Inside a senator's brain

By Dr. Sanjay Gupta
Chief Medical Correspondent

Somewhere deep inside the brain of Sen. Edward Kennedy, the neurons in his left parietal lobe were becoming angry. This is an area of the brain at about eye level just behind the ear. Something had invaded their space, a foreign mass of some type, and they were about to react in a way that would frighten the senator and those around him.

It was this past Saturday when the brain had a sudden burst of electrical activity and caused a seizure, also known as a convulsion. Certain parts of his body would first become rigid, and then start to shake. He would lose consciousness.

In most people, including the senator, there was really no way he could've known it was about to happen. Warning signs in the past may have been a vague headache, possibly some numbness in his right arm, maybe even the loss of a word when he was speaking. Any of those things may have been quickly forgotten or dismissed. A seizure, on the other hand, is a stern warning that the brain has reached a break point.

While the seizure can be a frightening thing to witness, for doctors it is a call to action. It spurs those in my field of neurosurgery immediately into medical mystery-solving mode. The seizure itself in most cases will eventually stop, leaving doctors in a quandary. What exactly caused the seizure in the first place? One of the dictums of medicine is that you imagine the worst things of all and immediately try and rule those out. In this case, an electroencephalogram, or EEG, was performed measuring the electrical activity of the brain and perhaps most importantly, an MRI scan of the brain showed that angry foreign mass to the outside world for the first time. It probably looked like an octopus with tentacles reaching into the surrounding areas of the brain. (Watch Dr. Gupta explain how doctors examined Sen. Kennedy's brain here)

Now, doctors had to figure out what it was.

The only way to know for sure was to cut the skin above this tumor, drill a hole in the skull and insert a probe through the brain square into the middle of this mass. The goal here is to remove small pieces of the fibrous tough tissue and examine it under a microscope. It’s likely that the pathologist looked up from the microscope with a concerned expression when he saw the telltale cells that are consistent with a malignant glioma, a brain tumor of the very worst kind.

They account for more than half of the primary brain malignancies that are diagnosed in the U.S. every year, and in the last 20 years, the grim survival statistics have barely budged. For the very worst type of malignant glioma, also known as glioblastoma, neurosurgeons are often forced to tell their patients that even with the best therapies, chances are they won't live longer than a year.

Some things have changed over the past several years. This is where it gets more optimistic. Nowadays, doctors can perform what is known as a functional MRI scan. While in an MRI scanner, doctors may ask the senator to raise his right arm or even just think about moving his right arm. The resulting scans will show if the tumor is located in areas of the brain responsible for movement. They will ask the senator to speak or think about speech, and again the speech areas of the brain will light up and their relationship to the tumor can be seen directly. (Read more about Sen. Kennedy's diagnosis here)

If the tumor is close to these motor or speech areas, doctors may choose not to operate or they may decide to forge ahead with the operation, keeping the patient awake. The whole time, while operating, they would ask the senator to move his arm and talk. As soon as anything seemed abnormal, that would send a message to the surgeon that it was time to stop.

Unfortunately, more times than not, operations, chemotherapy and radiation, also known as the conventional therapies, simply aren’t that effective. Patients and their doctors then have the option of turning to some of the most cutting edge therapies that have been developed in decades. Nowadays, there is such a thing as a brain tumor vaccine.

Doctors would take the patient's own tumor cells and combine them with their own white blood cells, which are part of the immune system. This concoction, according to Dr. Michael Gruber, chief of neuro-oncology at Overlook Hospital and a neuro-oncologist at the New York University Langone Medical Center, offers a 50 percent two-year survival in a small group of patients, almost double the survival rate without the vaccine. There is also a type of gene therapy, where specially engineered viruses are injected directly into tumor cells that may cause the tumor to die or at least be more susceptible to radiation.

While the doctors figure out the best options to present to the Kennedy family, the senator will likely rely on the fighting spirit, for which he is so well known.

Dr. Sanjay Gupta is a practicing Neurosurgeon at Emory University Hospital in Atlanta

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