Epilepsy: Making Diagnoses More Precise! - Mastaneh Torkamani Azar, University of Eastern Finland
Learn about some cool research into focal, drug-resistant epilepsy - using brain tissue itself - in Finland! We hear how special extra-accurate MRIs (11.7 Tesla!) are used for ex-vivo experiments… (they aren’t used in-vivo and are not (yet!) being used like regular MRIs for human bodies) - all with Post-doc Researcher Mastaneh Torkamani Azar! Transcription and links to Mastaneh below! 👇🏻
Reported by Torie Robinson | Edited and produced by Carrot Cruncher Media.
Podcast
-
00:00 Mastaneh Torkamani-Azar
“This kind of microscale imaging can actually show you more details about the tissue that can potentially also improve the precision of our diagnosis.”
00:09 Torie Robinson
Fellow homo sapiens, my name is Torie Robinson, and welcome to, or welcome back to Epilepsy Sparks Insights. If you're new and you haven't done so already, please do like and comment on this episode, and subscribe to our channel, so to support our mission to decrease the discrimination faced by, and improve the quality of life of those affected by the epilepsies. And actually, also, get everybody appreciating the amazing epilepsy research that is out there!
Now today we hear about some core research into focal drug resistant epilepsy using brain tissue itself in Finland. We hear how special extra-accurate MRIs (11.7 Tesla!) are used for ex vivo experiments—they aren't used in vivo, and are not yet being used for regular MRIs for human bodies—all with postdoc researcher Mastaneh Torkamani-Azar.
00:57 Mastaneh Torkamani Azar
My name is Mastaneh Torkamani Azar, and I'm currently working as a postdoctoral researcher at the A.I. Virtanen Institute at the University of Eastern Finland in Kuopio. My background is actually, so it has been related to electronics engineering, but then at the same time—so, almost all of my research was basically concerned with bio signals or bio signal processing, for example…
01:19 Torie Robinson
Mm-hmm.
01:20 Mastaneh Torkamani Azar
…EEG, ECG, ENG, etc. But then, well, especially, actually, so here for the past maybe 2 and a half years, I have been involved in a huge and exciting project - basically a huge consortium - that has been going on between the Kuopio University Hospital, basically the Kuopio Epilepsy Centre, as well as the neurosurgery [and the] imaging centres. And so actually yes, we do basically focus on the special case of patients who have focal drug resistant epilepsy. The title of this project is Multi-Scale Assessment of Epileptogenicity in the Human Brain for Better Diagnosis and Treatment of Drug Refractory Epilepsy. And the project is basically funded by the Jane and Aatos Erkko Foundation in Finland.
02:01 Torie Robinson
There are so many things in epilepsy that you could focus on. Why this?
02:15 Mastaneh Torkamani Azar
Great question. So actually, the thing is that of course the statistics are different, but then, it is actually estimated that something between 25 up to 30% of the patients with epilepsy may basically, actually demonstrate signs of drug resistance.
02:31 Torie Robinson
And how many people are involved in this project, and are you still looking for participants?
02:37 Mastaneh Torkamani Azar
Currently in the research team, we have more than 25 basic researchers as well as clinicians, and of course the interactive and neurosurgery team. So, this is a huge group effort that's actually going on. So far, basically, we have had something around 24 or maybe 25 actually patients. And then yes, of course, at the same time, the recruitment of the patient is actually going on, of course, depending on the pre-surgical evaluation giving us the green light, to basically go with this patient.
03:08 Torie Robinson
So far in the study, have there been any sort of results? I know you're halfway through it, or you're only part of the way through it, but are there any indications or discoveries made so far?
