Research

The Cancer Treatment Within You

Posted on Nov 20, 2019 in Affiliates, California Pacific Medical Center, Expanding Access, People, Quality, Research, Scroll Images, Sutter Medical Center, Sacramento, Transformation

How blood, urine and gene mutations may unlock secrets to lung cancer treatment options.

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When Online Matchmaking and Cancer Treatment Collide

Posted on Nov 19, 2019 in Affiliates, Expanding Access, Innovation, Quality, Research, Scroll Images, Transformation

More than 600 types of drugs exist to treat cancer. A new tool will help doctors supercharge their searches for the ones that will work best for their patients.

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Quelling the storms of seizures in people with epilepsy: Part 2 of a series highlighting Sutter epilepsy research

Posted on Nov 13, 2019 in Affiliates, California Pacific Medical Center, Innovation, Mills-Peninsula Health Services, Neuroscience, Quality, Research, Scroll Images, Uncategorized

Epilepsy—a neurological disorder caused by abnormal electrical activity in the brain—impacts almost 3.4 million nationwide. Despite advances in epilepsy treatment, approximately one-third of adults with the illness experience recurrent seizures. Read more to learn how Sutter researchers are uncovering new clues about how epilepsy develops and how it can be treated more effectively.

Stimulating the brain with neuromodulation

“Neuromodulation” is a technique that stimulates the brain or spinal cord with electrical pulses or chemicals. When used to treat epilepsy, the approach may be used as an alternative to traditional epilepsy surgical approaches or to work in synergy with them.

David King-Stephens, M.D., FAAN, Director of the Sutter Pacific Epilepsy Program in San Francisco, and Peter Weber, M.D., the program’s surgical director, were instrumental in the testing and U.S. Food and Drug Administration (FDA)’s approval in 2013 of one type of neuromodulation, the Responsive Neuromodulation System® (RNS) developed by NeuroPace.

Similar to a pacemaker that monitors and responds to heart rhythms, the RNS® System is a medical device implanted in the skull that monitors and responds to brain activity to help prevent seizures. The device is approximately the size of a stopwatch.    

CPMC was the highest enrolling site in the RNS® System Pivotal Study—a national, multicenter clinical trial of the RNS® System for the treatment of uncontrolled seizures in adults with epilepsy.

Peter Weber, MD“Many patients experience a 70-80% reduction in seizure frequency, and the severity of seizures is also significantly reduced,” says Dr. Weber, lead neurosurgeon at Sutter for the RNS® System clinical trial. He notes that the RNS® System plus medication-based treatment is usually, for these patients, superior to standard medical management alone.

Now, nine-years after completion of the pivotal study, follow-up data is still being collected and assessed. “Results show that, for many patients, the RNS® System led to substantial reductions in seizures, with additional benefits such as improved quality of life, cognition, and memory,” says Dr. Weber.  The RNS® System is also now available at the Sutter Sacramento Epilepsy Center.

Targeting the epicenter of epileptic seizures

To understand the nuances of a seizure, researchers study the brain cells (neurons) that misfire and cause the underlying electrical storm. When a seizure occurs, networks of brain cells involved in the seizure begin pulsing abnormally, leading to the symptoms patients experience during a seizure.

Anti-epileptic drugs (AEDs) are designed to modify the way neurons “fire” and how they communicate with each other and the brain’s network, thereby stopping or preventing seizures. AEDs are categorized by their main mechanism of action, although many of them have several actions and others have unknown mechanisms of action. Most of these medications are anticonvulsants or sedative medications.

There is currently no FDA-approved AED that targets potassium channels that help regulate the communications between neurons involved in the cascade of synaptic events that promote seizures.

A randomized, double-blind, placebo-controlled clinical trial called Xenon 1101, sponsored by Xenon Pharmaceuticals, is underway to test a new anticonvulsant that acts on potassium voltage-gated channels.

“The potassium channel is a novel area of epilepsy study and one that offers potential to prevent seizures through agents that target it,” says Dr. Laxer, principal investigator of the trial at CPMC with co-investigator Dr. King-Stephens. “Our epilepsy program is the only center in Northern California evaluating this new anticonvulsant.”

Three hundred patients will be enrolled in the Xenon clinical trial from enrolling sites across the U.S., Canada, Spain, and the UK.

Stay tuned later this month for Part 3 of this series on Sutter epilepsy research, which will include information on laser ablation surgery.

Read Part 1, which described new ways to map and monitor brain activity in people with epilepsy.

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Quelling the Storms of Seizures in People with Epilepsy

Posted on Nov 1, 2019 in Affiliates, California Pacific Medical Center, Innovation, Neuroscience, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento, Transformation, Uncategorized

SAN FRANCISCO, Calif. – An electrical “storm” in the brain causes seizures in people with epilepsy, producing symptoms that may include lapses in consciousness, twitching or jerking movements, weakened or limp muscles, spasms, blurred vision, experiencing unusual smells or tastes, and changes in sensation or emotions.

