Host: Hi, everyone. Thanks so much for joining us for this latest episode of Medically Speaking. Joining me today is Dr. Elad Levy, who is the Director of Neuroscience for Kaleida Health. Thank you so much for being here.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Thank you for having me.

Host: And you have a very busy schedule, so we really appreciate you squeezing in some time. We've tried a couple of times. But when business calls, you've got to be in the operating room and getting things done.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: We get it done.

Host: Yeah. Yeah, absolutely. Let's talk first about you have a vision, right, for this Center of Excellence when it comes to functional neurosurgery. First, let's define what that is, functional neurosurgery. What does that mean for folks that aren't familiar?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: That is probably the most exciting space in neuroscience right now. It deals with degenerative brain disorders, so the aging brain. It deals with movement disorders, like tremor, like Parkinson's. It deals with seizure disorders. Basically, that is all wrapped into a word called functional neurosurgery.

Host: Yeah. And I feel like that's something that we could all potentially relate to whether it's ourselves, an aging loved one, right? So, this is why this is important to potentially have a Center of Excellence here in Buffalo.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: I mean, who doesn't know somebody who has Parkinson's disease or tremor, they can't button their shirt or a seizure disorder or difficulty walking? These are all the things that now we have the technology to improve.

Host: Yeah. And you're talking about real life, daily life, being able to get dressed, being able to get up out of bed. The work that you're doing is so incredibly important, but we're using technology to make these people whole or as whole as they can be. What types of things do we have at Buffalo General and GVI that are getting us on the way to this Center of Excellence?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Well, one of the most recent technology acquisitions was ClearPoint. So, what we did as a neurosurgery department at UBNS is we brought in talent. So, we brought in Dr. Riley from Emory, we brought in Assaf Berger from NYU, who specialize in functional neurosurgery and functional technologies. And once we had the manpower, thanks to our donors and philanthropy, we're able to purchase ClearPoint, which basically within sub-millimeter accuracy can pinpoint different parts of the brain, and we can infuse genes and reverse some of these disorders. There's some gene trials that now we're going to be a part of. We can place electrodes. But basically, we can use this GPS type technology to get within a millimeter of some of the most critical and difficult parts of the brain without disrupting all the other pathways.

Host: It is extreme precision that you're working with, and I would imagine no room for error if you go too far in one direction or the other, what could that potentially mean for a patient that's already dealing with issues?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Well, certainly, we're not going to help them if we're off target and potentially can cause significant issues. So, being able to navigate sub-millimeter in the deepest parts of the brain is amazing. And then, to be able to potentially infuse missing genes and reverse symptoms like Parkinson's disease, for example, is just amazing.

Host: You talked about recruiting talent from Emory and other places. When you approach these doctors, these really talented specialists, what is the sell to come to Buffalo and explaining what we're doing here and why they should want to be a part of that?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Well, it's not the weather, so it's not the sell.

Host: Certainly not.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: But we tell them we've changed the world once, right? We talk about stroke. We've talked about stroke. But when you get down to it, you can do the Google search, you can ask ChatGPT, the epicenter for thrombectomy going up and pulling clots out of the brain was 2001, Nick Hopkins, a former chair, I was a fellow, and he asked this poignant question, "Can we stop strokes the way people stop heart attacks?" And 15 years later, we published in the New England Journal of Medicine, along with others, a new standard of care. We've changed the world. This was the epicenter of stroke, basically, intervention. And that's a sell. And we did it once, right? We already won a world championship, for example, if we were a sports team. We need people like you to do it again. And I think the future, we've done stroke, that's great, but we don't want to rest on our laurels. What's next for Kaleida Health, right? What's next for Western New York? This is our next. This is our collective next, functional neurosurgery.

Host: And don't be fooled because Buffalo is a medium-sized city. You don't have to be a large city to have the talent, to have the technology. You have to have the guts, right? The smarts, and combining all of that to create, again, what we hope is a Center of Excellence.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: I think being a medium-sized city was a gift, because in a large city you have so much competition and you're spending time looking in your rear view and your side view to see where threats are coming from. But because Kaleida has such a big footprint and because UB Neurosurgery has such a big footprint, really, all our focus is through the front window, right? We're looking forward. We're looking for strategic growth. We're looking to push the envelope, and that's been our culture ever since I got here in 2001.

Host: You were talking about the thrombectomy, right? You were recently in Paris addressing a huge crowd, and you were telling me a story about how there were naysayers way back when. "You'll never do it. You won't do it." You got to present to this group. What did you tell them? And, you know, it was basically sort of an "I told you so," right?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: It was fascinating. So, we're in Paris. It's one of their biggest meetings. There are about 3000 doctors on the main stage. And we're talking about how we're doing awake aneurysms now and all the cool stuff we're doing at GVI. And, you know, everyone is impressed. But one of the European doctors thought that this was not the right way to go. He basically said it bothered him to the core. And we'll use an analogy to courage. He's like, "You don't have courage." But he used another word, which we're not going to use.

