AUGUSTA, Ga. (WJBF) – The Means Report is placing a focus on the medical side of events in our lives, and taking a look at the wonders of modern medicine and the exciting things going on right down the street at the Medical College of Georgia at Augusta University with a focus on the human brain. To find out everything we can about it, two of the area’s top experts, Dr. John Henson, neuro oncologist, and Dr. Fernando Vale, neurosurgeon, both take time out of their day to be with us.
Brad Means: Doctors, thank you so much for what you do and for being with me today.
Dr. Fernando Vale: Thank you.
Thank you.
Brad Means: Well, we sure do appreciate it. Dr. Vale, the brain, bottom line is fascinating. Is it not? It’s just like one super computer that we carry around with us.
Dr. Fernando Vale: Absolutely. I mean, the brain is a unique organ and is what I call the ultimate frontier. It’s not the universe, it’s the brain, it’s the connection, the network, the electricity that are computer-like, or the function of the brain that is special and unique. And we don’t know enough still yet, unfortunately.
Brad Means: Yeah, but you know, there can be concerns when that computer short circuits. Dr. Henson, is that when people come to see you? When everything’s not firing properly and perhaps people have seizures?
Dr. John Henson: Yeah, that’s certainly the case, Brad. And, you know, to tag on to what Doctor Vale said, you know, the black box phenomenon of the nervous system is really it’s most, one of its most attractive features. As a physician, we are very, very interested in the things that we don’t know and what we have to learn. We’re gonna talk a little bit about that today, I know. The nervous system is what makes us human. And, you know, I always tell the students here at MCG that, you know, you can study other parts of the body, but the brain is where the really interesting stuff is happening, in part because we know so little bit about it. And, so I think, you know, when the symptoms do arise in the nervous system, we have a terrific team here at AU Health and MCG, with almost any specialty that you can imagine in the nervous system.
Brad Means: Why don’t we know a ton about it, Dr. Vale? Is it just because it’s difficult to collect data from the human brain? What is holding us back from completely understanding that organ by now?
Dr. Fernando Vale: Well, first, we have to say very challenging is the micro-environment of the brain, the connection, billions and trillions of brain cells all connected in a unique way. And it’s very difficult to access. It’s not something that we can go and reach real easy. We have to depend on outside imaging. We have to depend on human understanding, behavior, physiology to get a better idea of brain function. So, I mean, just to reach to the depths of it is very difficult.
Brad Means: Let me bring a viewer’s question to you. We always ask viewers of ‘The Means Report” to give us their input and tell us what they’d like to see. And they said, “Please bring a brain doctor on your program and talk about P-V-N-H,” that’s the abbreviation. You can Google it, folks, if you want to know the official name of this. I tried to say it at the top of the broadcast, I think I succeeded. So it’s basically, I think, and I’ll say this, either doctor can answer, I don’t want to step on one of your areas of expertise, gentlemen. So just jump in if you want to respond. So PVNH, if I’m understanding it correctly, is a disorder when neurons in the brain are in the wrong spot and that leads to seizures. Is that an okay assessment?
Dr. Fernando Vale: I think that this is a good beginning and I’m gonna start and gonna let Dr. Henson finish it.
Brad Means: Perfect.
Dr. Fernando Vale: And we have to look at the name, periventricular, PV, and the ventricles are spaces filled with fluid in the brain and there are many reasons why we have brain fluid. Number one is protection. Number two is, it’s like a lubrication and it’s a cleansing solution. So we can get rid of the toxic chemicals for our hardworking brain. Then you get these, nodular means collections of cells that are heterotopia, which means they’re out of place. So basically they’re normal cells out of place and they usually present when it comes to neurosurgery and neurology with epilepsy. That’s the main reason that we see this patient. And unfortunately, it’s a constellation of symptoms. It is a genetic background and have other problems and concerns when it comes to the brain, epilepsy mainly, and learning disabilities. For the rest, I will pass it along to Dr. Henson.
Brad Means: Perfect, good job. Dr. Henson, what are your thoughts?
