• Akhil Surapaneni: Advancing Brain Tumor Treatments

For patients who undergo surgery to remove brain tumors, long-term impacts can include a loss of abilities that help them live meaningful lives.

Akhil Surapaneni, a fourth-year student at Dell Medical School, has helped care for patients with brain tumors through clinical rotations, while also investigating novel therapies to restore their functional abilities. When he graduates in 2025, he will have earned both an M.D. from Dell Med and a Ph.D. in biomedical engineering.

Portrait of Akhil Surapaneni.

Akhil Surapaneni, fourth-year student at Dell Med.

‘Disability & Devastation’

Glioblastoma, a brain cancer that is among the deadliest known cancers, has a median survival rate of 15 months that has only improved by five months in the last 50 years. In Surapaneni’s words, glioblastoma hijacks neural networks “as if disability and devastation are baked into its molecular essence.”

“Patients with gliomas are disproportionately affected by neurological deficits and psychiatric diseases,” Surapaneni says. “Tumors in important functional areas are also commonly unremovable through surgery, ordinarily one of the most potent weapons in our arsenal of treatments.”

Currently, neuro-oncology measures patient outcomes by examining the probability of survival at certain time intervals. Surapaneni says that this model doesn’t include factors that are central to patients’ quality of life, like motor function, language ability, cognitive ability and mood.

Maximizing Treatment, Minimizing Deficit

When on a clinical rotation helping to care for a young patient with a tumor affecting language abilities, Surapaneni realized how he wanted to move forward in his career:

“My goal for my Ph.D. is to combine brain-computer interfaces and neuromodulation to transfer functional ability stored in brain regions affected by tumors to non-affected regions prior to surgery,” Surapaneni says. “This will allow the surgeon to maximize tumor removal while minimizing the patient’s neurological deficit.”

Surapaneni is a part of a larger team of doctors, engineers and scientists at The University of Texas at Austin conducting a study investigating how to move critical brain functions away from surgical sites. This approach has the potential to improve overall survival for patients afflicted by brain tumors. It also promises patients a higher quality of life by retaining their ability to pursue meaningful activities that sustain their well-being, such as their hobbies, work, travel and interactions with family and friends.

“I am fortunate to be advised by faculty who are leading experts in brain-computer interfaces, neurosurgery, glioma biology and more,” Surapaneni says. “We have established a collaboration with neurosurgeons, neurologists and scientists that spans across the globe, and more importantly, everyone involved in this project is very passionate about it.”

Redefining What It Means to Be ‘Okay’

Surapaneni recalls speaking to the young patient before his surgery. The patient asked, “After the procedure, am I going to be okay? Like really okay?” The type of brain tumor he had — one that pressed into the language area of his brain — indicated decades of survival. However, the question probed beyond survivability.

“Would he lose his speech due to tumor growth or treatment? Would he still be able to live a meaningful life with this disease? That’s what he really wanted to know,” Surapaneni says. “Although I didn’t have an answer for those questions at the time, I hope to develop clinical and scientific knowledge to reply with, ‘Yes, you’ll still be able to do the things you love.’”


This news feature is part of Dell Med’s Voices, a series of profiles that highlight the people of Dell Med as they work to improve health with a unique focus on our community.

Original article

• CNBI Featured in What Starts Here campaign

The 2022 What Starts Here campaign highlights the TX Robotic collaboration between students and Faculty from Rehabilitation and Neuromuscular Robotics (ReNeu) and Clinical Neuroprosthetics & Brain Interaction (CNBI) labs.

WhatStartsHere

This is our moment. The University of Texas at Austin can become the world’s highest-impact public research university, unleashing knowledge, opportunity and innovation from the heart of Texas.

That’s why we’re undertaking the What Starts Here campaign: the biggest and boldest fundraising effort in university and state history.

Every gift supports the UT people, places and pursuits changing the world.

• Researchers at UT’s Dell Medical School Are Using Virtual Reality and Video Games to Help Teens With Epilepsy

Each year, around 4,000 Americans undergo surgery to treat epileptic seizures. The procedure typically involves excising a small portion of the patient’s brain where the seizures originate, and is considered a treatment of last resort due to its tendency to result in disability. But for these epileptic patients, it is also a lifeline. Their seizures often strike without warning and may occur several times per day. The rapid onset and loss of control associated with seizures pose a danger to themselves and others, which places the most mundane tasks of daily life—cooking dinner, driving a car, holding a job—out of reach. Some patients never fully recover the lost motor or cognitive skills that result from the surgery, while others slowly regain function through years of intensive rehab. But for many, it’s worth the risk.

In 2021, a multidisciplinary team of researchers from UT’s Dell Medical School received a $2.5 million grant from the Coleman Fung Foundation to explore how virtual reality and video games can be used to dramatically accelerate the recovery process for young adults about to undergo surgery for epileptic seizures. It’s an ambitious project aiming for nothing short of a medical breakthrough. If successful, it would represent the first time in the history of neurological medicine that epileptic patients could rewire their brains before they were damaged.

