An atlas of the brain

THE MOST COMPLEX organ in our bodies, the brain controls all of our senses – from our movements and physical responses to our minds. Despite the leaps made in the field of neuroscience over the years, much about the way in brain works remains a mystery. And when it goes wrong, such as with a cerebral haemorrhage or stroke, becomes inflamed or develops structural, biochemical or electrical abnormalities, the results can be devastating.
For the past several years, neurologists have routinely used advanced imaging technology to evaluate patients with suspected disease of the central nervous system. Now Thailand’s brain specialists have another tool to hand: a brain map that not only provides an understanding of the relationship between structure and function in the human brain but should help to prolong and save the lives of those suffering from such diseases as Alzheimer’s, Parkinson’s and dementia.
The brain mapping project, which was launched three years ago, is based on the Thai Brain Mapping research of Assoc Prof Dr Jiraporn Laothamatas, director of the Advance Diagnosis Imaging Centre (AIMC) of Ramathibodi Hospital.
The research brought together more than 2,000 volunteer samples representing people in five age groups starting six-year-olds to those over 65. Each group was further subdivided into male and female group and their scans, supplemented by additional information, has formed the first database of the Thai brain.
The volunteers’ brains were scanned with the Philips Ingenia MR, a digital broadband magnetic resonance system that generates up to a 40 per cent improvement in signal to noise ratio. Dr Jiraporn says that unlike the old generation MRI that only provided structural details, the Ingenia MR is able to collect information on the workings of the brain and the structure at the molecular level.
During the recent Asean Advanced Imaging Leaders Conference hosted by the AIMC and Philips, the neurologist explained the careful procedures adopted in selecting the right people for the Thai brain mapping. Every volunteer had to go through a neuropsychological test, a health check-up and a blood test prior to the scan.
The brain map serves as a reference of the average person’s brain. By applying brain mapping to a patient’s case, the doctor is better able to recognise health conditions that normally cannot be identified by imaging such as autism, Parkinson’s disease and Alzheimer’s disease.
“In the past, when a neurologist suspected a patient was suffering from early Alzheimer’s symptoms, an MRI would be ordered but almost inevitably the results would show no sign of disease. With the imaging techniques we now have, it’s possible to see if the patient’s brain is showing early symptoms of the disease,” Dr Jiraporn says.
“Using the brain mapping database to help diagnose brain symptoms can help slow down the progression of Alzheimer’s and Parkinson’s because we can see the symptoms earlier. This is a great improvement over the past, when all too often patients would only be diagnosed when the symptoms were very obvious, usually in the later stages of the disease. Now, by providing the proper treatment, we can slow the symptoms by 10 to 20 years.”
Brain mapping will also be useful in diagnosing and treating encephalitis, a potentially life-threatening condition whose cause is often unknown.
In addition to preparing this vital diagnostic tool, the project is taking a special look at child boxers.
Dr Jiraporn estimates that Thailand is currently home to more than 100,000 children between the ages of three and 16. A long-time fixture of Thai culture, the youngsters are often sent to boxing camps to continue their education and earn money for their impoverished families.
The children suffer repeated concussions, which often lead to brain damage. The project compared 13 of these young fighters to 200 children of similar ages in the brain mapping study and confirmed not just that their brains showed abnormalities but that their memory response was far lower.
“They look like ordinary children but all of them revealed abnormalities in their scans. Some have damage that looks similar to the diffuse axonal injury that occurs when the head is rapidly accelerated or decelerated, as may occur in auto accidents, falls, and assaults,” Jiraporn says.
But while the sport is dangerous for kids, banning them from taking part in fights is almost impossible.
“Once when the brain tissue is damaged, it can’t recover. So when there is something wrong in the brain, the fastest possible diagnosis and treatment is essential. Brain mapping will provide the clinical benchmark of health conditions and allows doctors to obtain a more precise diagnosis.”
Once the brain map is completed, doctors will be able to conduct research on mild cognitive impairment as well as mental disorders relating to neurons and chemicals in brain such as autism attention deficit hyperactivity disorder, schizophrenia and bipolarism.
In the meantime, the brain mapping of 300 child boxers will continue, along with follow up and research to clearly demonstrate the effects of boxing. Dr Jiraporn hopes the findings will push the government into looking closely at the health situation of these young fighters and take action to protect them from the sport.