“Nerve syrup” to treat epilepsy, ca. 1910

A Babylonian tablet created around 1000 BC and currently housed in the British Museum describes recognizable types of epileptic seizures and post-seizure psychosis. And this isn’t even the oldest record of epilepsy. Currently affecting 39 million people worldwide, epilepsy is one of the earliest recorded diseases, with the medical literature dating to the second millennium BC.

We still can’t always say what causes a person’s epilepsy, and the sense of mystery surrounding the disease that may have prompted ancient observers to record its symptoms might also account for the fact that epilepsy was long thought to be a spiritual disorder. People with epilepsy were regularly shunned, quarantined, and subjected to exorcism. Because the curse associated with it was thought to be contagious, epileptics were spit upon throughout the Roman period, as a way to keep away the demons…and because epilepsy is, of course, not contagious, this approach appeared to work. Epilepsy was still seen as a curse in at least one developing nation until late in the 20th century.

At the same time, early physiological theories correctly identified epilepsy as originating in the brain, a realization that led to the prescription of special diets, living conditions, bloodletting, and un-anesthetized “skull trephination”, i.e. boring a hole in the skull. Sounds painful, no? Still, these brain-focused treatments paved the way for drug treatments in the 19th century that successfully controlled seizures.

Currently, about 70% of patients respond to drug therapy. For those who don’t, surgery is often the best option: the part of the brain where seizures originate might be removed or disconnected from surrounding areas. Prior to surgery, tests are done to examine the structure of the brain and look at electrical activity to determine the site and sort of seizure a patient has. Simultaneously, doctors identify the functionally-important areas to be preserved, to maximize a patient’s quality of life.

Dr. Eishi Asano is Professor of Pediatrics and Neurology at Wayne State University and Medical Director of Neurodiagnostics at Children’s Hospital of Michigan. He specializes in functional brain mapping for epilepsy evaluation in children, and his lab has recently worked to create a ‘4D brain map’ to visualize the neuron interactions behind essential brain functions, like speech and language. This mapping project also aims to identify physical locations in the brain that contribute to remembering where things are if you’re no longer looking at them: aka visuospatial memory. By identifying these locations in children who are about to undergo surgery for epilepsy, the surgeon can attempt to avoid and preserve the child’s visuospatial memory.

Asano’s recent study, “Mapping visuospatial memory using a tablet computer program,” a collaboration with Lumosity, explored whether measuring high-gamma brain waves during game play could help determine where in the brain the visuospatial memory area resides. If this memory area is precisely mapped, a surgeon can do a better job of avoiding it during epilepsy surgery. Whereas other modes of locating the visuospatial memory network require children to lie perfectly still or be restrained, Asano’s mapping method accommodates children both by allowing them to move around and by offering an engaging game to activate the brain region.

Gamma waves are a frequency range of normal brain activity, with high-gamma waves associated with intense concentration, so they’re measured during game play as a way to see where and when the cerebral cortex is activated. When the child concentrates on remembering the location of something, this increase in activity maps to the area of the brain associated with visuospatial memory. So, measurement of high-gamma activity during gameplay will effectively highlight the brain networks supporting vision, memory, and motor function. Surgery can then be targeted accurately.

Lumosity game Memory Matrix

The game used in this study was Lumosity’s “Memory Matrix.” Memory Matrix targets visuospatial recall by showing a grid with a highlighted pattern of squares. The squares disappear, then you’re asked to click on the grid where the highlighted squares were. As the study notes, “We determined the spatial-temporal pattern of high-gamma modulation (i) at the onset of presentation of square stimuli, (ii) during encoding visuospatial working memory, and (iii) at the onset of initial recall response by finger tapping on a tablet screen.”

That is, the study broke visuospatial recall into three components (seeing the pattern, recalling the pattern, and replicating the pattern) and measured the high-gamma activation for each. As hypothesized, high-gamma activity increased with the game’s level of difficulty, confirming both that Memory Matrix (while not intentionally designed for clinical use) initiated increased high-gamma brain activity, and that this activity was mappable onto the physical brain.

The upshot? The location of visuospatial brain function is mappable by using a computer program in tandem with appropriately designed cognitive games that drive high-gamma activity — this is where Lumosity comes in. Mapping this brain area provides a new way to target epilepsy surgery, since doctors frequently test many functions — including visuospatial memory — to see what areas are functionally-important and need to be preserved during surgery.

Given the choice between exorcism or brain mapping using a computer program, I’d opt for the computer program. But that’s just a matter of personal preference.