Honouring Dr. Tellez-Zenteno’s Contributions to Epilepsy Research in Saskatchewan

Updated: Jan 7

“On October 2, 2020, we lost a valued member of Saskatchewan’s health research community. SHRF was saddened by this news and, on behalf of SHRF staff and the Board, I would like to wish Dr. Tellez-Zenteno’s family and colleagues our deepest condolences. Dr. Tellez-Zenteno held SHRF funding through our Health Research Group Grant program to develop a clinical and basic sciences group to serve patients with intractable epilepsy in Saskatchewan and build capacity in the field of epilepsy research in the province; and a Collaborative Innovation Development Grant to validate the use of mobile-EEG technology and the use of Telehealth for the creation of Canada’s first remote epilepsy clinic to serve those who live in distant communities in Saskatchewan. He was also a collaborator on other SHRF-funded projects in the areas of epilepsy and Parkinson’s disease. He will be remembered for his varied and important contributions to health research in the province, but more importantly, for the improved health he brought to Saskatchewan patients.”

– Patrick Odnokon, CEO, SHRF

Dr. Tellez-Zenteno was also supported by a partner organization of SHRF’s, the Royal University Hospital Foundation.

“The RUH Foundation and our donors have been honoured to support the work of Dr. Tellez-Zenteno since 2007 when he received the RUH Foundation’s Mudjadik Thyssen Mining Professorship in Neurosciences providing him with dedicated research time for five years, being a partner with the Saskatchewan Epilepsy Program’s annual Purple Day events, funding peer reviewed research initiatives, engaging with donors for new epilepsy equipment and monitoring technology and most recently supporting SHA’s request to raise $1.2 M to build a new dedicated four bed epilepsy monitoring unit at RUH. The Telemetry Unit was a program close to his heart and one Dr Tellez successfully advocated for. Our hearts go out to Dr. Tellez’s family, the Saskatchewan Epilepsy team, his patients and their families on behalf of the Board and Staff of the RUH Foundation.”

– Arla Gustafson, CEO, Royal University Hospital Foundation

You can see a collection of messages from friends, colleagues and patients on the RUH Foundation’s Facebook post here.

Donations made to the RUH Foundation in honour and memory of Dr. Tellez are going to support the Saskatchewan Epilepsy Program’s Epilepsy Monitoring Unit which will be opening in September 2021.

To learn more about Jose and his life’s work please visit http://josetellezzentenoepilepsy.com/

In 2019, SHRF shared a story of the work of Dr. Tellez and his team to ease the journey of patients in Saskatchewan to receiving an epilepsy diagnosis. In honour of Health Research Week and the impact that Dr. Tellez’s passion and commitment has had on the health of Saskatchewan people, we wanted to share this story again as a celebration of Dr. Tellez’s life and work.

Easing the Journey to an Epilepsy Diagnosis:

How one research team is taking an innovative approach to develop an epilepsy clinic using Telehealth and

a portable EEG machine

Research Team
From left to right: Chelsea Maskos EEG technologist at the Saskatchewan Epilepsy program (SEP), Pat Paulo administrative support at the SEP, Sareh Miranzadeh Master’s degree student involved in the project, Dianne Dash neurophysiology coordinator at Royal University Hospital, Dr. Lizbeth Hernández-Ronquillo epidemiologist at the SEP, Karen Waterhouse nurse at the SEP and Dr. José Téllez-Zenteno leader of the epilepsy research initiative

Facing a suspected epilepsy diagnosis can be complex and emotional for patients and their families and caregivers. Add in the need to travel long distances from rural and remote areas of Saskatchewan to reach specialists for diagnosis and treatment and this adds additional stress and costs to a patient’s journey.

Epilepsy is as common as five cases per 1,000 people and ranks as the second most commonly reported neurological condition worldwide. The incidence of new cases is also 2.1 times more frequent in northern Indigenous populations. These statistics outline a clear need for an innovative way for patients to access care in our province.

That’s where Dr. José Téllez-Zenteno and his research team come in to play. With funding from a Saskatchewan Health Research Foundation (SHRF) Collaborative Innovation Development grant, his team is investigating the use of Telehealth and a portable EEG device to see patients a little closer to home for the initial steps to diagnosis and decisions for an appropriate treatment plan.

