Decreasing Language Decline Caused By Epilepsy Surgery - Sjoerd Vos, UWA, WA, Australia
Physicist Sjoerd Vos shares his research in neuroimaging; aiming at decreasing language decline caused by temporal lobe resections!
Reported by Torie Robinson | Edited and produced by Carrot Cruncher Media.
Podcast
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00:00 Sjoerd Vos
We've done very well in trying to figure out what we think is causing language decline after a temporal epilepsy surgery - and that is 2 specific connections within the brain that connect different brain regions.00:13 Torie Robinson
Fellow homo sapiens! My name is Torie Robinson, and welcome to, or welcome back to: Epilepsy Sparks Insights.
Now, epilepsy surgery is outrageously underutilised as a tool for decreasing seizure frequency and severity (or even stopping the seizure entirely!), improving people’s quality of life, and reducing risk of injury and early death. It can be incredible - and I stand by that, myself, as someone who’s had most of their temporal sclerosis tissue removed! However, the surgery we are talking about today, a temporal lobe resection, commonly, can, negatively impact people’s memory. However (and gosh, talking about the epilepsies is full of “howevers”!), but also worth considering, just for perspective, is that if, as a result of the surgery, a person has fewer seizures and may be able to decrease their anti-seizure medications, then their cognitive function would be likely to improve (amongst many other things)!
Today, we hear from a physicist all about his research into temporal lobe resections and how we can potentially not just minimise the impact on a persons cognition, but also, potentially even improve it! May I introduce to you, Sjoerd Vos from WA, Australia!01:24 Sjoerd Vos
I'm Dutch originally, working in medical imaging field and MRI scanning specifically. After doing all my uni stuff in the Netherlands I moved to London where I came to work in epilepsy, and then after 8 years in London I moved to Perth in Australia not necessarily for the weather but it's a very, very good benefit to living here.01:47 Torie Robinson
Lovely when it's cool enough, but in summer can be challenging, right, in Perth?01:51 Sjoerd Vos
Definitely can, yeah, summers are hot, so the 40 degree days are a bit challenging. Luckily everything is inside and air conditioned and that helps a lot!02:01 Torie Robinson
Tell us what you do in neuroimaging, because I think lots of us, even some clinicians, no doubt, will think neuroimaging. OK, cool. So, maybe he goes and presses the buttons to do a couple of MRIs for patients or something. But there's way more to it. What do you do?02:17 Sjoerd Vos
With MRI scanning there is quite a lot of buttons to push and quite a lot of things to set up. So, that's what I work on, MRI scanning, so that can provide almost infinitely different contrasts and pictures of brain anatomy specifically or anywhere in the body. And my role as a researcher and as a physicist by training is really to set that up to get the best images that you can, in probably as short a scan time as you can - both for the institutions financially and for the patient experience. And that's… that is a lot of work to be honest. I think there's hundreds, thousands maybe, of researchers, trying to work on improving what scans we get from the brain, in a shorter scan time, all over the world. And over the time in London, I started working in epilepsy imaging. And that's kind of continued throughout in the last 10, probably 12 years since I started working in London. A lot of it is naturally, sort of, tying in with the clinical side to see what they currently do, clinically, to try and improve what that is.03:25 Torie Robinson
And so, just tell us a little bit about some of your research if you can.03:29 Sjoerd Vos
Yes, I've had the joy in London to work across a very broad range of epilepsy related topics. Most recently on a project funded by Epilepsy Research UK or Epilepsy Institute (now!); where we had funding between myself, John Duncan, and a few other people across the UK to hire a PhD student and do some research into trying to improve the outcomes of epilepsy surgery. So, when epilepsy doesn't get controlled with medication and if there's a one specific lesion or area within the brain what we know is causing that epilepsy, surgery can be an option to treat by surgically removing that part of the brain that's causing the seizures. Obviously, if you go into a surgery there's bits and pieces of the brain that you need to take out. But there's a lot of functions in the brain that you obviously don't want to disturb. And the project we had funding for was to try and reduce the amount of language damage or language decline that people undergoing the surgery would accrue because of the surgery. Language is already affected by…in people with temporal lobe epilepsy, so, if we could try and reduce how much damage we do with surgery, or even improve it…04:55 Torie Robinson
So, this was all temporal lobe epilepsy you were focusing on, was it?04:57 Sjoerd Vos
This was all temporal lobe epilepsy, correct, yeah. So, that was the aim of the project, and luckily with a great PhD student and a great team across all various sorts of specialties; from neurologists to surgeons to neuropsychologists (involved in the language testing and understanding), and imaging specialists, within the group; we’ve done very well in trying to figure out what we think is causing language decline after a temporal epilepsy surgery - and that is 2 specific connections within the brain that connect different brain regions across the longer distances within the brain and within the head. And those get…sometimes get damaged within surgery.05:48 Torie Robinson
Which regions are they?05:49 Sjoerd Vos
