Patient-specific modeling and network perturbation to enhance the predictability of direct cortical stimulation for epilepsy

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PROJECT SUMMARY/ABSTRACT Direct cortical stimulation of the brain is used to treat epilepsy and map brain function during surgery. Yet few patients are free of seizures with this treatment, and morbidity occurs despite ostensibly adequate mapping. When cortical stimulation is used, it is assumed that the area nearby the electrode, within a few centimeters, is most affected. But our prior work shows that stimulation evokes widespread effects in distant regions of the brain. Understanding these network effects will be key in improving our use of brain stimulation. Using patients with electrodes implanted in the brain for epilepsy treatment, I will investigate cortical stimulation by 1) using resting-state functional connectivity to predict evoked potential characteristics, 2) using detailed computer models of patient brains to predict the responses of stimulation, and 3) correlating the networks activated by stimulation with patient outcomes following NeuroPace Responsive Neurostimulator placement. I am a practicing neurosurgeon and neuroscientist with a career devoted to understanding electrical stimulation of the brain. I was trained as a computer scientist and have relied heavily on this skillset during my PhD and post-doctoral training. For my PhD, I designed the hardware and software for a closed-loop neurostimulator, and applied this system to epilepsy research. During my post-doc and residency in neurosurgery, I studied the basis of electrical stimulation mapping using high-density electrocorticography. While in industry, I worked as lead software engineer for a company designing closed-loop stimulation/recording technology for multielectrode arrays. Now, as a functional neurosurgeon, I use multielectrode stimulation and recording daily in my patients. Network imaging and computer modeling of stimulation will provide new ways to understand and restore brain function. Such modeling goes beyond the empirical data that most researchers collect, and that most of my prior research has focused on. To develop these models, I will work with an expert in neuromodulation modeling, Dr. Christopher Butson, at the University of Utah. I will acquire these skills through hands-on training, didactic coursework, and intensive mentoring. At the end of my training, my hope is to create an independent research program to further link brain stimulation with an understanding of brain networks, and use these insights to improve the safety and efficacy of the direct cortical stimulation I use in my patients.