CIMIT Stories: People

CIMIT Creates Climate of Collaboration for
Drs. Schachter, Guttag on Epilepsy Therapy

When Steven Schachter, MD, speaks on the disabling aspects of epilepsy, he sometimes shows a compelling video depicting a patient in the midst of a seizure. You can hear a pin drop as the audience uncomfortably watches an engaging, vibrant 30-something lose body control. The presentation is unsettling, especially when the man’s upper body rotates unnaturally and he eventually must be helped to the floor.

It is this disabling condition that Dr. Schachter, a doctor, researcher and authority on epilepsy, and colleague John Guttag, PhD, a professor and computer scientist, are focusing on as they work to discover better methods of treatment. They are passionate about using technology to provide innovative solutions, and have worked closely with CIMIT to advance their research.

Much of their story revolves around how they began their partnership. One of CIMIT’s great strengths is putting together motivated researchers who can complement each other, and this certainly has been the case with Steve Schachter and John Guttag.

Dr. Schachter is an epilepsy clinician at Beth Israel Deaconess Medical Center and a professor of neurology at Harvard Medical School. Dr. Guttag is a computer scientist and a professor at MIT.

Though only two miles separate BIDMC and MIT, the two institutions are worlds apart. CIMIT proved to be the meeting ground where these two energetic scientists began discussing a technology that could prove to be larger than the sum of its parts – and a promising technology for patients.

Scientists meet at a CIMIT Forum

Dr. Guttag was known to CIMIT through his work using machine learning to build patient-specific seizure-onset detectors. He and a PhD student, Ali Shoeb, had developed software, based on machine-learning technology, to which recordings of seizure activity were compared to normal brain activity.

CIMIT officials who thought the interests of Dr. Guttag and Dr. Schachter might coincide introduced the two at a CIMIT Forum, the weekly Tuesday afternoon event that brings doctors, scientists and engineers together to network and share information. Dr. Schachter is an expert in the treatment of epilepsy, and was interesting in exploring the use of a vagus nerve stimulator implant located under the collarbone. It soon became evident that the number-crunching ability of Dr. Guttag could play a meaningful role in his research.

Vagus nerve stimulation (VNS) is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. These pulses are supplied by a device something like a pacemaker. The VNS unit is sometimes referred to as a "pacemaker for the brain." It is placed under the skin on the chest wall and a wire runs from it to the vagus nerve in the neck. The vagus nerve is part of the autonomic nervous system, which controls functions of the body that are not under voluntary control, such as the heart rate. The vagus nerve passes through the neck as it travels between the chest and abdomen and the lower part of the brain.

The surgeon first makes an incision along the outer side of the chest on the left side, and the device is implanted under the skin. Then a second incision is made horizontally in the lower neck, along a crease of skin, and the wire from the stimulator is wound around the vagus nerve in the left side of the neck. The brain itself is not involved in the surgery. The device (also called an implant) is a flat, round battery, about the size of a silver dollar - that is, about an inch and a half (4 cm) across - and 10 to 13 millimeters thick. Newer models may be somewhat smaller.

The neurologist programs the strength and timing of the impulses according to each patient's individual needs. The settings can be programmed and changed without entering the body, just by using a programming wand connected to a laptop computer. The two scientists thought that by combining Dr. Schachter’s knowledge of epilepsy with Dr. Guttag’s expertise in algorithms, a new approach might be developed that could alert vulnerable patients to imminent episodes.

CIMIT provided support

The pair put together a grant proposal, and received CIMIT funding to validate the algorithm Guttag had developed. By applying it to prerecorded digital seizures with a view toward building a closed-loop system in which once a seizure was detected, it would trigger a treatment designed to abort the seizures. Their research has great potential for epileptics whose conditions cannot be treated by drugs. And since epilepsy affects close to 50 million worldwide, their work has the potential to help a great many people. Their basic research has gone so well that they have been seeking a partner to do hardware development and patients who could enter human trials.

Dr. Guttag credits CIMIT for funding their concept early in the process. “When I started,” Dr. Guttag said, “I had absolutely no track record in the medical area, so I would have had no shot at getting NIH money. They don’t fund engineers or computer scientists with no track record. So CIMIT took a real chance on me. No other external source would have stepped up at that point in my career.”

Dr. Schachter is program leader for CIMIT’s Neurotechnology Program, and has written a series of books on epilepsy called “Brainstorms.” He is in close contact with many patients and their families, and this research is an inspiring example of his drive to provide more effective care.

He said that CIMIT was the crucial component in moving his research forward, for without Dr. Guttag he might not have reached this point of development.

“The treatment I had in mind was the vagus nerve stimulator,” said Dr. Schachter. “We hope it can be successfully connected to Dr. Guttag’s innovative testing on identifying the earliest moments of a seizure. If that happened, an effective therapy will be possible where it never was before. And that could be of great help to many patients.”