Dr. John Henson: Well, so as a, as Dr. Vale’s pointed out, the fluid filled spaces in the middle of the brain are called the ventricles. And this periventricular nodular, it’s nodules of, of neuronal tissue, of nerve cells that form along the wall of the ventricles. Normally what happens in development is, is that the cells are formed along the wall of the ventricle. And then they migrate out to the surface of the brain for their final location, in what we call the cortex, or the electrically-active surface portion of the brain. And the way that those cells migrate from the ventricle down deep in the brain, the wall of the ventricles to the cortex, is a highly complex process that involves guide wires, called radial glia. This is, it’s a very, very interesting phenomenon. And on occasion, this is a rare syndrome to be sure, on occasion, the cells don’t migrate from the wall of the ventricle out to the cortex of the brain, and they form little nodules along the surface of the ventricle. And this is where we get periventricular nodular hyperplasia. And so, those cells are electrically active. People have shown that with various kinds of studies. Patients with this problem often have seizures and Dr. Vale is an expert in this area, can talk a little bit more about the symptoms. But it is a, it’s a developmental arrest of the migration of those cells from their birthplace in the middle of the brain, out to the surface of the brain. It’s a little bit like you might think of a pioneer, leaving the East Coast at the early part of this country. Some of ’em just barely made it a few miles before they found a good place to stop. Some of ’em made it to Chicago, we’ll talk about that. And some of them made it all the way to the West Coast, which would be the normal, the normal developmental pathway. And it’s the arrest of that pathway that gets us the syndrome.
Brad Means: If you have a seizure, whether it’s PVNH–related or otherwise, if you have a seizure, does that mean that you most likely have epilepsy or a tumor? Can you make that leap and say something is definitely wrong with me?
Dr. Fernando Vale: Well, I’m gonna start. And again, I’ll pass it along to Dr. Henson. A seizure by itself doesn’t mean epilepsy. Epilepsy, by definition, is a chronic disorder. There are many reasons why people can have a seizure. Could be medication-induced, could be stress, could be metabolic, and so on and so on. Now, once that you have more than unprovoked event, what we call a seizure, then we’re talking about epilepsy. And then that’s when, as a team, we evaluate the patient. Neurology to assess the seizure disorder, research for the head, we get neuroradiology to assess the brain structure abnormalities and that’s when usually we see this nodular heterotopia, for the most part. This is how these patients are diagnosed. But epilepsy by itself is a network problem. It’s a short circuit of the brain. And the question always come: What’s the problem? What is the etiology? What we can do about it?
Brad Means: Yeah, I was gonna ask this and maybe you can jump on this, Dr. Henson. If someone has epilepsy, it doesn’t necessarily mean they’re going to be susceptible to seizures, well they’re susceptible. But let me just phrase the question this way. I know a friend has epilepsy. He takes medication, never has a seizure. Can you completely manage the illness?
Dr. John Henson: In the vast majority of people we can actually stop the seizure activity from occurring with, typically with medications, although sometimes even behavioral or lifestyle changes can have an affect, but typically with anti-seizure medicines, antiepileptic drugs we call them. Sometimes patients need a more complex approach, shall we say, this is the program that Dr. Vale runs here where we need to do things like resect part of the brain where the electrical storm is initiated. Sometimes we do that. There are ways to send, this is really fascinating. There are ways to send blocking electrical impulses into the brain through the neck, such that if a seizure discharges, recognized by a little computer chip, it sends off, just like a laser blocker, it sends off a little impulse and stops the seizure. So we have a lot of very, very sophisticated technology to understand and treat. So, you know, it’s interesting, Brad. 1% of the population has a seizure disorder.
Brad Means: Wow.
Dr. John Henson: And that’s a lot, right? And so, you know, every viewer of your show is likely to know somebody that has that kind of a problem. And, you know, it’s typically, it’s a sudden onset, defined period of neurologic dysfunction that brings patients to the neurologist, who then is able to diagnose epilepsy in the appropriate, in the appropriate situation.
Brad Means: All right, what if, Dr. Vale, what if you’re not having seizures and you just have other symptoms of brain problems? How do you know when it’s time to come see your physician? How do you separate a basic headache from something, or a migraine even, from something that could be more problematic?
