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Stories: Voices from the frontline

Ryder Gwinn, M.D.

For years neurosurgeon Ryder Gwinn, M.D., and his lean team have pushed the boundaries of technology by pioneering treatments for patients with movement disorders like Parkinson’s and essential tremor, as well as epilepsy. As we work toward providing you innovative, leading-edge health care, Dr. Gwinn is one physician who is leading the way. He sat down with us to discuss how life-changing some of those new treatments can be for our patients—and how exciting the next evolutions in technology will be.

What inspired you to pursue neurosurgery as a profession?

I actually started out as a Russian literature major in college, and I loved the author Dostoevsky, who had epilepsy. He would describe seizures as almost these insightful periods into his own mind and understanding of things.

So I became fascinated by seizures and how the brain could go wrong in such a violent and catastrophic fashion and then pull itself back together so quickly and start functioning normally again. That led me to a psychobiology major and, eventually, medical school, where I pursued research into epilepsy.

It's incredibly satisfying to me to take something apart and figure out how it works. The brain is that ultimate black box that we may never really be able to figure out, but being able to even tinker around the edges has always kept me in the field.

One of the most transformative procedures to emerge in neurosurgery over the last decade is focused ultrasound. Can you explain what it is and why it’s so revolutionary?

This is a very new, groundbreaking tool for altering the way the brain talks to itself—and it allows us to make these changes without having to go through the skull. It’s entirely noninvasive.

The bounds of what we could accomplish with focused ultrasound are almost limitless. The first condition that we’ve treated with it has been essential tremor. In the past that was something we would treat with deep brain stimulation—an invasive procedure that can be scary for patients. Focused ultrasound accomplishes the same thing, but without touching the skull or brain. It’s one of the most satisfying things that I do as a surgeon. Patients are transformed right there in the operating room.

You mentioned that focused ultrasound could be used to treat other conditions. Like what?

Focused ultrasound works by lesioning a very specific part of the brain—the thalamus. We’ve known for decades now that lesioning a different part of the brain—the globus pallidus internus—could improve symptoms of Parkinson’s disease, but it was a very difficult, complex procedure that involved drilling into the skull. Focused ultrasound offers an ability to be anatomically extremely precise, and also have real-time feedback on where you are in the brain and helpful your lesion is becoming while also looking for side effects. We’re currently participating in a multisite trial exploring its use for treating Parkinson’s.

And I should say that we wouldn’t be able to do what we’re doing today without philanthropy. All of the benefits of that technology—from precision to safety to time savings—are possible because the community has supported us.

How could philanthropy help take your work to the next step?

What we really need are professionals who are able to easily move between the clinical realm and the neurophysiology realm. Having Ph.Ds. who are experts in signal processing and in brain-machine interface research would put us on the level of the Mayo Clinic.

And that would allow us to do what?

We would be able to conduct clinical studies that we're not capable of doing now. For example, if we wanted to test a new area of the brain that we could stimulate to inhibit seizures, we would first need to conduct a study and collect recordings from that area to determine how involved it is in epilepsy. You would need to not just collect those signals, but also analyze them and be able to statistically determine whether the center that you're looking at is more involved than another center that's well known to be involved in seizure propagation or generation.

Why is it so important that we continue pursuing this kind of research?

For the last four or five decades we've had a number of advances in medication for things like Parkinson's and epilepsy, so patients have had some tools to improve their quality of life. But there's always been an upper level to how much we can help them. But now, research into treatments like focused ultrasound has opened new doors and enabled us to say, "This is no longer the upper limit of how good you can feel for the rest of your life. We can take you to a new level.”

Now that we know that it's possible to make that kind of leap for patients with essential tremor, we want to have similar success in other chronic neurologic conditions. Epilepsy is a huge area of research right now with focused ultrasound. Alzheimer's disease, depression, obsessive compulsive disorder, addiction—for almost any chronic neurologic condition or behavioral condition that we know is related to the abnormal function of circuits in the brain, we now have a tool to both investigate and potentially improve the lives of those patients.

For more information on how you can support Dr. Gwinn’s research and patient care, please contact Samantha Vanover, vice president of major gifts, at 206-386-3349 or samantha.vanover@swedish.org.