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Innovative Therapy and Research: Dr. Daniel San Juan’s Experience in the world of Neuroscience

April 29, 2022

Neurovirtual: Hello Dr. Daniel. We would like to thank you on behalf of Neurovirtual for accepting this interview. Could you tell us a little bit about your professional and academic background?

Dr. Daniel San Juan: I want to thank Neurovirtual for inviting me to tell a little bit about my professional trajectory as an Adult Neurologist, Clinical Neurologist, and Epileptologist. During all these years at universities in Mexico,- Universidad Nacional Autónoma de México and Harvard University (USA)-, and then with my master’s degree in Germany, I had the opportunity to acquire the skills and knowledge necessary to comprehensively assist neurological patients.

NV: How was your experience as the Mexican Society of Clinical Neurophysiology president?

Dr. DSJ: It was a particular honor to preside over the Mexican Society of Clinical Neurophysiology, which has a long tradition in the field. The institution was completed within the 50 years that I was president. Through direct contact with my fellow Mexicans, I had the opportunity to gain an overview of the current state of neurophysiology. Aside from the challenges, there are also opportunities to improve them. It was a truly enriching experience both personally and professionally, as well as academic, which is the Society`s goal.

NV: What was your experience as a researcher at the Mexican National Institute of Neurology and Neurophysiology?

Dr. DSJ: The National Institute of Neurology is a top-notch neurological center. It is one of the centers of excellence in Neurology, in Latin America. It was an honor that, when I started working at this institute in 2008, I had access to all research that had the objective to study human beings’ nervous systems. In addition, I had the opportunity to learn about preclinical and animal research. It is important to note that it is difficult for other institutions in Mexico or Latin America, to concentrate so much research on the main neurological diseases that affect Mexicans. So I believe it has been enriching for my training, not only as a scientist but also as an academic, and administrator.

NV: As an active member in the scientific research development around neurology and neurophysiology, what challenges are you currently facing and how? Can more research be done in neurology, epilepsy, and neurosurgery fields?

Dr. DSJ: Yes, there are many challenges that clinical neuroscience research still faces. At the Instituto Nacional de Neurologia, research is carried out in the three main clinical neuroscience areas: psychiatry, neurology, and neurosurgery. Each of them is individual, with different approaches, but the neurological problems are similar. We have, for example, Alzheimer’s disease, and vascular and brain neurological diseases. Despite not being so common globally, the management of brain tumors by neurosurgery is also a challenge that continues to exist. I believe that infrastructure is an important element, as much as human resources and training. Medical specialists must have time to carry out research and build it at a high level.

Government institutions, including public ones, also need funding for their maintenance. This has to do with the resources that each country has, whether economical or financial, for cutting-edge projects.

I believe that these are the most important elements to determine that a group of researchers, in this case, has access to patients to carry out research: technological resources and training.  In addition, funding is necessary to support these investigations in the short or long term.

NV: Doctor, among your more than seventy publications on neuroscience, which one do you consider the most challenging?

Dr. DSJ: It’s an interesting question because I think it is also related to professional development. Probably the first one, which seemed more challenging to me because I was learning. But as you progress, it follows the same learning curve. Currently, I think the most challenging is a clinical trial because we involve human beings, especially children. Mainly when I have to perform interventions. These are the most challenging because many scientific, academic, ethical, precautionary, and safety challenges need to be faced.

Interventions were carried out pharmacologically and non-pharmacologically, which posed the greatest challenge for the researcher. Not just for me, but everyone involved in it. Today, when one-off investigations are not carried out, it is necessary to coordinate scientific and international research teams, which poses an even greater challenge than carrying them out locally.

NV: About your publication, “Transcranial direct current cathodic stimulation in refractory epilepsy: a non-invasive neuromodulation therapy”, published by the American Journal of Clinical Neuropsychology, could you comment on how this neuromodulation therapy is performed?

