#363 ‒ A new frontier in neurosurgery: restoring brain function with brain-computer interfaces, advancing glioblastoma care, and new hope for devastating brain diseases | Edward Chang, M.D.

Edward Chang delves into the rich history and evolution of neurosurgery, highlighting the contributions of its pioneers, Harvey Cushing and Wilder Penfield, and the transformation of surgical techniques from highly invasive to minimally invasive procedures using advanced technologies.

Neurosurgery Transformed: 19th Century Pioneers Harvey Cushing & Wilder Penfield

Cushing: Father of Modern Neurosurgery and Brain Endocrine Pioneer

Edward Chang speaks glowingly of Harvey Cushing, marking him as a clear inflection point in the domains of medicine, neuroscience, and neurosurgery. Cushing, considered the father of modern neurosurgery, made profound contributions through his exceptional surgical abilities and observations. Beyond his surgical prowess, Cushing was an astute internist, being the first to diagnose pituitary tumors and their effects on the endocrine system. Chang acknowledges that Cushing's era introduced the brain's modern tools of craniotomy to access tumors.

Penfield's Epilepsy Surgery Advanced Brain Mapping, Revealing Motor and Sensory Organization

Wilder Penfield emerges as another titan in the field, renowned for his work at the Montreal Neurological Institute and his significant advancements in modern epilepsy surgery. Penfield's work popularized the homunculus—a depiction of the brain regions controlling each muscle in the body—and greatly enhanced the understanding of language. He was also a forerunner in developing the concept of awake brain surgery, which profoundly influenced Chang's own neurosurgical career.

Neurosurgery Evolution: From Invasive to Targeted With New Technologies

Chan ...

Attia and Dr. Edward Chang delve into the intricacies of brain surgery, with a particular focus on surgeries where the patient is awake, enabled by the brain's lack of pain receptors.

Awake Brain Surgery Possible Due to Lack of Pain Receptors

The brain itself doesn’t have pain receptors, which enables the possibility of awake brain surgery. Pain receptors are present in nerves and the scalp, as well as throughout the body, but brain tissue is devoid of them. Sensitivities can exist around the blood vessels and the dura membrane on top of the brain, but these can be numbed, making surgery on the brain itself pain-free for the patient.

Awake Brain Surgery Patients Are Lightly Sedated, Allowing Critical Brain Function Mapping Without Damage

During an extensive conversation about awake brain surgery, Attia and Chang discuss that patients are lightly sedated with a much lower dose of sedation than that used for general anesthesia. A medication like [restricted term] is administered at a very light dosing and can be stopped when necessary, such as when the surgery requires the patient to be fully awake for critical function mapping of the brain.

Chang notes that patients are only awake for an hour or two during a surgery that could last several hours, primarily for brain mapping while fully conscious. This meticulous process allows surgeons to map and preserve crucial areas of the brain responsible for language or motor abilities while intermittently sedating the patient for comfort.

Surgeons Push Boundaries of Safe Resection, Preserving Patient's Language, Movement, Abilities

Chang explains that brain ma ...

Edward Chang's research in the field of neural engineering aims to decode and interpret neural signals, potentially restoring speech and movement for paralyzed patients through brain-computer interface (BCI) systems.

Researchers Use BCIs to Decode Neural Activity and Control Devices for Restoring Communication and Motor Function in Paralyzed Patients

Chang's work bridges the operating room, the research lab, and the engineering bench. His focus is on using BCI systems for interpreting brain signals, which can then be used to move a computer cursor or restore speech for someone who's paralyzed and cannot talk.

BCI Systems Use Non-Invasive Scalp EEG or Invasive Brain Surface Electrodes (ECoG)

Edward Chang acknowledges that the restoration of function in conditions like paralysis hasn't been possible until recently due to advancements in brain-computer interfaces (BCI). The use of electrocorticography (ECoG), where sensors are placed over the speech area, allows dense sampling across that region, and is leveraged to restore communication for paralyzed patients like a patient named Anne, who communicates through devices tracking her eye movements.