That patients can rehabilitate lost motor control after surgery is due to a remarkable feature of the brain known as neuroplasticity. This is the brain’s innate ability to rewire itself in response to changes, whether that means learning new information or, in the case of epilepsy patients, undergoing surgery that results in brain damage.

“The idea of human neuroplasticity has been around for decades, and the ability to shape neural circuits through experience has been well-documented in animal models,” says David Paydarfar, a professor and the inaugural chair of the Department of Neurology at Dell Medical School. “We thought it would be really exciting to study a problem that would not only advance the science of neuroplasticity, but would also be something that would be relevant to patients.”

Although the brain rewires itself naturally, the researchers at Dell are interested in exploring methods that force neuroplasticity to occur in a controlled manner. The idea is to take a behavior, like movement or speech, that is encoded in an area of the brain that will be damaged during surgery and move it to a nearby region that won’t be affected. Paydarfar compares it to moving furniture around in your house to allow a contractor to work.

“Epileptic neurons are used for other purposes by the brain when they’re not producing a seizure,” Paydarfar says. “So, if there’s this overlap with these vital functions, we want to know if we can train patients to move these vital functions to another area so that when the surgeon goes in, they’re operating on a circuit that is no longer as critical for memory, speech, or movement.”

Video games and virtual reality (VR) are already frequently used to teach people new cognitive and motor skills. Pilots use simulators to familiarize themselves with new aircraft, therapists use VR for exposure therapy to help patients overcome phobias, and educators have seen success using video games to teach children. Adding an immersive element to those games with VR only makes the connections stronger, by forcing the brain to focus on the game itself rather than external stimuli.

In most video games, the brain area associated with the new skill is just one of many that are activated. Virtual experiences can create and endlessly repeat scenarios that facilitate learning, strengthening the connections in the player’s brain associated with the new skill at every repetition. It’s a scattershot approach to training your brain, but the Dell researchers need a far more focused method to maximize the chance of a successful outcome for their patients. Researchers working on brain-machine interfaces have pioneered targeted approaches to rewiring the brain to teach paralyzed patients to control robots or prosthetics so they can regain lost motor and cognitive functions. This is similar to what the Dell researchers will attempt with epileptic patients using VR video games. The difference, says José del R. Millán, a co-leader of the epilepsy project and the Carol Cockrell Curran Chair in the Department of Electrical and Computer Engineering at the Cockrell School of Engineering, is that all brain-machine interface training occurs after the patient has already experienced brain damage.

“If people are capable of voluntarily changing the dynamics of their brain signals, this is because we are inducing some kind of plasticity in our brain,” Millán says. “Any rehabilitation process that aims to restore a lost function relies on the fact that the brain can reorganize itself to execute that function in a different part of the brain.”

To test their hypothesis that it is possible to rewire the brain before it is damaged, the researchers will study several young adults aged 10 to 20 who are scheduled to undergo surgery for epileptic seizures. Each patient will have small electrodes implanted in their head around the region that will be surgically removed, giving the researchers a fine-grained view of brain activity occurring in that region and its immediate surroundings while the patients play the game.

“This is a level of game analysis that has never been done before in terms of how gameplay maps to the brain,” Paydarfar says. “If there’s a five-second video game sequence that hits the sweet spot of brain activity, we need to know why it causes those activations so we can create more fun and equivalent sequences that can be strung together for training.”

The goal is to transfer normal brain activity from the area producing seizures to the region immediately surrounding it, even by just a millimeter. Researchers will use an immersive device called the Infinity treadmill developed by Blue Goji, a company co-founded by Coleman Fung.

The Infinity machine consists of a treadmill combined with a high-resolution screen that can be connected to a VR headset to create an immersive virtual world. Players can use the treadmill to walk around in VR games, and the machines can be outfitted with all the sensors the researchers need to monitor their patient’s brain activity as they play. The researchers will likely use commercially available games and tweak them as necessary to induce directed neuroplasticity in the patients, possibly including customizations specific to individual patients.

“In the beginning there will be many mistakes because the brain keeps firing from the center of the epileptic region,” Millán says. “We hypothesize that immersion in a game will keep them playing longer and accelerate that process of increasing activity around the area that will be removed while decreasing activity in the center.”

The Dell researchers are just beginning to work on the Infinity treadmills to prepare them for the study, and they don’t expect to start enrolling patients until the middle of 2022 at the earliest. Their work is pathfinding, but if it’s successful, Paydarfar says it could have big effects in the field of neuromedicine. He envisions a future center at UT Austin devoted to human neural plasticity, where similar techniques could be applied to patients suffering from a diverse range of neural issues ranging from PTSD to traumatic brain injuries.

“We’re trying to learn in a very precise way about a single condition, and then we can start applying that knowledge to other conditions,” Paydarfar says. “This scientific effort will give us a greater understanding of the brain that could open up all kinds of clinical applications and translational research.”

Credit: Maciej Frolow,

original article 

• UT Austin Study Aims to Shield Critical Brain Functions From Surgery

JULY 27, 2021
Brain Functions

The brain controls much of what it means to be human — speech, memory, reasoning and everything we feel, think and believe. When brain surgery is necessary, the areas that control these crucial functions are often perilously close to the surgical site.