So, I said, you know, "You all said that back in the early 2000s, you all said that about thrombectomy when we were changing the world. You all were naysayers, you all were doubters. You all thought that we were crazy cowboys out of Buffalo, New York." But everyone sitting in this room today uses the techniques that we pioneered and others for sure in Western New York.

So, I'm here to tell you again that we're onto the next, right? Yeah. That's been there, done that. What's next? And, you know, again, you use another word. I was like, don't challenge me when I have courage, because I said, "I have 'more courage' than all of you sitting in this room.

Host: We certainly showed them what we can do here in Buffalo. And you mentioned awake aneurysm.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: So, we are one of the only places at Gates that does awake aneurysms through endovascular routes. Are there some places that are doing it? Yes, but those are places where we trained those doctors. They were our fellows. But again, that was pioneered here. We published it here, we're now doing this as awake cases. And in the really healthy ones, some of them can go home the same day.

Host: Which is incredible. Speaking of incredible, let's talk about the permanently implanted brain computer interface. It's like something out of sci-fi or a video game. When I read about this, I'm like, "They can actually do that?" And you not only can you do it, you are doing it. You have done it.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: We have done it. We were one of three centers in the Syncron trial, which is using the body's vessels to place a brain computer interface. It was Kaleida as well as two other centers, one in New York and one in Pennsylvania. And now, we're on to sort of that second phase of the study that now that we showed that it was safe. And it was interesting. And, you know, Elon Musk gave a talk at one of our national meetings. He has Neuralink and, you know, they have robots doing it and, you know, his sort of passion, his modus operandi, his desire to do this is so we can download data faster and maybe we can compete with our iPhones and compete with other technology where we just want to make people human again, right? These are patients that may have ALS, Lou Gehrig's disease, or strokes and they can't move their bodies.

Host: You're talking independence.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: We're talking functional independence. They can't speak. They have to have a caretaker 24/7. But imagine this brain computer interface can outsource their speech, outsource their reading. They can use WhatsApp or an iPad or motorize their wheelchair just by thinking about it. Turn on a light just by thinking about it. This is sort of gen one computer interface, but we're really excited because I think that's the future. Can we restore your humanity, your independence after an injury?

Host: How does that work? Because we're talking teeny tiny pieces, right? And how do they get implanted? Are you going in through arteries or veins? Clearly, you're the professional over here. I don't even--

Well,

Elad Levy, MD, MBA, FACS, FAHA, FAANS: if you tell your listeners, they may not come to Gates anymore, right? They're not going to come here.

Host: We don't want to give away too many trade secrets.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: So, the way we've been doing it is we go through the jugular vein, up the vein, and then kind of backwards, right? Veins drain the brain. But we go against the grain, swim upstream and position it over the center of the brain. So, both the motor cortex, a part of your brain that creates motor function, and then we train that computer. So when you think of things, that computer lights up in a certain way and your brain lights up in a certain way, but there's a disconnect, right? Your brain is a power plant, but it's not getting to your arms and legs. So, the computer understands those waves, those brainwaves, and basically can then tell a computer interface what to do.

Host: Can you train that computer to do different things, speech versus being able to walk, or is it one-size-fits-all?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: So, this is gen one and certainly we can train it to do many things. And it outsources to peripherals like Apple Vision Pro, an iPad, a motor, potentially a wheelchair. I think right now, the technology in the future is limitless. But we're learning, we're growing. It's still gen one.

Host: For the patients that have been through this gen one, what does it mean for their future and what they're able to do now that they perhaps weren't able to do prior to this?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Oh, the videos are tremendous. It's emotional. It's game changing, because it connects them to the outside world. Imagine that you're just in a chair, you're awake, but you can't interface. Somebody has to ask you, "Do you want a glass of water? Do you want to go to the bathroom? Do you want me to take you outside?"

Now, imagine flipping that and you just have to think it, and the iPad will convert it into speech and say, "Can I have a glass of water? Can you wheel me outside?" I can turn the light on by looking at a light icon. And so, it is amazing that we are restoring people's functionality. And the amount of functionality is certainly going to grow as we get better with this technology.