Epilepsy—a neurological disorder caused by abnormal electrical activity in the brain—impacts almost 3.4 million nationwide.1 Despite advances in epilepsy treatment, approximately one-third of adults with the illness experience recurrent seizures.2

Epileptic seizures are generally categorized into three main groups: generalized (affecting both sides of the brain), focal (seizures that start in one area of the brain), and those that could start anywhere.

The stormy weather of seizures can clear with medications called anti-epileptic drugs (AEDs). AEDs can to stop seizures from occurring, but they do not always lead to a remission or cure epilepsy. With the right AEDs, up to 70% of people with the illness may remain seizure-free, and sometimes may “outgrow” seizures or go into remission. For other people whose seizures are uncontrolled with conventional AEDs, other treatments including surgery may be an option. Surgery may involve removing part of the brain that causes the seizures.

Michael Chez, MD

“Knowing where seizures start in the brain provides us clues into what occurs during a seizure, what other conditions or symptoms may be seen, how they may affect someone and, most importantly, what treatment may be best for that seizure type,” says Michael Chez, M.D., a pediatric neurologist and epileptologist, and Sacramento regional director of pediatric epilepsy and research at the Sutter Neuroscience Institute.

“Life without seizures and improved quality of life is what specialists aim to provide epilepsy patients, through a treatment plan personalized to their particular type of epilepsy and seizures,” says Dr. Chez.

Two Sutter hospitals, California Pacific Medical Center and Sutter Medical Center, Sacramento are renowned for providing patients specialized Level 4 epilepsy care— a designation by the National Association of Epilepsy Centers—guided by leading-edge research. Sutter researchers are uncovering new clues about how epilepsy develops and how it can be treated more effectively.

Sutter examining new ways to ‘map’ and monitor brain activity

Epilepsy is usually diagnosed with magnetic resonance imaging (MRI) and electroencephalogram (EEG) testing. Those techniques are also used to regularly monitor brain activity in people with the illness. Sutter researchers are studying the use of novel neuroimaging techniques to visualize and track the brain’s electrical activity in people with epilepsy.

For patients with refractory epilepsy (in whom medications are not adequately controlling seizures), a new “high-density” EEG machine is being tested to locate precisely where a patient’s seizures originate in the brain.

“Use of these high-density or high-array EEG machines can help dramatically accelerate research and patient care by identifying the focal point of a seizure,” says Kenneth Laxer, M.D. a researcher in the Sutter Pacific Epilepsy Program at Sutter’s California Pacific Medical Center (CPMC).

With more than 40 years’ experience in epilepsy research, Dr. Laxer is renowned for studying neuroimaging techniques including magnetic resonance spectroscopy for the evaluation and management of the illness. With high-density EEGs, the patient wears a net over their head, and the brain’s electrical activity is recorded from 250-plus electrodes. The recordings are combined with the patient’s own high-resolution MRI scan to help localize the seizure focus. Surgeons use these precise images to remove the section of the brain that’s causing the seizures.

“If we pinpoint that abnormal area, we can remove a smaller portion of the abnormal brain tissue and therefore decrease the risk of serious complications from the surgery,” says Dr. Laxer. He notes that 50-70% of patients who undergo a focal resection may become seizure free. “Most of these patients remain on seizure medications, frequently at reduced dosages; however, the goal of surgery is to bring the epilepsy under control—not to stop epilepsy medication use. Patients who undergo such surgeries typically experience improved quality of life.” Stay tuned later this month for Part 2 of this series on Sutter epilepsy research, which will include information on neuromodulation and anti-epileptic medications.

Stay tuned later this month for Part 2 of this series describing epilepsy research at Sutter.

References: 1. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/about/fast-facts.htm 2. Epilepsy Foundation. https://www.epilepsy.com/learn/types-seizures/refractory-seizures SAN .

Lucky Landing: Mobile Stroke Unit Treats Traveler at SFO

Posted on Oct 28, 2019 in Expanding Access, Innovation, Mills-Peninsula Health Services, Neuroscience, Quality, Research, Scroll Images, Uncategorized

BURLINGAME, Calif. – It was a 9-1-1 response three years  in the making.

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Sutter Research: Advancing Care for Patients with Breast Cancer

Posted on Oct 21, 2019 in Affiliates, Alta Bates Summit Medical Center, California Pacific Medical Center, Expanding Access, Innovation, Memorial Medical Center, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Quality, Research, Scroll Images, Sutter Medical Center, Sacramento, Transformation, Women's Services

SAN FRANCISCO, Calif. – Breast cancer research has the potential to improve cancer care for the 3.8 million American women living with the illness. Recognizing Breast Cancer Awareness Month, we’re highlighting the bold science and game-changing breast cancer research at Sutter. This work can help advance knowledge of how to detect and treat the illness.

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