The Latest Ways To Scan Your Brain! - Part 1 - Ben Brinkmann, Mayo Clinic, USA
Exciting neuroimaging techniques are getting out there to help more and more people become seizure-free. Hear more about the latest from Clinical Support Scientist, Ben Brinkmann.
Reported by Torie Robinson | Edited and produced by Pete Allen
Podcast:
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01:49 Benjamin Brinkmann
Hi, Torie. Thanks for having me today. This is great to talk to you. I'm a clinical support scientist with the epilepsy group at the Mayo Clinic. I do a bit of work with mostly our patients who are going towards surgery. These are the people who medications haven't worked for. And we're looking at trying to see if the seizures come from a focal part of the brain that can be surgically removed to make them seizure free; that’s the goal of course. I work with a number of different technologies in my job which is which is really fun and keeps it keeps it very interesting. So it's, and of course we you know people who come in for an epilepsy evaluation they get they get an EEG, they usually have an MRI, they'll get others other imaging tests as well, and I get to work with all of that data in one form or another and try to try to bring it together. We make a surgical plan about where we're going to put the invasive electrodes, hopefully we’ll capture a focal seizure onset and be able to help the person that way. And of course if surgery is not an option, if resecting that area, we've got neuromodulation options now as well that help neurostimulation.
02:02 Torie Robinson
And by patients who you're talking about, largely adults or children or both.
02:07 Benjamin Brinkmann
We see both, we see both, yeah, yeah. Yeah, both adults and children.
02:11 Torie Robinson
And what led you to this? Well, I know a little bit in advance. I remember I said, oh, I was going to ask you the question, what led you to the epilepsiesy? And you're like, yeah, it wasn't direct. But that's interesting. Tell us what happened.
02:22 Benjamin Brinkmann
Yeah, you know, in some ways it's just serendipity. You know, when I was in graduate school, there was a really interesting project on epilepsy imaging with SPECT imaging (nuclear medicine), which measures the blood flow during a seizure. And then you come back for a baseline scan when you're not having a seizure, and we look at the difference between those two scans. And that tells us a bit about where your seizures come from. That was my project when I went to graduate school. And it was very interesting. And, I don't know, I guess epilepsy just sort of stuck.
02:53 Torie Robinson
As awful as it is, it's horrifically interesting, right?
02:56 Benjamin Brinkmann
Oh, absolutely, absolutely. And it is such a difficult condition, and I don't know, maybe... there's so many resources going towards cancer and Alzheimer's and other diseases - which is great - but epilepsy really is, I think, a compelling condition, and we've gotta do more to help people.
03:16 Torie Robinson
Thank you very much, yes. And in the process, you're helping the people with the diagnosis, but also the people around them. A bit like the cancers, for instance, they affect the people that love the person with the diagnosis. And it's the same really for epilepsy.
03:28 Benjamin Brinkmann
Absolutely, absolutely. And so many people forget too, so many diseases that we focus on, they don't affect children or epilepsy affects children. So, someone with epilepsy could live a very long life with their seizures. And when you think about, you know, what can I do to improve someone's quality of life most? You know, catching them early and helping them early in life is tremendously impactful ang I guess I find that pretty meaningful.
03:59 Torie Robinson
You are involved in heaps of types of imaging. I've listed MRIs. Well, of course there are EEGs, but MRIs, PET scans, SPEC imaging, which you just mentioned, and you've done research into all of these, jumbled up and also separately. Can you tell us a little bit about that and what you've discovered and what you're focusing on right now?
04:14 Benjamin Brinkmann
My work has been, I jokingly say, it's been a little bit scatterbrained, and that's probably partly true, but it's all interesting. So, you know, a lot of the focus in the last few years of my research has been in EEG source imaging. So, you know, people come in and they get an EEG. You know, the great thing about EEG is it gives you very fast information. So it's, the temporal resolution is very quick, so you can see where the seizure starts. And of course when seizures begin, they often propagate very, very quickly. So if you look at the information, say, you know, five seconds after the start of the seizure, you may not be looking at the start. You may be looking at propagation, or, if you think of it as a row of dominoes, you know, you want to look at that, you want to know where that first domino is. You know, if you're looking at the tenth or the twentieth domino, you might still be able to help the person, but you've got a better chance with the first one.