03:18 Mastaneh Torkamani Azar
Yes. One of our main goals, actually in this project was to basically improve the precision as well as the specificity of the presurgical... So, the neuroimaging techniques. And so then, because of that, we have been successful in basically developing, as well as actually validating extensive sequences. So far, we have been able to basically develop and then also validate a special algorithms for the MRI acquisition - that we actually call them the research sequence - which are not only limited to the structural MRI, but then also to the raft board and break multidimensional actually, so diffusion MRI. But then that is only the presurgical! After the surgery, when these actually tiny basically tissues have been resected, which are usually from the cortex, sometimes hippocampus, amygdala, sometimes also tumour, we basically immediately actually transfer them, you know, and go to our labs. After that, these tissues are actually dissected and then distributed between the different research groups.
04:25 Torie Robinson
All these research groups, are they within the same building or are they...
04:28 Mastaneh Torkamani Azar
Within the same building. Yes, same building.
04:30 Torie Robinson
I was going to say, it's not like you can slide over to Paris or something, right?!
04:32 Mastaneh Torkamani Azar
Exactly! So, because of that, we actually then record electrophysiological recordings, you know for example, using patch clamp as well as the tiny microelectrode array. And then, well, at the same time, basically some of those tissues are also being utilised, for example, in the case of the genetic studies, you know, like a sequencing, for example, the different protocols. We also have microscale imaging, using the MRI scanners, which actually have the field strength of 11.7 Tesla, which gives you amazing detail.
05:06 Torie Robinson
Compare 11.5 Tesla to a regular MRI. So, can you tell us that?
05:11 Mastaneh Torkamani Azar
At the basic, most of the clinical centres, hospitals, for example, around the world, you know, so usually they're using the 3 Tesla MRI, which is kind of the standard basically clinical use, you know.
05:22 Torie Robinson
And if they're old MRI machines, they're often less.
05:24 Mastaneh Torkamani Azar
It would be, for example, like a 1.5 Tesla.
05:26 Torie Robinson
Yes, I've seen ones that are 1.5, 2…
05:28 Mastaneh Torkamani Azar
Yes.
05:29 Torie Robinson
What are the discoveries?
05:30 Mastaneh Torkamani Azar
So, after the MRI, we are also actually, like, performing histopathology. So then, for example, the tissues, they're being actually stained, and then after that, for example, scanned using the brightfield microscopy as well as with the electron microscopy.
05:45 Torie Robinson
Because you see these beautiful pictures of neurons and stuff. Can you just tell us about that?
05:50 Mastaneh Torkamani Azar
In the case of drug resistant epilepsies, you know, so actually then maybe for example, some of the most common findings are, for example, the case of hippocampal sclerosis, you know, but as well as maybe, for example, focal cortical dysplasia, etc. And so, actually, each of these basically disorders, they actually affect the shape as well as the structure.
06:11 Torie Robinson
The shape of the tissue as a whole or of the neurons, or the cells.
06:16 Mastaneh Torkamani Azar
The shape of the neurons, the glial cell, and astrocytes, you know. And so, because of that, our multi-scale actually imaging allows us to actually visualise these differences in the shapes, numbers, as well as the distribution of these actually neuronal cells in the tissues that have been resected.
06:35 Mastaneh Torkamani Azar
Yes. What we're actually going to do is to basically help the clinical decision making at the end, so that we basically use all of these findings, looking at the molecular level, electrophysiological level, structural level, and basically return this knowledge to the beginning of the pipeline to help the clinical decision makers.
06:56 Torie Robinson
And have you collected and analysed enough data, where you are able to already do this? Give useful tips to clinicians?
07:03 Mastaneh Torkamani Azar
So far, we have had, for example, something around like 24 to 25 patients, but then one of the challenges is that we have had so much heterogeneity in the data set, so the meaning that there have been different actually types of diagnosis. That's of course actually challenging in case of the data analysis, but at the same time, we're actually trying to basically perform personalised analysis of the data. So, we basically look at each individual, as a whole, the whole story coming from the patient history, as well as the presurgical evaluation and level, of course, all of these post-surgical findings. We have started that, of course, so then, for example, this kind of analyses is a bit easier, in the case of patients who may have been diagnosed with different types of, for example, hippocampal sclerosis.
