CHI Seminar - Patrick Karas, MD

Center for Health-System Improvement (CHI) "Works-in-Progress Seminar"

Tuesday December 12, 2023, 12:00 - 1:00 PM
Hybrid Attendance: 4.108 JSA Conference Room or Zoom
Presenter: Dr. Patrick Karas, MD

“Combining epileptogenic zone localization algorithms and machine learning methods to improve surgery outcomes for drug-resistant epilepsy”

Drug refractory epilepsy (DRE) affects 34% of patients with epilepsy and can be successfully treated with surgery. Surgery involves identifying and removing the epileptogenic zone (EZ), defined as the brain region where the seizures begins. Identification of the EZ by a trained neurologist using intracranial electrodes (iEEG) is the clinical standard. However this method, which relies on visual review of hundreds of electrode recordings, is time-consuming and has mixed inter-rater reliability. Moreover seizure-freedom rates after surgery are unsatisfactory, varying from 30 to 80% based on individual patient complexity and difficulty localizing the EZ. Automated localization of the EZ with computational algorithms is an active area of development, but currently requires costly software licenses, computational science background, and statistical expertise. The most promising algorithms for automatic localization of the EZ have reported significant improvements compared to clinician manual localization in the recent literature (+20% accuracy and specificity). We will review several automated EZ localization algorithms and present recent work we have performed to implement these algorithms within RAVE, a compelling open-source, free, user-friendly, intuitive, NIH-supported software for consistently replicable statistical analysis and visualization of iEEG data. We will also discuss the development of supervised machine learning algorithms with a goal of combining the predictions from existing EZ algorithms. The final goal of this research is to provide clinicians with a free user-friendly application, easily accessible through any web browser, to assist and improve EZ localization, and ultimately improve patient outcomes after seizure surgery. Completion of this research project will allow consistent evaluation and development of new and/or improved algorithms, machine learning models and extensive clinical validation. This compelling application will be freely available for researchers and physicians treating DRE worldwide.

Patrick Karas completed his undergraduate education at Dartmouth College in Hanover, NH with degrees in mathematics and chemistry. He then obtained his MD from Columbia University College of Physicians and Surgeons in New York, NY. Dr. Karas completed his neurosurgery residency at Baylor College of Medicine. During his residency he was awarded an NIH R25 grant to study multisensory integration using human intracranial recordings. His training also included over a year of time dedicated to brain tumor surgery at MD Anderson Cancer Center. After completing residency, he continued his study of epilepsy surgery techniques at the Charles Shor Epilepsy Center at the Cleveland Clinic. Dr. Karas’s clinical interests include epilepsy surgery, brain and skull base tumor surgery, and functional neurosurgery. He performs the full range of modern techniques for epilepsy surgery, including robotic sEEG placement, open resection, minimally invasive laser ablation, and neuromodulation techniques (responsive neurostimulation and deep brain stimulation). He also offers awake surgery and advanced brain mapping techniques for difficult to remove brain tumors. Additional clinical interests include deep brain stimulator insertion for movement disorders, as well as percutaneous and open techniques for the treatment of facial pain. Dr. Karas also runs a lab studying human electrophysiology. Current projects focus on using intracranial brain recordings to understand how auditory and visual signals are combined in multisensory regions of the brain. Dr. Karas currently serves as a full-time faculty Neurosurgeon at UTMB, operating at both Galveston and Clear Lake campuses. He is a member of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, American Association of Stereotactic and Functional Neurosurgeons, Texas Association of Neurosurgeons, and the American Epilepsy Society.