Dr. DSJ: Of course! This therapy is innovative, experimental, and non-invasive, as the name implies. It has a long history and allows brain activity to be modulated. Upon returning to Mexico in 2008, after my studies at Harvard University, I saw that there were no resources available to treat patients with difficult-to-control epilepsy. We then collaborated with the same Harvard professors to enable the implementation of this experimental technology in our patients. In 2011, we first treated patients with Rasmussen’s encephalitis, which is a severe and progressive form of encephalitis, and the results were positive. The treatment was replicated in Turkey and Germany. As it is rare, or rather not so easy to get patients to receive this treatment, we did this study now in collaboration with Boston Children’s Hospital. This is the article that is published in the Journal of Clinical Neuropsychology in the USA. We included children and adult patients that are seen much more frequently. What we found is that it is a safe and effective therapy.

The reduction in the number of seizures in these patients is around 40%.  With that, the new drugs added to the treatment did not offer so many effects in reducing the number of seizures. So it seems like a good option. It is important to point out and convince the scientific community that “it is going well”. We believe this is an important publication because it is international, multicentric, and also includes children.

NV: Doctor, and what hypothesis does this research propose?

Dr. DSJ: The heart of research like this – about neuromodulation-  is that we can change or inhibit areas that have the highest level of epileptic activity. And with that, it is possible to reduce the number of seizures in patients. More interesting than seeing the surrounding phenomena is that patients have fewer seizures. We achieve up to 50% reduction, which is not easy.

NV: Doctor, could you tell us about the invitation to be the editor of the Journal of Clinical Neuropsychology in the United States?

Dr. DSJ: Sure. I have been an active member and am now a fellow of the American Society for Clinical Neurophysiology since I returned from the US. I had the opportunity to be a professor at the Society’s annual Congresses. In one of them, where we were presenting a symposium focused on these experimental non-invasive brain modulation therapies, the idea arose that this could be on paper. The editor-in-chief, Dr. Hossaín, personally made invitations to all panel members who were Mexican, as well as a US representative. Now it’s there, on paper, so that everyone, even those who didn’t attend the conference, can have access to this information, ideas, challenges, and developments that non-invasive neuromodulation entails today.

NV: Is this an alternative treatment to surgery? For what types of epilepsy can we consider neuromodulation?

Dr. DSJ: In this particular edition, we suggest that it can be applied to focal epilepsies. It is not yet a proven therapy and therefore should not delay a candidate for epilepsy surgery. However, unfortunately, not all patients are candidates for epilepsy surgery. Some are not even rated for it. Whether due to myths, risks, or lack of reference from doctors. Therefore, it constitutes a therapy that in the future intends to be an alternative for some selected patients. Not for everyone.

NV: In which cases is it recommended that the patient be operated on to treat epilepsy? Does this surgery recommendation change according to the patient’s age?

Dr. DSJ: This is a very important question because it has been discussed that patients can be operated on at many ages. However, in extremes of life, it is much more difficult, for example in newborns or patients over 65 years old. For medical and anesthetic reasons, not for neurological reasons.

Most patients, unfortunately, have an average of 19 to 20 years delay in evaluation for epilepsy surgery. However, if a patient has epilepsy that cannot be controlled with antiepileptic drugs, they would be a candidate to be evaluated.

Second, if the comprehensive assessment shows that all studies point to all abnormalities, both by neuroimaging and by clinical and electroencephalographic findings, it indicates that there is an area responsible for generating all seizures, and it can be removed. Putting it in context, adding an antiepileptic under these conditions, even if it’s very new, gives you 2% freedom from seizure. But maybe with surgery, at best, it will bring 80%. In addition to opening the possibility of healing.

NV: Would you recommend Neurovirtual to another colleague?

Dr. DSJ: Yes. It was another colleague who also recommended Neurovirtual to me. I think the way these devices can be promoted or recommended is basically through “how it works”. There are not many neurophysiologists in the field,  even in the United States it is not a very large group. With the high quality of Neurovirtual equipment, we easily recommend these types of devices and brand with which we carry out studies as they also allow data processing. Not only the standard but other options offered by the company.

NV: Doctor, with that question we end our interview. Once again, thank you for your time and for accepting.

Dr. DSJ: Many thanks to Neurovirtual for the invitation. And to all my fellow neurophysiologists and those who are interested in clinical neuroscience and in the particular analysis of brain functions, these devices that allow the recording of brain activity and the diagnosis and modification of treatment are highly recommended, reliable, and allow flexibility to your day today. Thank you very much.

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