Dr. Jonathon Parker, MD, PhD completed the MD-PhD program at the University of Colorado where a transformative mentor significantly shaped his path. At Colorado, he met surgeon-scientist Allen Waziri MD, who inspired him to use scientific inquiry to tackle malignant brain tumors, one of the grand challenges facing neurosurgeons. This was his onramp to neurosurgery and to translational research. He then attended Stanford for neurosurgery training, where mentors Casey Halpern MD and Gerry Grant MD, a pediatric and functional neurosurgeon, respectively, introduced him to the world of epilepsy surgery. At the time, there was significant interest in using emerging technologies in neurosciences, brain tumor care, and epilepsy surgery. Jonathon was particularly drawn to the scientific process of epilepsy surgery, which involves integrating various data streams to map seizure onset within the brain. This field is one of the more restorative forms of neurosurgery, involving the implantation of devices like deep brain stimulators and responsive neurostimulators. This approach called neuromodulation is also being used to help people rehabilitate from stroke. This passion for research and neurosurgery led him to the Mayo Clinic in Arizona, where he now works as an Epilepsy and Functional Neurosurgeon and Neuroscientist. Mayo Clinic is known for its impactful patient-facing translational research, which combines clinical and research expertise to address real-world problems with scientific solutions.
Q: Can you explain the latest advancements in epilepsy surgery and how these innovations are improving the outcomes for patients?
A: Over the years, epilepsy surgery has significantly advanced. In the past, the procedures we had in our toolbox were highly invasive, required large incisions, craniotomies, and large grid electrodes placed on the brain's surface. The traditional standard of care was to remove or disconnect the pathological area causing the seizures. However, in the last 10-15 years, there has been a shift toward minimally invasive techniques, such as stereo electroencephalography (stereo EEG). This method uses a robot to assist in drilling very small holes, about the size of a pen tip, into the skull, allowing electrodes to be placed through these tiny openings to map seizure onset in three dimensions rather than two. This approach has been transformative, enabling us to better understand seizure networks and propagation.
Today's epilepsy surgery toolbox has expanded beyond traditional microsurgery to include laser ablation and neuromodulation. Neuromodulation uses small, controlled amounts of electricity to modify and repair the function of neural circuits. In clinical trials, we are exploring the potential of stem cells to biologically repair neural circuits, making the brain less prone to seizures. These advancements have made epilepsy surgery less invasive and more effective, attracting more patients due to the increased safety of modern surgical options. Technological advancements, especially in imaging, have played a crucial role in this progress. Improved brain imaging, higher resolution scans, and other ancillary imaging techniques, such as magnetoencephalography (MEG), functional MRI, and high-density EEG, have enhanced our ability to study abnormal brain circuits both structurally and functionally. These technological strides have refined surgical techniques in the operating room, riding the wave of advancements in brain imaging.
Q: How does Mayo Clinic stay at the forefront of epilepsy treatment and research?
A: Epilepsy affects a vast number of patients, and it's crucial to consider the broader public health implications. While there are ambitious, long-term goals to pursue, we must also focus on near-term improvements for current patients. In the realm of epilepsy and neuromodulation, we have been successful in reducing seizure frequency, but it remains rare for individuals to become completely seizure-free with device-based neuromodulation approaches. Destructive neurosurgical techniques, such as laser ablation or resection, are effective but carry risks and are irreversible. My goal, along with my colleagues at the Mayo Clinic, is to transition these neurostimulation approaches from merely reducing seizures to curing them altogether. We need to dig into science to understand why we can reduce seizures but not stop them completely, exploring both technical and biological aspects.
At my research lab, the Device-Based Neuroelectronics Lab, we have assembled a multidisciplinary team, including neuroscientists, electrical engineers, biomedical engineers, and clinicians to focus on generating the next generation of device-based neuro therapies. This collaborative approach helps us stay at the forefront by addressing everyday questions and limitations and striving for continuous improvement while keeping an eye on future advancements. Achieving complete seizure control with neuromodulation is a moonshot, as there is a significant gap between reducing seizures and completely stopping them. To bridge this gap, we host a weekly Mayo Clinic neuroelectronic seminar series, where innovative neurotechnologies and therapies are presented and discussed. We actively seek out and bring new technologies to the Mayo Clinic, ensuring they are safe and beneficial for our patients. We believe that device-based neurotherapies is a key strategic area focus for the Phoenix medical device ecosystem.
