Surgical and clinical advances help providers and patients gain a better understanding of epilepsy.
By P. David Adelson, M.D.
A pediatric epilepsy diagnosis can be devastating. Parents are all too familiar with the terror and helplessness they feel when their child experiences a seizure. For kids, epilepsy creates hurdles socially and academically. Classmates may not want to befriend a child who has seizures, and anti-seizure medications can cause side effects that impair learning. At Barrow Neurological Institute at Phoenix Children's Hospital, we treat some of the toughest cases. New treatments are less invasive, lower risk and deliver excellent outcomes—even for kids who don’t respond to anti-seizure medications. In some cases, we can eradicate the disease.
A number of medically intractable epileptic children suffer from hypothalamic hamartoma (HH), a rare, noncancerous brain lesion, which causes gelastic or "laughing" seizures. In the past, treating HH required removing the lesion through open surgery or an endoscope. Patients with tumors in an inoperable area of the brain had few options. But by using a laser ablation procedure, we’re curing epilepsy in children with HH and other types of seizures with focal onset.
This minimally invasive procedure requires the expertise of neurology, neurosurgery, neuroradiology, pediatric anesthesia and numerous other disciplines. First, a small, flexible laser applicator is guided to the target using a computer targeting system. The child is then placed in an MR scanner, and MRI is used to guide and monitor the effects of the laser on the tissue. The laser light naturally heats and eradicates the lesion and its connections to the seizure network. It’s necessary to view these tissue changes in real-time to prevent damage to surrounding healthy tissues.
The treatment is accurate within millimeters and requires just a single stitch when the laser is removed. The effectiveness of the procedure, combined with careful decision-making with HH patients, has resulted in 100 percent success; every one of the laser ablation patients is cured.
Vagus nerve stimulation (VNS) prevents seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve, which passes through the neck as it travels between the abdomen, chest and the lower part of the brain. A pacemaker-like device under the skin generates the pulses. Newer models transmit seizure data and allow neurologists to adjust the strength and timing of the pulses.
Another option, responsive neurostimulation (RNS), is nearing FDA approval for children. Doctors implant electrodes connected to a device under the scalp. Leads from the device monitor brain waves, looking for activity that may lead to a seizure. The RNS sends pulses that disrupt seizures and normalize brain waves, often before the patient feels symptoms. This device comes with a remote monitor that collects brain wave data and seizure activity. VNS and RNS work 24 hours a day, and the outcomes are astounding. In addition to reducing or eliminating seizures, patients don’t suffer any side effects associated with anti-seizure medication.
Our ability to diagnose and treat epilepsy has improved dramatically in recent decades. But to continue innovating and identifying solutions, we must first be willing to talk about the problem. Our work is in treating epilepsy patients, and our mission is to help children live happy, normal lives, free of the symptoms of epilepsy.
P. David Adelson, M.D., is director of the Barrow Neurological Institute at Phoenix Children's Hospital and chief of Pediatric Neurosurgery. Send questions or comments to firstname.lastname@example.org.