HOUSTON, TX (Ivanhoe Newswire) - Peeling back the scalp, cutting the skull and removing a chunk of the brain. It's the traditional way to cure certain kinds of epilepsy, but the complications can be worse than the seizures. Now there's a new high-tech and low-risk way to erase epilepsy.
Robin and Khris Dysart say their son Keagan had a seizure three times every hour. A craniotomy was the best chance for a cure. Surgeons may have to take out normal brain tissue to move the lesion causing the seizures. Complications can include paralysis and uncontrolled urination.
"There were lists of children who have died," Robin Dysart, Keagan's mom, told Ivanhoe.
"You can't put back brain that you wish you hadn't taken out," Angus Wilfong, M.D., director of the Texas Children's Comprehensive Epilepsy Program at Texas Children's Hospital, said.
To avoid taking out any brain, doctors Wilfong and Daniel Curry of Texas Children's Hospital developed a low-risk minimally invasive MRI guided laser surgery to cure epilepsy. Keagan was one of their first patients. With a tiny instrument smaller than the size of a pencil lead, the doctors navigated their way to Keagan's deep-seated lesion
"Actually it's possibly the worst place you can have a lesion," Daniel Curry, M.D., Director of the Functional Neurosurgery at Texas Children's Hospital, said.
With the MRI, they were able to see in real time exactly where they were in Keagan's brain. The doctors watched the laser destroy the lesion and cure Keagan's epilepsy
"That's exactly what's happening and it's really amazing to see," Dr. Wilfong said.
Today Keagan is seizure free.
"Now the world has opened up to him," Robin Dysart said.
Instead of his seizure-induced giggles, he's a happy boy.
"We walked around the corner and he was really laughing for the first time we've ever heard him laugh at a TV show," Khris Dysart, Keagan's dad, said.
Texas children's hospital is the first in the world to perform the MRI guided laser surgery to cure epilepsy. The procedure was adopted from a technique to treat brain tumors. It's now being used for kids and adults. The doctors tell us some of their patients go home the day after their brain surgery.
BACKGROUND: Gelastic seizures are epileptic events characterized by bouts of laughter. Laughter-like vocalization is usually combined with facial contraction in the form of a smile. Gelastic epilepsy is very rare and occurs slightly more commonly in boys than in girls. Of every 1000 children with epilepsy, only one or at the very most, two children will have gelastic epilepsy. (SOURCE: www.epilepsyfoundation.org, www.ncbi.nlm.nih.gov/pubmedhealth)
The gelastic and other types of seizures are often very difficult to control. It is rare for anyone to have their seizures controlled for more than a few weeks or months at a time. The best outcome is probably seen in those children (and adults) who have a benign tumor in the hypothalamus (the hamartoma or astrocytoma) causing their epilepsy. Successful surgery in these children and adults may improve not just their seizure control but also improve their behavioral and even learning problems. (SOURCE: epilepsy.org.uk)
TREATMENT: The type of treatment prescribed will depend on several factors including the frequency and severity of the seizures as well as the person's age, overall health, and medical history. The majority of epileptic seizures are controlled through drug therapy. Patients may take a drug called anticonvulsants, to reduce the number of seizures they experience. Patients may also make changes to their diet. In certain cases in which medications and diet are not working, surgery may be used. (SOURCE: www.ncbi.nlm.nih.gov/pubmedhealth, www.webmd.com)
LATEST BREAKTHROUGHS: Real-time MRI-guided thermal imaging and laser technology is now being used to destroy lesions in the brain that cause epilepsy and uncontrollable seizures. The surgery is performed by first mapping the area of the brain where the lesion is located using magnetic resonance imaging. The catheter is inserted through the skull in the operating room and then the patient is transferred to an MRI unit where the ablation of the lesion is performed. The MRI confirms probe placement in the target, and the magnetic resonance thermal imaging allows the surgeon to see the ablation of the lesion by the laser heat as it happens with an automatic feedback system that shuts the laser off when the heat approaches nearby critical brain structures. SOURCE: (www.texaschildrens.org)
Dr. Daniel Curry, Assistant Professor of Pediatric Neurosurgery at Baylor College of Medicine-Texas Children's Hospital, talks about a laser that's zapping seizures!
Tell me a little bit about the laser.
Dr. Daniel Curry: The ability for us to target lesions with this laser is actually greater than when we're doing epilepsy surgery. In the conventional manner we can be very precise because it's microsurgery, but our problem is especially on deep seated targets. In a traditional surgery, we have to make relatively large incisions just in order to get our surgical instruments to our target. What this new technique allows us to do is, forego that large operation and the large incisions in the outer layers of the skull and brain and allow a very small straw sized trajectory through the brain tissue and into these central targets. It's entirely different from a conventional craniotomy and resection of say a deep seated lesion like a hypothalamic hamartoma.
How small is that incision?
Dr. Daniel Curry: Theincision is literally what we call a stab incision. It's about 3 mm, 4 mm and there's no hair shaved. It's simply parted and the hole that we make is 3.2 mm wide. Through a 3.2 mm entrance into the skull we can get to a lesion that is 2-1/2 cm wide with this laser.
Can you tell me about Keagan?
Dr. Daniel Curry: Keagan tumor was actually in the worst place you can have a lesion and incredibly difficult to get to through surgery. It's right in the middle of the brain. It's surrounded by the tissue called the hypothalamus which takes over a lot of the functions that we don't think about like heart rate, appetite and consciousness. The other circuits that go very close to this lesion are those that are connected to our memory system. Traditionally, to get there we would have to perform a very large operation because it's in the middle of the brain and we have to injure the 7 cms of intervening brain to get to the lesion. We make a hole in the skull after doing an incision on the order of 7-10 cms. Once we get to the bottom of that space between the two hemispheres we actually have to cut the crossing fibers of the two hemispheres in the front part of the brain. Once we're there, we then have to make another incision in what's called the third ventricle, a fluid filled space in the very base of the brain. We have to separate out the memory circuits, which are very nearby and they're very delicate and intolerant to retraction, so that's why a lot of the children who have the conventional approach have profound memory problems. This type of surgery has many risks including the risk of blindness, paralysis and all of our patients develop a condition called diabetes insipidus and have to be treated with medicine for the rest of their lives or they could urinate to death.
With the laser procedure, since it is a minimally invasive procedure, all of these risks subside dramatically and most patients go home within a day after surgery seizure-free. Keagan went from having 3-4 seizures an hour to being seizure-free.
How does the laser work?
Dr. Daniel Curry: A catheter is inserted through the skull in the operating room and then the patient is transferred to an MRI unit where the ablation of the lesion is performed using the laser. The MRI confirms probe placement in the target, and the magnetic resonance thermal imaging allows the surgeon to see the ablation of the lesion by the laser heat as it happens with an automatic feedback system that shuts the laser off when the heat approaches nearby critical brain structures. We can put the cursor on those targets and the computer will immediately detect any increase in temperature near that target and shut off our system automatically. It's controlled with us, but it's also controlled automatically which is another level of safety for this device. It's also maximally engineered so it's cooled, and the heat that we deliver is very much controlled.
FOR MORE INFORMATION, PLEASE CONTACT:
Texas Children's Blue Bird Circle Clinic (832) 822-5046.
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