Q: What do you see as the future of epilepsy and functional neurosurgery in the next 5-10 years? How do you envision new technologies like AI and robotics impacting your field?
A: In general surgery, such as kidney or appendix removal, robots have become prominent, especially in prostate gland procedures, because they allow for small incisions on the abdomen through which instruments can be inserted for direct visualization. Surgery typically involves structures that can be seen, touched, and felt. In contrast, stereotactic neurosurgery, a subfield of neurosurgery, involves placing very small electrodes or instruments into precise areas of the brain, where direct visualization and tactile feedback is not possible. In neurosurgery, robotics is beginning to be used, but unlike general surgery, it faces unique challenges because the brain is a soft structure that can shift during surgery. To address this, we use stereotaxis, which involves taking an operative image of the brain, uploading it into the robot, and registering this image to the robot's spatial understanding. However, even the steadiest robots struggle with the brain's shifting position. The challenge lies in developing intraoperative imaging technologies that can provide real-time imaging of the brain, allowing for more accurate targeting in a structure that is soft and constantly moving. The development of such cutting-edge technologies in neurosurgery is highly challenging but crucial.
Q: From your perspective, what are some of the most significant trends shaping the future of medical device manufacturing?
A: I often think about the longevity and durability of the device we implant into our patients that we intend to be permanent. In epilepsy and functional neurosurgery, where I see patients of all ages, the goal is to build devices that stand the test of time and can be future proofed to avoid repeat surgeries. When I think about the future of implantables, I envision modular devices that can be updated over time to meet evolving therapeutic needs.
A key challenge for MDM2 is leveraging the strengths of the Phoenix Metro Area, which boasts expertise in the semiconductor and medical device manufacturing industries, with strategic players like Dexcom and Medtronic. Our local strengths include sensor technologies and integrated circuits for communication. We need to harness these strengths to develop the next generation of ultra-low power, highly reliable, and durable implantable medical devices over the next 5-10 years. As we learn more about diseases that can be decoded into signals, whether metabolic from interstitial fluid sensors or electrical from brain sensors, the ability to digitize, store, and stream this data becomes crucial. However, data storage and transmission require power. For long-lasting devices, we need low-power architectures that can transmit data to the cloud, providing scientists with the information to generate actionable insights for physicians. This grand vision for future medical devices should be a major focus of MDM2.
Q: Is there anything else you would like to share about your work or any upcoming projects that you are excited about?
A: One of the most important aspects of our work in MDM2 is the crucial role of institutions. While having the right players and structure is critical, human resources and ingenuity are equally vital. The bright young undergraduates from UofA, NAU, ASU, and GCU, along with the innovative thoughts from clinicians and experienced professionals, are essential. We need to foster collaboration between these talented individuals and the industry, including medical device manufacturers, to attract and retain the best minds in Phoenix, Arizona. At Mayo Clinic Arizona, Dr. Steven Lester and Aric Bopp have taken the lead on planning for the Discovery Oasis development, that aims to be a physical hub for biotech and medtech companies to locate immediately adjacent to the Mayo Arizona Hospital. This medical innovation hub will put Phoenix on the map as “place to be” for medical device innovation and clinical trials. I believe it is essential to raise awareness and put Phoenix on the map as a premier destination for young scientists, graduate students, undergraduates, and career changers interested in medical devices. Phoenix has long had a nucleus of talent in this field, but now it is growing rapidly. This city is becoming a top destination for those looking to be at the forefront of innovation in design, implementation, and clinical testing. It's an exciting time to be part of this effort, but we can't do it alone. To establish Phoenix as a thriving medical device manufacturing hub for the future, we must generate excitement about the opportunities here.