The Saskatchewan Epilepsy Program (SEP) is located at Royal University Hospital (RUH) in Saskatoon. It is here that patients from across the province come for in-patient monitoring or possible surgical workups and to meet with neurologists and neurosurgeons for diagnosis and treatment.

“The time that it takes, not only the time the patient spends travelling, but the time it takes to arrange the travel, is a long time,” says Dr. Lizbeth Hernández-Ronquillo, epidemiologist in the epilepsy research initiative. “This Telehealth approach will mean that patients will be seen easier and faster. This research is working to prove the concept so that patients can be assessed, and they can have answers faster.”

Evolution of the electroencephalogram – EEG

“EEG is the gold standard test for epilepsy,” says Chelsea Maskos, EEG technologist in the SEP. “A lot of people don’t realize how limited of a resource that is.”

There is only one English-speaking school in Canada that trains technicians. To become a registered technician, it is a two-year program. Serving Saskatchewan is the SEP and one satellite lab located in Regina. The wait list to be seen by specialists is long.

So, what is an EEG and why is access an issue in our province?

EEG machine
EEG machines were once very large, sensitive machines that produced paper reports

Invented by German psychiatrist Hans Berger in 1924, an EEG, or electroencephalogram, catches the electrical activity, or brain waves, coming from our scalps. Traditionally recorded much like a polygraph, EEG machines historically were very large and used a lot of amplifiers and pens on paper to produce a large paper recording. These hefty reports would then need to be physically in front of a trained doctor to read and decipher. These machines were not portable, they were incredibly sensitive, and it would be difficult to get a nice clean recording. These large paper machines were used up until as recently as 2004.

Developments in technology have led to a somewhat more compact unit on a cart with a full CPU computer, an amplifier machine, a smaller headbox and about 30 wires that attach to the patient. The unit also includes a camera that records a video of the patients during EEG monitoring, allowing doctors to correlate the electrographic data with physical traits or symptoms that occur during the test. These units are still by no means portable and require the patient to come to the clinic for diagnosis.

Achieving the correct placement of the electrodes connected to each wire requires precise measurement by a technologist for each patient. Then you must apply a paste that scrubs the skin or causes micro-abrasions. This can be a source of infection and discomfort for the patient. The electrodes are then applied with a conductive gel and the patient’s head is wrapped up in a protective covering.

ZETO EEG helmet versus other materials needed to place electrodes for EEG
Pictured in the foreground is the new technology that replaces the need for all the materials pictured in the background currently needed to place wire electrodes on patients for an EEG.

More recently, there has been the invention of what is called a dry electrode system (ZETO-EEG). At first glance, the helmet holding these dry electrodes resembles a bike helmet. The embedded amplifiers and electrodes themselves look like small, soft, rubber-tipped wire probes. They are called dry electrodes because to ‘place’ the electrodes requires no abrasive paste or conductive gel. This new helmet also eliminates the need for measurement by providing a custom fit for each patient by simply tightening each section of the helmet.

“The helmet expands and contracts and still adheres to the standards for correct electrode placement,” says Maskos. “It’s much easier and quicker for the patient, requires less cleanup, and the helmet and its software have been developed in a way that it can be administered by an allied health professional.”

A Process of Validation

With any new technology or treatment approach, it’s important to validate that the method and results are consistent with traditional practice. The ZETO-EEG system is currently FDA approved in the United States, however, with differing standards in Canada, validation is the first step for the research team.

Karen Watherhouse, nurse coordinator of the SEP, explains that the plan to validate the technology and its potential use for Telehealth clinics in epilepsy in the future is to have 30 patients who had a single unprovoked seizure from the single seizure clinic, undergo the regular EEG, using the paste, gel and wire setup. These same patients will then have an EEG done using the dry electrode helmet and the results of both tests will be compared for accuracy.

In research, you need to start slow. That’s why the team is beginning the validation process before taking the technology further to rural and remote locations of Saskatchewan.

The research team is excited for the potential this innovative technology and approach holds for meeting the needs of patients across Saskatchewan. The transfer of information is a huge advantage with this new system. In real time, physicians and technologists with proper login can view the EEG and video recording at the same time that it is being administered.