Doctors, And A Special Patient, Use New Imaging Tools To Document How A Seizure Travels Through The Labyrinth Of The Brain

Main Category: Neurology / Neuroscience
Article Date: 06 Apr 2009 - 3:00 PDT


For the millions of people who suffer from epilepsy, what is going on in Jeff Nelson's brain might be a map to freedom.

Twice now, Nelson has come to Stanford Hospital & Clinics to undergo long hours of testing. First, he sits patiently while neuroscientists attach electrical cables to a special hat he wears during testing. It takes some time-the cables are as plentiful as blades of grass sprouting from a well-sown lawn. Then, into the narrow tunnel of the MRI he goes. The wires gauge his brain's electrical pulses, sending the data as an electroencephalogram-an EEG. The MRI records changes in blood flow in his brain.

Stanford is one of just a few places in the world with the technology to correlate the information from the EEG and the MRI. The combination of the two forms of seizure observation allows Stanford physicians to see something previously very elusive: the real time interaction between the brain's architecture and the electrical abnormalities that spark epileptic seizures.

Nelson is here because he has a special kind of epilepsy. Instead of being random, unpredictable occurrences, reflex epilepsy's seizures happen after exposure to a certain sight, smell, or sound. Those known triggers enable Nelson's physicians at Stanford to produce and then observe a seizure, capturing valuable data. The analysis of what goes on in Nelson's brain during a seizure is building a behavioral diagram that will one day guide a less invasive, less risky and more permanent treatment for epilepsy.

"We know that seizures do not affect single centers in the brain," said Josef Parvizi, MD, PhD, a neurology specialist with the Stanford Comprehensive Epilepsy Clinic who leads the team of investigators studying Nelson's brain. "Instead, the excess electrical activity that produces a seizure travels on a network whose pathways range over several areas of the brain. Being able to interrupt, very specifically, the seizure network's connections and pathways, is the treatment goaland an alternative to brain surgery."

"Saying seizures start in one place is a simplification because our trillions of brain cells are interconnected," said Epilepsy Center Director Robert Fisher, MD. "The type of work Dr. Parvizi is doing by combining state-of-the-art electrical and imaging methods will take our understanding of seizure origin and behavioral consequences into the next dimension. Within a few years, this work may allow us to disrupt the spread and mitigate the effects of seizures."

More than two million people in the U.S. have epilepsy, more than 50 million worldwide. Nelson sees the test as a way to speed the day when he and others whose lives are altered by epilepsy will no longer need to shape their lives around it. His seizures began in childhood and, now, even with medication, he may have up to 20 seizures in one day.

He does not concentrate on what he cannot accomplish, but on what he can. With an undergraduate degree in art history from University of California-Santa Cruz, Nelson was on course to begin a master's degree in ancient Chinese history. Instead, he is chronicling, with an artist's eye, the hallucinations he sees while in seizure.

He lives in a small Central Valley town where he can get around by bike. He doesn't feel safe to drive and uses his license for identification only. He takes other precautions, too. If he meets someone for the first time, Nelson may not make direct eye contact. Sometimes, that kind of look can trigger a seizure. He had wanted to be a teacher, but he cannot trust that he will not have a seizure in front of a classroom of students.

Each seizure is unique and comes with its own emotional overlay and visual expression. A seizure "can start as a bright light flashing in the center of my vision," he said. "From there, things start to swirl around, a lot of swirling colors, like a galaxy."

Sometimes, a bright white light suffuses whatever is before him. Then the objects fracture until everything jumbles up like a do-it-yourself kaleidoscope. Once, he said, "I honestly could describe what I saw as angels. I felt like I was almost lifted out of my body. There were three angelic figures. They were just hovering. Normally in a seizure, I get an unpleasant feeling, a fear. This time I had a real joyous feeling. I felt very much at peace and didn't want it to stop."

In other seizures, things go black and he sees a ball with colors emanating off it. "This ball feels like it's moving through my brain," he said. "It's a grinding feeling. I almost have this sense that it's grinding my brain."

He experimented with painting after college. "I just kind of did it to see what it was like," he said. When epilepsy derailed his plans, he had time on his hands, so he picked up brush and canvas again. At first, he painted only what he saw in his seizures. "I call this my therapy period," he said, "because what I was doing was getting out a whole lot of this stuff that was inside my head, what was going on with me, the direction of my life."

He is painting more than his seizures now, as a way to nourish his interest in art. He has learned, he said, to take satisfaction in simple things in life-like riding his bike. "I sometimes push myself a little bit, to find my limitations," he said. "It doesn't mean I don't get frustrated, but I'm also happy with what I'm able to accomplish."

The joy he feels in painting is something to balance his obvious frustration with a disease that limits his ability to be with people. "It's socially crippling," he said. "People who know me are aware of my seizures and are okay with it. It probably bothers me more than it bothers them. When it comes to making new friends, I've got a lot at stake. Do I tell somebody right off the bat or do I wait?"

He is eager to see what his tests reveal about his epilepsy, to see if enough new information might be visible to outline new treatment for him. "But I consider myself blessed," he said. "So many people have it a million times worse than I do."

Additional photos available on Flickr

About Stanford Hospital & Clinics

Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiac care, cancer treatment, neurosciences, surgery, and organ transplants. Consistently ranked among the top institutions in theU.S. News & World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. It is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford.

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