So, those are the inferior occipitofrontal fasciculus which connects the frontal and occipital lobes within the brain, so front to back primarily. And that is the medial longitudinal fasciculus which runs from the temporal lobe (which obviously is affected within TLE) to the occipital lobe as well. And they're at risk of damage from surgery. They don't get damaged in everyone that undergoes the surgery because everyone's brain anatomy is slightly different and the surgery for everyone is just slightly different based on natural factors. So, based on, I think, a cohort of 100 plus cases from London we managed to find out that there is a correlation between damage to these 2 structures and language outcome, and [a] prospective study to validate whether that actually can help people improve the surgery or it can help us improve the surgery for patients with epilepsy. That's still ongoing. I think the delays post-COVID are still affecting that - even these many years after the lockdowns and the pandemic, but that's ongoing still.07:02 Torie Robinson
What's benefits does what you have learned through this research…what has that brought or what shall that bring in terms of improving surgical outcomes, do you think? And has it already benefited patients or are we waiting and kind of until the end of the study?07:28 Sjoerd Vos
Having looked at some of the preliminary data (just as we go to make sure that we're doing what we planned on doing, reviewing it with the whole clinical team); I think that is looking promising in that so far the ratio of people having a language decline is lower in the prospective study of trying to validate this than it was before. Obviously, that could just be by luck because we haven't really gotten to the end stage of the study yet where, you know, it might average out over the 2, 3, 4 years that this study runs. But, hopefully that means that if it is the case, then the people who are part of the study will have that benefit already. And once that gets confirmed, hopefully(!), we can disseminate that and make sure that everyone else in the world and all their epilepsy centres can do that too.08:09 Torie Robinson
And I can say, as someone who has had temporal lobe section about, gosh, yeah, about 12 years ago, I do see even improvements today compared to way back. What would you say to people who say “Do know what? I'm going to kind of hang on for now. I'll see if things improve in the future.” - because lots of people are nervous about surgery too. What would you say to that?08:30 Sjoerd Vos
I can totally understand that. I've had enough operations all orthopedically to know it's not, it's never nice to have to go through. It's always worrisome for yourself and people close to you. I do think that the evidence in epilepsy is there that if you have the surgery earlier in your course of epilepsy or as early as is recommended; that does improve your outcomes. So, that's in part because, obviously, every seizure kind of has an impact on the brain and over time things get worse. I agree that technology and understanding does get better over time and in 5 years time we might have better treatments, either medications or other treatments, but I think from a surgery perspective, I think the literature is quite clear that the sooner the better.I've had really rewarding collaborations within London on epilepsy; partly with the clinical team and partly with the patient and sort of responses that I get at events like the Euro UK Grand Launches and everything that I've had with a variety of people that I think it's been a very rewarding field to work in and I'd love to rekindle that here in Australia.
So, currently, I work in an imaging centre that's generally doing all kinds of research on MRI scanning and medical imaging with very little epilepsy research happening with MRI scans (there’s a lot of clinical-based population studies and medication studies that I wouldn't necessarily be involved in [though]). But I'd love to get back into that more. I think there’s so much to do, yet partly the research community, like having so much interaction and conferences and meetings. It's a very inspiring and fun field to work in. So, that would my prime aim over the coming months, having been here a few years now.10:33 Torie Robinson
Well, there's the Australian Epilepsy Project, right, which is coming over to Perth.10:37 Sjoerd Vos
That's right, that's a very big study led from the Florey Institute in Melbourne. They are currently rolling it out across the whole country and we're in discussions with how to set that up here. There's a few practical and technical aspects to tackle but, hopefully, we can get that sorted before the end of the year and contribute to their amazing research.10:58 Torie Robinson
Huge thanks to Sjoerd for the reassurance that researchers and clinicians see the importance of cognitive function to people’s quality of life, sharing with us his cool research, and giving us something to be excited about for people who have a temporal lobe resection in the future.
Do check out Sjoerd’s papers and more about his work on the website torierobinson.com (where you can also access the podcast, the video, and transcription of this episode), and if you haven’t already, please don’t forget to like, comment, and subscribe to this channel, and share this episode with your friends/family/colleagues - whoever it might be. See you next week! -
Sjoerd Vos is a Senior Research Fellow at the University of Western Australia, where he is the National Imaging Facility (NIF) Fellow overseeing the new 3T human MRI scanner that is being installed in the Western Australian NIF node. This new scanner is the only research-dedicated MRI scanner in WA, and intended to facilitate high-end in vivo human imaging for the state.
Sjoerd graduated from the VU University Amsterdam with a BSc and MSc in Medical Physics, before beginning a PhD in diffusion MRI at the Image Sciences Institute at the University Medical Center Utrecht, also in the Netherlands. Upon completion, Sjoerd joined University College London (UCL) in March 2014, working between UCL’s Centre for Medical Image Computing (CMIC) and the epilepsy imaging group. In September 2019, he started as lecturer in Quantitative Neuroradiology, with a joint appointment between CMIC and the Neuroradiology department at Queen Square where he worked on integrating quantitative neuroimaging techniques into routine radiological practice. This resulted in integrating quantitative imaging and analyses in dementia diagnosis and, for epilepsy, hippocampal lesion detection and characterisation. His ongoing collaborations with UCL involve improved surgical planning for epilepsy surgery using white matter fibre tractography, and automated image quality control of neuroimaging data.
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