

1816
00:58:05,439 --> 00:58:07,975
IS THAT ONCE THEY GET TO A LARGE

1817
00:58:07,975 --> 00:58:09,142
EPILEPSY SURGERY IS IT, WHERE

1818
00:58:09,142 --> 00:58:10,777
THEY CAN GET A COMPLETE

1819
00:58:10,777 --> 00:58:12,079
EVALUATION THEN WE CAN MAKE

1820
00:58:12,079 --> 00:58:13,914
DECISIONS ABOUT WHETHER THAT'S

1821
00:58:13,914 --> 00:58:15,315
ACTUALLY THE MOST APPROPRIATE

1822
00:58:15,315 --> 00:58:15,616
THING.

1823
00:58:15,616 --> 00:58:16,516
BUT MY MESSAGE TO EVERYBODY OUT

1824
00:58:16,516 --> 00:58:18,685
THERE IS IF YOU HAVE TRIED 2

1825
00:58:18,685 --> 00:58:20,220
MEDICINE AT FULL DOSES AND IT'S

1826
00:58:20,220 --> 00:58:22,522
NOT WORKING, YOU ARE BASICALLY

1827
00:58:22,522 --> 00:58:23,457
BECOMING A SURGICAL CANDIDATE.

1828
00:58:23,457 --> 00:58:29,763
SO WE TRY TO KEEP IT VERY

1829
00:58:29,763 --> 00:58:30,230
SIMPLE.

1830
00:58:30,230 --> 00:58:31,064
NANY OTHER QUESTIONS HERE, WE

1831
00:58:31,064 --> 00:58:33,267
HAVE A QUESTION FROM OUR

1832
00:58:33,267 --> 00:58:35,802
VIDEOCAST AUDIENCE:  WHAT IS THE

1833
00:58:35,802 --> 00:58:37,337
ROLE OF AMPLATTORY MONITORING IN

1834
00:58:37,337 --> 00:58:39,973
EPILEPSY RESEARCH AND DIAGNOSIS?

1835
00:58:39,973 --> 00:58:42,309
>> YES, SO WE DON'T DO

1836
00:58:42,309 --> 00:58:43,010
AMBULATORY MONITORING HERE SO

1837
00:58:43,010 --> 00:58:44,811
ALL I KNOW IS TALKING TO MY

1838
00:58:44,811 --> 00:58:46,113
COLLEAGUES AND FELLOWSHIP WHICH

1839
00:58:46,113 --> 00:58:48,248
IS A LITTLE WHILE AGO BUT I

1840
00:58:48,248 --> 00:58:50,350
THINK IT'S AMAZING FOR THE RIGHT

1841
00:58:50,350 --> 00:58:50,617
QUESTIONS.

1842
00:58:50,617 --> 00:58:52,352
SO NOBODY UPONS TO SIT AND HERE

1843
00:58:52,352 --> 00:58:53,220
WHEN THEY'RE ESSENTIAL HEALTHY

1844
00:58:53,220 --> 00:58:56,056
AND WAIT FOR US TO MONITOR THEM

1845
00:58:56,056 --> 00:58:57,124
AND THEY FEEL GOOD AND THEY'RE

1846
00:58:57,124 --> 00:58:58,025
TRAP INDEED A HOSPITAL ROOM.

1847
00:58:58,025 --> 00:58:59,459
SO FIELD FUNCTIONS KNOW WHAT

1848
00:58:59,459 --> 00:59:01,094
YOU'RE SEIZURES ARE LIKE, AND

1849
00:59:01,094 --> 00:59:02,629
I'M WONDERING ARE YOU HAVING

1850
00:59:02,629 --> 00:59:04,765
SEIZURES YOU'RE NOT AWARE OF,

1851
00:59:04,765 --> 00:59:05,599
THEN AMPLATTORY MONITORING IS

1852
00:59:05,599 --> 00:59:05,933
GREAT.

1853
00:59:05,933 --> 00:59:08,235
WE HAVE THIS WITH LEFT TEMPORAL

1854
00:59:08,235 --> 00:59:09,870
LOBE PATIENTS WHERE A LOT OF

1855
00:59:09,870 --> 00:59:12,039
TIMES THEY ARE UNAWARE OF THEIR

1856
00:59:12,039 --> 00:59:13,807
SEIZURES AND IF THEY LIVE BY

1857
00:59:13,807 --> 00:59:15,409
THEMSELVES, THEY'RE HAVING TONS

1858
00:59:15,409 --> 00:59:17,144
OF SEIZURES AND DON'T KNOW IT OR

1859
00:59:17,144 --> 00:59:18,645
MAYBE THEY DON'T HAVE ANY AT

1860
00:59:18,645 --> 00:59:18,812
ALL.

1861
00:59:18,812 --> 00:59:20,714
SO IT'S LIKE A YES NO QUESTION.

1862
00:59:20,714 --> 00:59:22,582
IT'S LESS GOOD IF YOU'RE TRYING

1863
00:59:22,582 --> 00:59:23,784
TO DECIDE WHERE YOU WOULD LIKE

1864
00:59:23,784 --> 00:59:25,652
TO DO A SURGERY IN WHICH CASE WE

1865
00:59:25,652 --> 00:59:27,654
REALLY WANT THE VIDEO AND MORE

1866
00:59:27,654 --> 00:59:30,123
CONTROLLED SCENARIO, BUT I THINK

1867
00:59:30,123 --> 00:59:32,225
AMBULATORY EEG IS,A MAZING AND

1868
00:59:32,225 --> 00:59:34,294
IT'S A REALLY GOOD TOOL WHEN

1869
00:59:34,294 --> 00:59:37,297
USED IN APPROPRIATE SITUATIONS.

1870
00:59:37,297 --> 00:59:37,931
>> DR. INATI, THANK YOU
VERY

1871
00:59:37,931 --> 00:59:39,132
MUCH FOR SHARINGIOURE WORK AND

1872
00:59:39,132 --> 00:59:40,067
YOUR INSIGHTS ANDY WOO LOOK

1873
00:59:40,067 --> 00:59:41,068
FORWARD TO HEARING ABOUT YOUR

1874
00:59:41,068 --> 00:59:42,736
WORK IN THE FUTURE.

1875
00:59:42,736 --> 00:59:43,770
THANK YOU FOR COMING OUT TODAY

1876
00:59:43,770 --> 00:59:47,207
AND WE'LL SEE YOU ALL NEXT WEEK.

1877
00:59:47,207 --> 00:59:47,574
[ APPLAUSE ]

1878
00:59:47,574 --> 00:59:57,985
>> THANK YOU SO MUCH.