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Newest Surgical Techniques for Treatment of Epilepsy

Epilepsy and Seizure TreatmentSeeing a loved one suffer a seizure can be a terrifying experience. And when she receives a diagnosis of epilepsy—a condition involving recurrent seizures—it can be devastating. Epilepsy, which affects up to 3 percent of the population, can be a real game changer for people trying to live a quality life.

It is very common for people with epilepsy to take medication to control their seizures. However, many patients continue to suffer from seizures despite medication. In these patients, physicians often look to epilepsy surgery to try to prevent patients from seizing.

It is important to stop patients from seizing, if possible. Epilepsy impacts patients’ quality of life and prevents them from activities like driving. In addition, patients with epilepsy may not live as long if their seizures are not controlled, and in rare cases they can die from sudden unexplained death in epilepsy (SUDEP).

Neurosurgeons have been focusing on exciting new techniques for both diagnosis and treatment of recurrent seizures. Such advances were recently reported in a paper by Columbia University Medical Center/NewYork-Presbyterian Hospital neurosurgeon Dr. Guy McKhann. He published the paper*, with Columbia neurosurgery residents Dr. Robert A. McGovern and Dr. Garrett P. Banks, in the journal Current Neurology and Neuroscience Reports.

First, the doctors describe a minimally invasive procedure that is used to find the seizure focus; this is the part of the brain where the seizure originates. The technique is called stereoelectroencephalography, or SEEG.

Most patients are familiar with traditional electroencephalography (EEG), where sensors known as electrodes are placed on the scalp. By measuring the brain’s electrical activity, traditional EEGs can tell us about the type of seizures a patient is having and the approximate location.

To better identify the exact region within the brain where seizures begin, surgeons can place electrodes directly onto the surface of the brain. However, this requires a major operation, with removal of a portion of the skull.

A less invasive and safer method of finding the seizure focus is SEEG. Here, surgeons use sophisticated computer imaging to produce a highly precise three-dimensional map of the brain.

Using this information, together with a patient’s seizure behavior, our epilepsy team of neurologists and neurosurgeons like Dr. McKhann and pediatric neurosurgeon Dr. Neil Feldstein predicts where the patient’s seizures are most likely to arise in the brain. Dr. McKhann and Dr. Feldstein then place electrodes directly into specific areas of the brain to record the patient’s seizures.

Instead of opening a large portion of the skull, the surgeons are able to accomplish this by making tiny holes in the skull. This allows them to go deeper into the brain and also reach more areas of the brain spread farther apart.

Once a seizure focus is precisely identified, Dr. McKhann can treat it using a variety of methods. One described in the paper is laser interstitial thermal therapy (LITT).

Here, the neurosurgeon threads a laser fiber through a small hole in the skull and into the brain, where it can destroy the abnormal seizure-causing brain tissue with a burst of heat. The major advance in LITT is the ability to use brain MRI scanning to follow the laser damage in real time, which increases the accuracy and safety of the procedure.

Radiation is another method of treatment described in the paper. In a procedure called stereotactic radiosurgery, the physicians use CT and MRI scans to pinpoint the seizure focus. They then direct a beam of radiation directly at the area to destroy it. Despite the word “surgery” contained in the term, radiosurgery is noninvasive; the radiation eliminates the problem without a single incision.

The authors also discuss another treatment, electrical stimulation. Just as a cardiac surgeon might install a pacemaker to alter the heart’s activity, a neurosurgeon can change the electrical activity of the seizure focus.

Several different methods of electrical stimulation are possible. In anterior thalamic stimulation, the surgeon threads an electrode through a small hole in the skull to the thalamus, an area in the lower part of the brain.

In vagus nerve stimulation, they plant electrodes in a nerve called the vagus nerve. The vagus nerve runs from the brain and influences many brain and body functions. It can be reached through the chest and neck. Once implanted, the electrodes can produce electrical impulses that can modify or turn off seizure activity.

Finally, Dr. McKhann discusses a technique that carries electrical stimulation one step further. In responsive neurostimulation, an electrical device is actually implanted in the seizure focus, where it’s able to record activity. Based on the activity it “sees,” the device is able to predict that a seizure is about to happen. It can then produce an electrical impulse that can turn off the seizure activity.

You can learn more about the latest techniques used in the treatment of epilepsy in the authors’ paper here.

Learn more about Dr. McKhann at his bio page here.

*Paper authors: McGovern RA1, Banks GP2, McKhann GM 2nd2.

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