07:53 Torie Robinson
Very common.
07:54 Mastaneh Torkamani Azar
Very, very common, exactly. But then, we have also had some cases, for example, who may have some of these tumour-related malformations. In those cases, of course, it's a bit difficult because of the multi-factorial nature of these diseases. Something that I would like to emphasise, one of the actually delicate developments in the past 2 years, was basically developing a very basically concise research data management system, or RDM.
08:23 Torie Robinson
Okay, and why is that important?
08:24 Mastaneh Torkamani Azar
So, usually, each of these, for example, clinical centres, or for example, like, the research labs, they may be doing their data acquisition, analysis, and processing in isolation. But in our project, we would like to actually integrate all of this data and essentially all of this knowledge together to basically actually then perform this kind of the holistic multimodal approach. This kind of approach would allow clinicians at the end, to have basically a quicker, and then at the same time, a more precise actually, clinical process.
08:56 Torie Robinson
Ahhhh.
08:57 Mastaneh Torkamani Azar
If we can actually improve the precision of this diagnosis, and then at the same time try to actually speed up the timeline from diagnosis of drug resistance up to the epilepsy surgery, that would be a huge contribution to the xx.
9:11 Torie Robinson
What are the potential benefits of your work to quality of life? Because people think of epilepsy, they think of seizures, but it's far more than that. So, what do you anticipate or even observe already the benefits of your study to the quality of life of people with epilepsy and even their families, you know?
09:30 Mastaneh Torkamani Azar
Patients are being treated with a different kind of anti-seizure medications - it could sometimes actually also have some adverse consequences, for example, on the cognition of these patients. And so because of that, if we can actually try to predict, that if an individual is actually going to be drug-responsive or maybe drug-resistant, earlier, actually during the treatment, then we can, of course reduce all of these adverse effects, and then we'll hopefully also contribute to the increased quality of life. We're actually improving the pre-surgical neuroimaging detection techniques. And then, well also actually, for example, try to basically, so, actually, then we use the current findings from the project - which are going to be published soon - exciting news, of course, to basically actually understand that how all of these kind of the microscale imaging a structural or findings are actually going to contribute to our initial diagnosis of the epilepsy syndromes or their correct classifications.
10:36 Torie Robinson
Thank you so much to Mastaneh for sharing her cool work using extra accurate MRIs 11.7 Tesla, the value of human tissue for research, and how this is also helping improve diagnosis in people with an epilepsy. Check out more about Mastaneh and her research on the website torierobinson.com, where you can also access the podcast, the video, and the transcription of this episode all in one place. And if you haven't already, don't forget to like, comment and subscribe to the channel and share this episode with your friends, colleagues, family members, universities, schools, people in the shop(!), whoever, because this all supports our mission to decrease the discrimination faced by, and improve the quality of life of those affected by the epilepsy, and also get everybody appreciating the incredibly cool epilepsy research out there. See you next week.
-
Interested in the main theme of mental state monitoring, Mastaneh explores neuroscience from the perspective of directing and maintaining attention during various mental workload situations with the aim of improving the quality of brain-computer interfacing (BCI) by adapting the system to the users’ underlying cognitive states. For this end, she designs and conducts behavioural studies and EEG recording sessions and utilise temporal, spatial, and spectral signal analysis, statistical signal processing, and pattern recognition on electrophysiological recordings.
Mastaneh’s other field of research is related to characterising affective responses and neural correlates of emotional word processing from English and Turkish texts. Besides applying statistical signal processing techniques on EEG data recorded by myself in our lab, she supervised a senior design project which resulted in development of a Turkish affective norms list with valence and arousal ratings from a homogeneous group of young, native Turkish speakers. -
-
Jane and Aatos Erkko Foundation 15-meu-funding-for-development-of-treatment-for-drug-resistant-epilepsy