O The building of the Multimodal Neuroimaging Center for Epilepsy Studies at Unicamp will be built on land adjacent to the Hospital das Clínicas of the Faculty of Medical Sciences. The work, in the bidding phase, is the result of a consortium formed by the “Gleb Wataghin” Institute of Physics, Faculty of Medical Sciences, Hospital das Clínicas and Rectory. The building will function as a kind of virtual headquarters for CInAPCe. It will house interns from the Medical Physics course, the magnetic resonance imaging machine and part of the laboratories, in addition to centralizing the research carried out in the nine Unicamp units that make up the program. There are multiple focuses of studies – ranging from neurophysics to sensory analysis; from image processing to molecular engineering; from genetics to scientific dissemination, among countless examples. It is no surprise that the program coordinators, professors Fernando Cendes and Roberto Covolan, see the Center as a milestone within the scope of the program and in the history of Unicamp itself.

“Based on neuroimaging, but not only on it, the center will function as a platform for an advanced research center in neuroscience. Without false modesty, we are really looking for this more ambitious thing”, admits Covolan, for whom the concentrated effort undertaken by Unicamp and partners in the project and its derivations is not only on the same level as the most advanced institutions in the world but can also serve, in the future, , reference for similar programs. “We will compete internationally. The group as a whole already has a large presence, with a considerable number of scientific publications in high-impact journals”, says Cendes, endorsing his colleague’s arguments.

Geographic limits will not be a problem. The interface between researchers at Unicamp and other institutions will be created – and facilitated – by the KyaTera Project (Optical Research Platform for the Development of Advanced Internet), a high-speed network. The virtual environment will enable everything from organizing video conferences to the simultaneous exchange of information between different groups.

In Covolan's assessment, the benefits of this research environment for the University will be many, starting with the training of qualified personnel. The physicist considers that, when talking about cutting-edge technology, people ignore the fact that major leaps in development occur at a time when complex problems need to be solved. “Discoveries occur precisely when you look for instruments to solve these equations,” says Covolan. “This is a question of strategic knowledge, which leads to technological development.” The expert highlights that, in this context, epilepsy, apart from the relevant aspects from a clinical and humanitarian point of view, fits into the program's objectives. “The study of brain dynamics is emblematic of the system to be used.”

The machine - The high-field MRI machine, whose definition and capacity are much greater than those currently on the market, will play a fundamental role in the project – whether in brain mapping or in significantly increasing the number of patients who will be treated. However, Covolan highlights aspects as important as those mentioned above. The first of these concerns the operation of the equipment itself (read text on this page). Multimodal, the machine features a wide variety of advanced techniques that require, in most cases, image post-processing or research effort focused on pulse sequence work. “These techniques are not trivial at all. We will need to develop technological aspects to put it into full operation. This also requires robust computational programs and image processing tools. It is necessary to have a team with multiple skills to operate these systems and adequately deal with the issues that will be investigated.” This is where, explains the scientist, the importance of multidisciplinary approaches.

Another factor mentioned by the physicist is the combined use of the resonance machine with other techniques, including electroencephalography and optical tomography. In the latter case, Covolan reveals that, although the program is in the process of acquiring a prototype, the group is interested in developing a similar national one, which will certainly give rise to a line of research. “This is state-of-the-art equipment that uses laser sources. The laser light passes through the cortex and provides information about how the brain works,” he explains.

Borders - Fernando Cendes also sees a series of benefits in image studies from a multimodal perspective. For the FCM professor, the method opens frontiers of knowledge as it will be possible to study the pharmacology, anatomy and physiology of the nervous system in a completely non-invasive way. “In an MRI exam, you do not inject anything, nor do you subject the individual to ionizing radiation. Even the inconvenience of the noise made by the machine can be overcome.”

The neurologist also remembers that, unlike specialized clinics that purchase equipment already formatted for use, CInAPCe will invest massively in the development, study and testing of applications. The research, Cendes anticipates, will lead to the development and testing of new routines that will benefit patients over time. “We will exploit the machine to the fullest. It will not just be an instrument used to carry out exams. We will make it a great multimodal laboratory.”

 

To come out of the shadow

Neurologist Li Li Min, professor at the Faculty of Medical Sciences at Unicamp, knows the impacts caused by epilepsy on the social fabric like few others. Li coordinated, in Campinas, the World Health Organization (WHO) campaign “Epilepsy Out of the Shadows”, whose objective was to formulate a model of comprehensive assistance for people affected by the disease. The progress made by the campaign, which ended in May, was significant. The scientist recognizes, however, that there is much to be done, especially to mitigate the stigma surrounding the disease, which is often seen by sectors of the Brazilian population as “demonic”. Li, author of the acronym CInAPCe – a word game inspired by the Greek term synapse (point of contact of neurons) – will have a role considered strategic: the scientist will coordinate the program's areas of education and social interaction.