Host: I'm sure you have a long wishlist of things that you would like at GVI. Is there anything on the horizon that is really important that you think can bring us to the next level? And how do we acquire something like that?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: So, my focus right now is-- so, we are a center of neurovascular disease. We see patients from Europe, Middle East, all over the world, recently from Asia. We would like to make a center of excellence for functional neurosurgery, everything you asked me about. And one of the other pieces of equipment that's integral is in sci-tech. And maybe I'm dating myself, but if you've seen Star Trek or any of these kind of sci-fi shows, you may be injured, they wheel you into a machine or they pass some weird light over you and energy fixes it.

Host: Okay.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: So, imagine now instead of having to cut a hole in your skull or go through brain tissue to fix a lesion, we can use energy, ultrasound to fix a tremor. So, you can't drink your coffee in the morning because your tremoring and it spills all over. You need somebody to button your shirt, unbutton or tie your shoe because of your tremors. And now, we make small incisions, we implant electrodes. But imagine we don't have to do that. Imagine you lay down and we use focused ultrasound. Ultrasound just like you may see--

Host: Just the ultrasound waves going through your body.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: But highly focused ultrasound to treat a lesion or basically create the right sort of lesion in the brain that fixes the tremor. No incision. And that's the equipment that we are acquiring.

Host: Yeah. And no incision, what does that mean for a patient? Immediately, I think of fewer risks, fewer complications, fewer chances for maybe an infection. Are there other benefits to not having to actually go into somebody's head and through their skull into their brain.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Well, I can tell you in the many thousands of patients I've operated on, not one was excited for us to cut into their brain. Not one.

Host: I would imagine. It's a little scary.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: So if I could have said to them, "Hey, you know what? We don't have to open you up, we don't have to do brain surgery. We can do this non-invasively using energy." I mean, game-changing. And a lot of these patients aren't healthy, right? So, the risks are very high when you're dealing with frailty, right? These are older patients sure enough.

Host: Sure. What else is on the horizon that is exciting? There's probably so much in your world.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: So, the world of brain computer interface is exploding. There are many companies. So right now, we are becoming this epicenter or this sort of technology clearinghouse for functional. So, we're going to be looking at some other brain-computer interface technologies that are a little maybe different than the one we're looking at. We're continuing to sort of build with manpower, so we're recruiting a few more neurosurgeons that are focused. We recently recruited one that does minimally invasive tumor removals from the skull base, Dr. Algattas. So, I can't imagine a future more exciting for the partnership between UB Neurosurgery and Kaleida.

Host: You touched on philanthropy a little bit. I always use the cell phone as the analogy, right? You buy one cell phone. Within a couple of, you know, weeks or months, the newest, latest, greatest technology comes out. It's more expensive. But you have to have it. Now, that's a cell phone. We're not saving any lives with cell phones. The equipment that you and your teams use, I would imagine changes all of the time. You talked about generation one, the next generation, and the one after that. But it's expensive, right? How do we acquire this with the help of very generous people who believe in you and your mission and your team's talent and what they can do in the future?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Yeah. Great, great points. The head is challenging, right? We can't see in it. We need technology to look inside. Basically, there's not a lot of space there. Very high rent, right? Millimeters are high rent. These are like penthouse Park Avenue, right? Whether you move a few millimeters left or right, you need to be precise. And to your point, this is some of the fastest evolving technology. Nothing is evolving faster than neuroscience tech and neurotech. Nvidia, all these other companies are investing in it, because what we're doing today is something that couldn't even have been imagined five or 10 years ago what we can treat and with the safety; doing patients awake, doing aneurysms outpatient. You know, maybe we thought about this 20 years ago, but we just started doing that this year. Energy to treat patients with brain disease, again, unbelievable. And this technology is expensive. And I want to thank all the people who've donated to Kaleida and all the philanthropy because it's not possible without them. And we certainly hope it continues because the culture, as I said, is innovation. It is being on the leading edge. It's about inspiring kind of our community into the collective what's next.

Host: Yeah. And we can't wait to see what's next. Thank you so much for being here with us today. We covered a lot. You're also very active on social media, posting different studies that you're a part of, different articles. How can people stay up to date on the very latest that you're up to?

Elad Levy, MD, MBA, FACS, FAHA, FAANS: Well, we have X or Instagram, EladLevyMD. So, we show teaching videos, it's our professional or UBNS has its own social media handle too.

Host: And I see you on LinkedIn a lot as well so...

Elad Levy, MD, MBA, FACS, FAHA, FAANS: And LinkedIn.

Host: We'll come and track you down. All right. Dr. Elad Levy, our guest for today. Thank you so much. We appreciate your time and I can't wait to have you on again in the future to talk about the next generation of things that are happening at Buffalo General and GVI.

Elad Levy, MD, MBA, FACS, FAHA, FAANS: It's been my pleasure. Thank you.

Host: Thank you.