05:15 Benjamin Brinkmann
So EEG source localisation, we look at the very, very early parts of a seizure, we can map that onto the MRI, and it gives us a good estimate of where the seizures are beginning. And of course, one of the things that EEG source imaging does a great job of is with interictal discharges. These are these little blips that go on in the brain that are characteristic of epilepsy, but aren't an actual seizure. You know, to our knowledge the have no real consequences, but, they can help us identify the part of the brain that's abnormal and that we need to focus on. And the great thing is you get, you know, you record someone's EEG, you get hundreds of these blips, you can data average them, you could get a tremendous signal to noise ratio, and it makes the whole process more accurate so you can see a little more clearly where those are coming from.
06:07 Torie Robinson
I'm imagining some sort of 3D fancy model combining all this information. Is that kind of what we're looking at here?
06:15 Benjamin Brinkmann
Absolutely, absolutely. Yeah, there's some cool software that can make a nice tiled model of the brain, and you can rotate it around and spin it. And actually, the thing that's most helpful, I think, is to scan through the slices. We impose it onto an MRI. Actually, in a number of patients just over the years doing this clinically, we've seen where the abnormal activity is coming from. We look back at the MRI, and we find, you know, actually there's something really subtle here that's not really normal. And our radiologists maybe will go back and take another look and say, gosh, there's, yeah, maybe there is a focal cortical dysplasia or some other abnormality here. And statistically, that's amazing news for the patient because if you can find an abnormality on MRI - something that's potentially causing their seizures - and you find a structural focus for that, their chances of being seizure freedom go way up. If it's in the temporal lobe it's something like 75 percent chance of seizure freedom long term and I think extra temporal. Out of the temporal lobes, it's something like 60 percent chance.
07:27 Torie Robinson
Amazing. So lots of people, and I've known people like this, still know people like this, who will say, I have no idea where my seizures originate from. I go and have my EEG showing nothing, nothing colorful, same with the MRI. Even though things have changed, improved over the past few years, still not showing anything. Would your type of work do you think benefit those type of people? Are we finding answers for more people like that now?
07:53 Benjamin Brinkmann
Definitely, definitely. And I think functional imaging is really making great strides and I have great hopes for it. So EEG source localisation, MEG, which is Magnetoencephalography, that's…
08:08 Torie Robinson
Fancy.
08:09 Benjamin Brinkmann
Yeah, very fancy, very cool technology. Again, it's a lot like EEG, but it's magnetic fields instead of the electrical fields. And why is that important? Well, the brains is… the brain and the skull and the scalp are mostly transparent to magnetic fields. So, a very small magnetic field emitted deep in the brain:you can see it with a good MEG system, whereas with an EEG system you might not be able to see it, it's attenuated, it might get, you know, the transmission can be a little bit different. So MEG can be very, very accurate at pinpointing those areas.
08:45 Torie Robinson
And even if you just, if anybody wants to see what they look like, well obviously they vary, but it's like having a big sort of… they remind me of those… what are those, hairdryer things you get in old salons, where people, I don't know, they have perms or something and it's like over your head, right?
09:01 Benjamin Brinkmann
Yes, yes. Exactly, exactly. Yes, yes. It does look like one of those big hair dryers. With liquid helium.
09:07 Torie Robinson
Hmm, slightly different! But I love what you were saying about how, you know, that there are limitations, for instance, especially with EEG, you can only go so far deep into the tissue, but this, you know, can go right, pretty much right the way through.
09:21 Benjamin Brinkmann
Yes, yes
09:23 Torie Robinson
Without harming.