Chang and his team have spent over a decade using methods like ECoG to map the "mini-homunculus" in the brain that corresponds to parts of the vocal tract. Their research has identified neural signals for every consonant and vowel in English, which they've used to help restore communication for Anne, who could vocalize a little but was otherwise unintelligible.

Mapping Neural Representations Enables BCI to Convert Signals Into Text or Control Devices

Chang's clinical trial involves a surgically placed array connected via a port anchored to the skull to decode brain activity. The BCI decodes brain signals for a woman trying to speak but cannot because her lips, jaw, and larynx are paralyzed, rendering her unintelligible. In an experiment, they could decode words and display them as text with about 95% accuracy after a week of testing.

The discussion includes decoding brain activity associated with the volitional intent to speak, rather than inner monologues or reading. The patient's intent to speak sentences displayed on a screen is critical for training the BCI decoder. Initially, the system mapped brain signals to a simple vocabulary of 27 words translated into text with about 50% accuracy a ...

Recent discussion with experts, like Edward Chang and Peter Attia, reveals the growing potential for brain-computer interfaces (BCIs) and other technologies to provide novel treatments for neurological conditions.

Brain-Computer Interfaces Offer Hope For Restoring Function in Paralysis, ALS, and Parkinson's Disease

Chang’s work illustrates the possibility of using BCIs to treat patients with paralysis due to neurodegenerative conditions such as ALS, where damaged motor pathways prevent speech.

BCI Systems Might Bypass Damaged Motor Pathways to Restore Muscle Control For ALS and Spinal Injury Patients

Chang’s team has shown how BCI technology, specifically ECoG sensors implanted on a patient’s brain, might bypass damaged motor pathways and restore communication abilities. This suggests potential for BCIs to address conditions resulting in paralysis, like ALS and spinal cord injuries.

Advances in Neural Engineering, Including Biocompatible Brain Implants and Machine Learning Algorithms, May Transform Parkinson's and Glioblastoma Into Manageable, Chronic Illnesses

Advances in fields like material science could lead to biocompatible brain implants, and genetic understanding may custom-treat glioblastoma. Though Chang does not expressly mention the role of machine learning algorithms for Parkinson's or glioblastoma, the implication is that such advances, like ECoG implants and immunotherapies, are on the horizon, offering hope for managing these illnesses.

Stem Cell and Gene Therapies Targeting Neurodegeneration Mechanisms Could Treat Alzheimer's, Parkinson's, and Cognit ...

Dr. Edward Chang offers insights into the rapidly evolving field of neurosurgery, shedding light on the shift towards biological and genetic solutions, less invasive procedures, and a multidisciplinary approach.

Neurosurgery Shifts to Less Invasive and More Biological/Genetic Solutions

Neurosurgeons Focus On Brain Circuitry for New Therapies

Chang discusses new therapies focusing on brain circuitry and how this understanding could lead to treating diseases like glioblastoma as a chronic condition rather than a terminal one. For instance, he describes dissociation syndrome, which results from seizures rapidly spreading across the brain and indicates a need to control brain cell synchrony. Historically, the corpus callosomnium procedure disconnects brain hemispheres to stop seizure propagation, showing the emphasis on modifying brain circuitry to tackle such conditions.

Organoid Tech, Neural Engineering, and Gene Therapy May Regenerate Damaged Brain Tissue and Modulate Neural Function, Potentially Transforming Intractable Neurological Disease Treatment

Chang envisions a future where neurosurgery involves high-bandwidth wireless connections to brain circuitry and less invasive brain-computer interfaces (BCIs). He anticipates that advancements in organoid technology and genetics will provide better models for diseases and new approaches for treatments such as Parkinson's. Additionally, in the context of organoid advancement within UCFS trials, combining BCI systems with organoid technology for neurological disease treatment is anticipated.

Future Neurosurgery: A Multidisciplinary Approach Integrating Computer Science, Electrical Engineering, and Materials Science for Innovative, Personalized Solutions

Chang foresees a future where neurosurgery will incorporate disciplines like computer science, electrical engineering, materials science, and medicine. He mentions tha ...