But what if there was a way to shift critical brain functions farther away from the surgical site, lowering risks to those critical functions? Doctors, engineers and scientists at The University of Texas at Austin are beginning a study to help adolescents who need brain surgery for epilepsy — advances that may one day also lead to new approaches to treat neurological conditions such as stroke, traumatic brain injury and post-traumatic stress disorder.

Illustration of the left hemisphere of the brain.

A 3D model of the brain’s left hemisphere highlights regions responsible for movement and touch (red), speech perception (orange) and speech production (blue).

As part of a three-year study, researchers will map the brains of adolescents before and after epilepsy surgery to examine how novel brain-machine interfaces and embodied learning technologies — such as playing games on a virtual-reality treadmill — can help the brain rewire itself before surgery, move key functions away from the surgeon’s target, and recover more quickly afterward.

Lead investigator David Paydarfar, M.D., chair of the Department of Neurology at Dell Medical School at UT Austin and director of the Mulva Clinic for the Neurosciences, compares it to evacuating a site before a nearby building is demolished.

“We want to prevent important real estate in the brain from becoming collateral damage to the surgeon’s knife,” he said. “Our initial study will explore how we can do that for young people undergoing surgery for epilepsy, but we hope our findings will have broader implications for brain health.”

Rewiring the Brain for Healing

Learning to harness neuroplasticity, the brain’s ability to rewire itself, presents a new frontier for healing from brain disorders. Researchers hope the study, funded by a $2.5 million gift from the Coleman Fung Foundation, will set the stage for further discoveries in neuroplasticity.

Fung Infinity Treadmill

Two Infinity Treadmills donated by the Coleman Fung Foundation will be used to study the brain’s ability to rewire itself.

“Although neuroplasticity is such a well-understood attribute of the brain, we have not proactively leveraged it in a clinical setting. That’s why I am so excited to support this multidisciplinary team and its groundbreaking research,” said Coleman Fung, a serial entrepreneur whose foundation is also donating the two VR treadmills that will be used in the study.

Fung’s latest Austin-based company, Blue Goji, develops the Infinity Treadmill, which gamifies cognitive and physical rehabilitation.

An Interdisciplinary Approach

In addition to Paydarfar, the multidisciplinary research group includes José del R. Millán, Ph.D., from the Cockrell School of EngineeringLiberty Hamilton, Ph.D., from the Moody College of CommunicationElizabeth Tyler-Kabara, M.D., Ph.D., Dell Med associate professor of neurosurgery and director of restorative neurosurgery; Nicholas Barbaro, M.D., professor and associate chair for education in Dell Med’s Department of Neurosurgery; and Stephen Strakowski, M.D., Dell Med’s vice dean of research and an expert in bipolar disorder and neuroimaging.

A professor in the Department of Electrical and Computer Engineering, Millán is known internationally for his work in brain-machine interfaces, including neuroprosthetics, and is a past president of the International Brain-Computer Interface Society. He is also a professor in Dell Med’s Department of Neurology.

“Our research program brings together a unique convergence of engineering, neuroscience and clinical perspectives to foster brain plasticity through the use of brain-machine interfaces,” Millán said. “Engineering and neuroscience principles enable users to achieve a seamless connection with their brain-controlled devices, while the integration of clinical principles into brain-machine interfaces promotes rehabilitation and functional recovery.”

Hamilton, an assistant professor in the Moody College’s Department of Speech, Language, and Hearing Sciences, maps where speech is processed in the brain. She already studies the brains of adolescents preparing for epilepsy surgery, mapping where speech functions occur. Her expertise will be critical in identifying prime areas for rewiring — and assessing whether the rewiring has been successful.

“Speaking, language and communication are critical functions in our everyday lives,” said Hamilton, also an assistant professor in Dell Med’s Department of Neurology. “By mapping out specific aspects of language in the brain, including not only the words that are heard but also the melody of a loved one’s voice, we hope to understand which brain areas should be preserved, as well as which functions may be at risk. By harnessing the power of the brain to rewire itself, we hope to provide better outcomes for our patients.”

A pioneer in the field of functional neurosurgery and minimally invasive skull base surgery and a researcher of brain-machine interfaces, Tyler-Kabara, who has trained surgeons for internationally successful brain-computer interface programs, will perform the surgeries involved in the study. She also serves as chief of pediatric neurosurgery and co-chief of pediatric neurosciences at UT Health Austin, the clinical practice of Dell Med, and chief of pediatric neurosurgery at Dell Children’s Medical Center.

“This extraordinary gift allows us to bring together the world-class researchers at UT in the field of brain-machine interfaces and apply our existing knowledge to help improve the quality of life for our patients. The opportunity to incorporate state-of-the-art virtual reality, which has already proved beneficial in training patients to use brain-machine interfaces, will enhance patient engagement,” Tyler-Kabara said. “The success of brain-machine interfaces in improving patients’ outcomes requires that we explore new and creative applications like this one.”

Preparing for surgery — a controlled, precise brain injury — is not the only application for inducing neuroplasticity. It also promises to help people recover after brain illness or injury.