Dr. Fernando Vale: Well, you know, the way that I teach, let’s say, let’s assume that I’m teaching you. You’re one of my residents and I’m trying to then to identify that potential life-threatening injury or condition. So I always say you have to look for a pattern. What is different? You had a headache every day and the headache are the same way they have been for the last five years, or 10 years. Probably for the most part, it’s gonna be okay. But if you see it change in intensity, the frequency, in the type or situation that brings those headaches, then it’s time to seek medical attention. Otherwise, it’s very hard to know from a distance. So, just gotta listen to the patient. The patient, for the most part, will tell you when there have been a change and that’s the time to modify it or search for an answer
Brad Means: Well that’s a great answer. Makes it a lot easier to understand all things about the brain, or easier to understand, if you listen to doctors Vale and Henson for a few minutes here on “The Means Report”. And we’re gonna continue our conversation with these gentlemen, focus on the work that’s being done when it comes to epilepsy at MCG at AU. They are absolutely battling that illness with all guns blazing, doing incredible things over there. And we’ll discuss that and more on “The Means Report” in just a moment.
Part 2
Brad Means: Welcome back to “The Means Report”. We are talking about the human brain today, taking a fascinating journey through that fascinating organ that controls just about every single thing we do in every moment of our lives. Dr. Fernando Vale and Dr. John Henson from MCG at AU are guiding us down that path. We talked about PVNH, a disorder, in our first segment and I wanted to dig a little bit deeper into that, doctors. And by the way, I think you’re doing a great job of just deciding who gets to answer each question. I’ll continue to defer to you all on that front, but PVNH is hereditary. So sort of tell me how that works and perhaps how parents can know, if it’s possible, beforehand that their baby might have it.
Dr. John Henson: Well, this, this turns out to be one of the most fascinating features, you know, beyond the structural brain problem of the migration. The actual genetics of how this works are fascinating. And I think the viewers would enjoy hearing about this. So basically, it’s a genetic riddle. And what I mean by that is, is that this is, this nodular heterotopia is a disease of mothers and their daughters and the mothers can’t have sons. So, it’s always in the females of the family, not in the sons. And the reason behind that is really, really fascinating from a genetic standpoint. And here’s how it works. The gene that’s abnormal that causes these cells to fail to migrate like they should sit, the abnormal gene sits on the X chromosome. Now, women have two X chromosomes, and so they’ve got one abnormal gene and a normal gene. And so, they develop just fine as a fetus and grow into an adult, but they develop these migration problems. It’s not severe enough for them to be able to live. On the other hand, males only have one X chromosome. And if they have the abnormal gene, this actually keeps the embryo from being able to develop into a normal, living human being. And so we see that the males in families with this syndrome, when they get the gene, there are miscarriages, or very, very early deaths after birth. And so what happens is, is that the only place that you see the condition is in the mothers and their daughters. And so, when you see this, the most common type of this nodular heterotopia, it has that fascinating hereditary feature of being moms, daughters, no sons in the family.
Brad Means: Well, I guess, Dr. Vale, if the women, if the girls are growing up to be women and growing up to bear children, then the disease is manageable in those females. Is it? When you have it, can you lead a somewhat normal life through proper treatment?
Dr. Fernando Vale: From a functional point of view, you can lead a normal life. Now there are ways that you can figure out if you’re a carrier, you are part of this process. And of course, the easiest way, getting an MRI of the brain that will define these periventricular lesions. There are genetic studies, and of course, I mean, there are other studies that you can do early in uterus, in case you wanna, or early in pregnancy, in case you wanna assess the fetus. And I’m gonna let Dr. Henson add a little more into this situation.
Dr. John Henson: So, the ability of a woman affected with this to live a normal life, is indeed the correct statement. The seizures typically can be controlled. Not always. Some women actually don’t have seizures with this at all. The vast majority of women with this syndrome have a normal intelligence, although sometimes there are problems with learning disorders and whatnot, but it turns out that this is a reasonably manageable condition in many, many women. And then, as Dr. Vale has pointed out, there are genetic techniques in which we can either avoid a woman having a child with, with the genetic disorder, by for example, you know, choosing embryos that don’t have the gene abnormality. There are lots and lots of different ways to sort of manage this, that medicine has kind of brought us these gifts to be able to help people from having these problems. But if you have it, it is something that in the vast majority of people, we can manage.
Brad Means: What about other ailments that you’re studying there and our ability, your ability to manage them? Have you found through your research with just say epilepsy, and it’s been very in depth research to say the least, has that helped you address some of the other issues we’ve been talking about? PVNH? The treatment of tumors? Does that epileptic research kind of have a, a domino effect for other ailments?
