Cincinnati Children's is First Free-Standing Pediatric Hospital in the U.S. to Own Device that May Uncover Secrets of the Brain
Clinical Use and International Research Began January 11
Monday, March 06, 2006
CINCINNATI – Cincinnati Children's Hospital Medical Center has become the first free-standing pediatric hospital in the country to own a MEG (magnetoencephalography) for clinical and research purposes. Clinical applications at Cincinnati Children's began on January 11, 2006.
Children have been studied previously with MEG at other medical facilities in the United States, including the University of California Los Angeles and National Institutes of Health, but usually in programs directed primarily toward adults.
MEG is used to study and aid in the treatment of brain diseases and disorders such as epilepsy, tumors and tuberous sclerosis. MEG is based on the principle that electrical currents in brain cells generate a surrounding magnetic field. The pattern of these magnetic fields can be used to determine the location, orientation and strength of the electrical source.
"MEG can take common activities that everyone does like swallowing and show, in chronological order, what precise areas of the brain are involved during this apparently simple, but essential and neurologically complex activity," said Douglas Rose, MD, a neurologist at Cincinnati Children's who leads the clinical aspects of MEG.
"The millisecond time resolution of MEG is particularly important as fundamental brain processes can occur in much less than a second," added Ton deGrauw, MD, chief of the Division of Child Neurology at Cincinnati Children's.
MEG has advantages over electroencephalography (EEG), which measures electrical impulses of the brain, because EEG results can be altered or blocked by the skin, fluid or skull surrounding the brain. Using 275 sensors called gradiometers, the CTF MEG reads magnetic impulses directly, which are not distorted by skin, fluid or bone. The sensors are contained within the MEG helmet which is worn by patients in a sitting or supine position. The result is better spatial localization of areas of the brain targeted for surgical removal and more accurate spatial localization of areas of the brain that should be preserved because they control functions such as language, movement or touch.
"Although the MEG is a step up from the EEG, there are still many benefits to having both at Cincinnati Children's," said David Wright, business director in the Division of Neurology at Cincinnati Children's. "We will continue to use EEG for most of our routine studies and for studies when we record brain waves for several days," said Dr. Rose
MEG has some limitations since magnetic fields generated deep within brain tissues decay rapidly over distance and may be less likely to be detected at the surface compared with electrical fields. Therefore, surface EEG and MEG are often considered complimentary technologies. For clinical purposes, Cincinnati Children's will be combining up to 128 EEG sensors with the 275 MEG sensors during examinations.
"However, MEG does bring special new capabilities by itself. We will work closely with the Department of Radiology and the Imaging Research Center here to develop useful combined studies and further improve functional neuroimaging for each child," said Dr. deGrauw.
Anatomical MRI is typically combined with MEG for improved visualization. Using specially-designed, advanced computer software, the images from both the MEG and MRI can be transformed in to three-dimensional images showing brain anatomy and highlighting regions of brain activity. Functional MRI and MEG can also be combined to evaluate the brain's activity with very fine spatial and time resolution.
Another benefit to children and adults, is that many insurance companies in the US now cover MEG procedures, although EEG has a longer and broader history of acceptance. The Centers for Medicare and Medicaid Services now approve MEG for evoked and spontaneous (non-evoked) brain activity. This coverage is currently useful for epilepsy, localization procedures and presurgical functional mapping of the brain. Increasingly, insurers are following this lead, which will gradually make it easier for children and adults to receive the MEG evaluation.
"I remember when I first began to study the brain, we used a one-sensor MEG. It took one to two weeks to complete an examination because we had to study the brain section by section," said Dr. Rose who has been involved with MEG imaging for over two decades. "With the CTF MEG, there are 275 of these sensors simultaneously at work in a helmet encompassing the head, and even the most complex cases now take less than four hours per patient."
At Cincinnati Children's, the MEG will be used for children needing brain surgery near critical areas (mostly the top half of the brain). As the abnormal areas being removed surgically may be located near areas of primary cortex involved in sensory, motor or language function, the MEG will help neurosurgeons to preserve these critical areas.
Possible future applications of MEG to help patients at Cincinnati Children's include stuttering, development of language after cochlear implantation, traumatic head injuries, cognitive and emotional adjustments due to abuse, Tourette's syndrome, Down syndrome, autism, and some psychiatric issues like bipolar disorder and schizophrenia.
The technique itself is extremely sophisticated. Detection of the weak magnetic fields depends on gradiometer detection coils coupled to a superconducting quantum interference device (SQUID), which in turn requires a specialized room, shielded from other magnetic sources. Mathematical modeling programs based on idealized assumptions are then used to translate the detected signals into functional images.
The cost is $2.368 million and has been completely funded through Cincinnati Children's and its division of Neurology. Other funding is currently being sought for special research activities that could expand the use of MEG.
"Cincinnati Children's Hospital's new MEG machine will continue their tradition of excellent medical care for our children and keep them on the cutting edge of research and treatment. This is the type of project I support and try to fund in appropriations earmarks. I am very disappointed that all earmarks were deleted from the Fiscal Year 2006 Labor / HHS / Education Appropriations bill because we could be doing more of this type of great research and treatment for children if those earmarks had stayed in the bill," said Senator Mike DeWine (R-OH). "Ohio has more children's hospitals than any other state, and Cincinnati Children's is one of the very best in the country. With the new capabilities this machine provides, families will feel the direct impact of their advanced capabilities through increased research in pediatrics and improved, more precise treatment of brain diseases and disorders."
Cincinnati Children's will be the only MEG provider for adults or pediatrics within a 250 mile radius of Cincinnati. Within the medical center, the MEG is located on the neuroscience floor near the long-term EEG monitoring for in-patients, and the EEG lab, where regular outpatient check-ups are conducted.
Jing Xiang, MD, PhD, a neurologist who is internationally known for his research with the MEG has joined the team at Cincinnati Children's to continue to lead research in this area. Before January, he was with The Hospital for Sick Children in Toronto, Ontario, where he studied with similar MEG equipment for six years. Dr. Xiang's responsibilities will include developing new data analysis methodologies and transforming MEG clinical research studies into new clinical applications for children. He will bring with him technical and clinical research fellows and collaborative support from China to aid in these projects.
Added Dr. Rose, "During war time, the Navy would use this equipment to monitor large metal objects moving deep under the sea. Now we use it to unlock secrets of the brain. We've come a long way."
About Cincinnati Children's Hospital Medical Center
Cincinnati Children's is a 423-bed institution devoted to bringing the world the joy of healthier kids. Cincinnati Children's is dedicated to transforming the way health care is delivered by providing care that is timely, efficient, effective, family-centered, equitable and safe. It ranks third nationally among all pediatric centers in research grants from the National Institutes of Health. The Cincinnati Children's vision is to be the leader in improving child health.
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