Its agenda will be extensive, but will derive from a project to disseminate adequate information about the disease to the general population. To this end, Li intends to act on several fronts. One of them, ambitious, is unprecedented in the country: trying to understand the neural bases behind prejudice and stigma. To make the study viable, Li will have the support of specialists in functional-cognitive assessment, with the support of magnetic resonance equipment. With this, the neurologist imagines, it will be possible to understand, among other things, how a person's brain works when they say they reject people with epilepsy. “We are studying several proposals along these lines. It is necessary to understand – and discuss – how prejudice is processed”.

The knowledge gap is another problem to be addressed. The neurologist recalls that misinformation is still rife, despite a quick search on epilepsy on the Internet bringing up more than 90 articles. This is a mass of data that almost never reaches the population. According to Min, there are many people who think the disease “gets”. To provide the correct information, in the most appropriate way, the teacher, together with experts from Labjor (Advanced Studies in Journalism Laboratory) and the Faculty of Education (FE), will formulate programs that prioritize scientific dissemination. “We intend to organize a 360-hour course for journalists. We want to reach opinion makers, people who work in the media in general”, says Min. “The spread of correct and enlightening information will result in social inclusion”.

Other initiatives will focus on the role of medical professionals, especially with the creation of training programs along the lines of those currently promoted by Aspe (Health Assistance for Patients with Epilepsy, www.aspebrasil.org), an NGO of which Li is part of and is basically made up of Unicamp professionals. “There is, without a doubt, a gap. Patients are not always treated appropriately due to the lack of preparation of people who work in primary care”, admits the neurologist, who reveals: prejudice extends to professionals who, in theory, should combat it.

Optimism – In Li's opinion, systematic action to attack specific problems will have visible effects when society begins to assimilate the disease in a more natural way. The neurologist's reasoning is anchored in years of practical experience. “Once society knows how to deal with differences, patients will feel more comfortable accepting their condition and seeking treatment”, he explains, mentioning the difficulty that people with epilepsy have in accepting the diagnosis. “This is unnecessary suffering. It needs to become increasingly clear that the disease is as treatable as any other chronic pathology.”

In his assessment of the clinical aspects of the program, Li does not hide his optimism. The specialist foresees gains in the areas of diagnosis, prevention and rehabilitation. Advances that, in his opinion, will also benefit, even indirectly, thousands of people who do not have the pathology. Li states that the choice of the project's thematic focus could not have been happier. Using a topic dear to his research repertoire, the scientist associates the public health problem with social exclusion. And what will the State's investment in a program like CInAPCe mean? “For the benefit of Joseph and Mary,” he replies. “And this is our biggest challenge.”

 

How the equipment works

The magnetic resonance (MR) equipment to be used in the CInAPCe Program are 3 Tesla tomography machines. Several benefits are obtained when using high-field MRI. The first of these is the increase in the signal-to-noise ratio, significantly improving the quality of the images obtained. The importance of this point goes far beyond the aspect linked merely to image visualization, as the computational methods of analysis and quantitative processing used in this area depend directly on the image quality. High field, in this case, translates into more abundant and more accurate experimental data. In the area of ​​in vivo spectroscopy, the high field implies an improvement in chemical selectivity, since the separation of peaks from different metabolites becomes greater. This implies precision in the quantification of brain metabolites. Another important aspect is that contrast mechanisms related to susceptibility effects become more effective in high field. As a consequence, functional MRI signals, which use the blood oxygenation level as an endogenous contrast medium, present higher amplitudes, facilitating the recording and localization of a given brain activity. With this, in vivo brain mapping can be performed accurately and non-invasively.

 

UNICAMP UNITS AND TEACHERS
OFFICES Medical Sciences College Gleb Wataghin Institute of Physics Faculty of Electrical Engineering and Computing Institute of Computing Chemistry Institute Institute of Biology Faculty of Food Engineering Education University Nudecri PROFESSORS Coordinators Fernando Cendes Faculty of Medical Sciences (FCM)	Roberto JM Covolan Gleb Wataghin Institute of Physics (IFGW) Alexandre Xavier Falcao Anibal Eugênio Vercesi Anita Jocelyne Marsaioli Benito Pereira Damasceno Carlos A. Mantovani Guerreiro Carlos Alberto Vogt Eduardo Tavares da Costa Edwaldo E. Camargo Elba CSC Etchebehere Ester Maria Danielli Nicola Francesco Langone Gabriela Castellano Iscia Lopes-Cendes Jorge Humberto Nicola Li Li Min Lília Freire Rodrigues De Souza Li Marcelo Knobel Maria Aparecida Azevedo Pereira da Silva Maria Teresa Eglér Mantoan Marilisa Mantovani Guerreiro Roberto de Alencar Lotufo Roger Frigério Castilho
Source: Roberto Covolan