09:24 Benjamin Brinkmann
Oh yeah, yeah, and this is just, this is a passive sensing technology. It's, you know, we always use the metaphor of microphones, right? You just have really sensitive microphones that are listening, except they're magnetic microphones or they're, with the EEG, they're electrical microphones, I guess. The other really interesting thing that's come out now, we've had one for a couple of years, but in structural imaging, 7-Tesla MRI. So it's a really high field strength. And you might say, well, why is that important? It's just an MRI, right? And it is. It is essentially the same technology as MRI, as conventional MRIs. But having that high field, what it does, it's a signal to noise question. If you think about tuning your radio and it's staticky, you can kind of make out what the person's saying. Maybe that's an old MRI system. 7-Tesla MRI, it gives you a more clear signal. So you have a lot more signal in the brain. So, you can trade that off. You can get to finer resolution, so you can tell the difference between very, very small structures in the brain. We have a number of cases where we've, we've looked at the person's 3-Tesla MRI and it's, we see some things and not really sure. And then we send them the 7-T and something pops out that we didn't see before.
10:49 Torie Robinson
7-T MRIs, are they common yet? Or are they only available in a few sort of fancy centres because they're expensive or whatever?
10:59 Benjamin Brinkmann
They're still only available at a few centres, but they're becoming more common. I think people are seeing the value of them, and I think they're only going to get more common. And I think that's a good thing. I think that's going to help people. It helps people with epilepsy, helps people with dementia, cancer, even musculoskeletal imaging. It can be really helpful there as well.
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Ben Brinkmann is associate professor of neurology and a clinical support scientist for the Division of Epilepsy at Mayo Clinic. This unique role as an engineer embedded in a clinical practice area allows him to help patients and informs the focus of his research. His research efforts are directed toward developing seizure detection and prediction capabilities using noninvasive and minimally invasive biosensors, and improving the accuracy of pre-surgical seizure evaluation using novel methods for image and neurophysiology analysis.
Ben has developed and implemented enterprisewide analytics supporting pre-surgical epilepsy evaluation and systems for statistical processing of ictal single-photon emission computerized tomography (SPECT) images. He has also used and applied methods to verify stereotactic electroencephalogram (EEG) electrode placement for patients with epilepsy.
Ben collaborates with the Bioelectronics Neurophysiology and Engineering Lab at Mayo Clinic.
Ben’s focus areas are:
Noninvasive wearable devices for seizure detection and forecasting
Machine-based learning and signal-processing methods for seizure forecasting using ambulatory intracranial EEG with applications to neuroimaging studies to identify abnormal and potentially epileptogenic brain regions
Detection, analysis and mapping of high-frequency oscillations from chronic and intraoperative intracranial EEG recordings
Ictal SPECT image processing and analysis in seizure localization
Voxel-based morphometric analysis of magnetic resonance imaging (MRI) for localization of structural abnormalities in epilepsy
Volumetric functional and structural image analysis
Significance to patient care
The goal of Ben’s research is to go beyond predicting the probable occurrence of a seizure to the actual delivery of therapy to prevent the seizure. These next-generation epilepsy management and therapy platforms will have an inestimable impact on the quality of life of patients with epilepsy. Prevention of seizures will allow patients to pursue normal activities of everyday life, such as driving. More importantly, it will counteract the comorbidities of epilepsy such as depression, impaired cognition, and sleep disturbances.
Professional highlights
Voting member, Working Group (WG)-32: Neurophysiology Data, Digital Imaging and Communications in Medicine, January 2020-current
President and CEO, 3D Medical Imaging, Inc., Byron, Minnesota, 2006-2015
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Twitter: BenHBrinkmann
LinkedIn: benbrinkmann
Mayo Clinic: brinkmann-benjamin-h
ResearchGate: Benjamin-Brinkmann
Google Scholar: https://scholar.google.com/citations?user=ax95gtwAAAAJ&hl=en
ILAE: benjamin-brinkmann
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