Dr. Fernando Vale: Let me clarify a little bit about epilepsy. We did say before that 1% of the population will suffer from seizures and most likely epilepsy. However, about 80% of those are gonna be responders to medical therapy. We’ve got 20% that fail to respond to medication, what we call medically resistant epilepsy, that usually gets referred to our center. Now, those patients get a full evaluation. Usually start with a high resolution brain imaging to assess structural abnormalities. And that will follow closely with a video EEG in which we’ll record the actual event. And based on that, we can treat accordingly. Now, epilepsy could be the result, or let’s say seizures, could be the result of many problems.
Brad Means: Yeah.
Dr. Fernando Vale: So our goal is to identify those problems. And again, that could be a genetic problem, like periventricular heterotopias. It could be a brain scar that is leading to seizures. Could be a history of trauma before. And even in the worst case scenario, could be a tumor. So, you need to assess these patients so you know the cause and treat them properly. And in that sense, that’s why Dr. Henson and I work very close together, is in the management of brain tumors and epilepsy.
Brad Means: Is there lot of surgery these days or can most treatments be done without it?
Dr. Fernando Vale: Well, like I mentioned before, 80% of those patients would respond to the medications, but for those 20% that are medically resistant, or what we call refractory, we have many options. It could be resected brain surgery for those for which we identified a lesion and a specific cause of the problem. Sometime we could do surgery to disconnect brain tissue, that’s to prevent seizures spread and more damage to the individual or to the contralateral brain. Right now, we have the use of neuromodulation that is using pacemakers to help control seizures. Seizures are bad electricity. That mean there is a short circuit in the brain. It’s a network problem. And we have found that fighting electricity with electricity, we can modify seizure activity. And that’s why neuromodulation had become a more frequent option for this patient. We had little option 10, 20 years ago.
Brad Means: What about brain fog that some people have said that is an effect, an aftereffect even, of the Coronavirus? Is that y’all’s area at all? Have you seen that?
Dr. John Henson: Well, we, we definitely deal in brain fog. And as a brain tumor specialist, I meet that phenomenon. I had a patient with it this morning, in fact, in clinic. And that’s something that we do see. It is certainly within the realm of neurology, more so than neurosurgery. It is a sort of general dysfunction of the brain typically that wouldn’t have a surgical, a surgical approach to managing. So yes, we see that. We see that it is a neurological issue. And, so it’s, you know, it is something that would be appropriate for our department.
Brad Means: Probably just my last question. What’s the best way, and gentlemen, just take a brief moment each to answer this. What’s the best way that we can ensure better brain health? Things we can do on our own before we come to see you?
Dr. Fernando Vale: Well, I could start here because, you know, I’m always telling my patients the first thing that you can do for yourself is exercise. You exercise you, you improve tissue oxygenation, that means we get better brain health, and you get these endorphins that allow for brain repair and recovery. Of course, you gotta eat well. Balanced nutrition. That’s something that we all talk about it and we rarely do. Correct? Then we get a good night’s sleep. We need to rest our brain. I mean, we have stress, we overuse caffeine, we overuse alcohol. All those things kind of, at the end of the day, we tend to pay a price for our brain health. So, stay active and take care of yourself.
Brad Means: Can we kill brain cells, Dr. Henson? Or is that something our parents just said to scare us? Can you really kill brain cells?
Dr. John Henson: Well, let’s see. Absolutely. I would maybe rephrase that and say brain cells can be killed. Lack of oxygen would be the, you know, the number one risk. So yes, you can do that. Now, if you ask: Can you kill brain cells with some certain, you know, like toxins or things? Yes, you can do that. It’s probably not the case that the kinds of things that we’re talking about right now for brain health, that we’re avoiding killing brain cells. On the other hand, there’s emerging evidence that despite the brain being fully formed soon after birth, that there is actually some additional brain cell formation that goes on throughout our lifetime. And so, you can form new cells. You certainly can kill them with certain kinds of toxins and things. And, I think Dr. Vale’s list of the brain health items is, is right on the mark. I have a little to add to that.
Brad Means: Well, gentlemen, it is a challenge to tackle something so complicated in a time that is so brief, but you all have done an outstanding job with it. I look forward to talking to you again, hopefully in person very soon. Thank you all for what you do and for being with me today.
Dr. John Henson: Thank you, Brad.
Dr. Fernando Vale: Thank you.
