More than two million adults in the U.S. have epilepsy; 150,000 more will develop the condition each year. Usually, medication can control seizures but about 30 percent of patients do not respond. Now, patients have a new treatment option that uses lasers to stop the seizures.
For eight years, 30-year-old Nicole Dehn couldn’t drive. In 2005—she had a seizure while driving and lost her license.
“I was very, very depressed. I mean it’s a huge let down,” Nicole told Ivanhoe.
Nicole had her first epileptic seizure when she was just six months old and they got progressively worse. When medication failed, her only option was an invasive brain surgery that usually takes months to recover from.
“You actually remove a piece of the skull temporarily and then the surgeon has to go and physically remove or cut away the epileptic tissue,” Jerry Shih, MD, Director, Comprehensive Epilepsy Program, Mayo Clinic, Florida, told Ivanhoe.
However, Nicole opted for a different type of procedure called laser thermal ablation. A small hole is made in the back of the head and a laser probe is inserted into the skull. Using MRI guidance, heat from the laser then destroys the tissue causing the seizures.
“We’re very excited, she is excited, our patients have really all enjoyed having this option for them as a procedure,” Dr. Shih said.
Eight months after her procedure, Nicole is back to driving, and has been seizure-free ever since.
“Having my license back now, everything has just totally changed, new doors, new opportunities,” Nicole said.
The therapy is already FDA approved for treatment of tumors in other parts of the body such as the liver and kidney, but only recently has it been available for the brain.
About 14 patients have undergone this treatment to date at the mayo clinic. And researchers say that so far their first five patients all had positive results which included shorter recovery times, decreased number of seizures, and possibly less cost than the standard surgery.
The research is ongoing, but Dr. Shih hopes that one day the laser thermal ablation will be the standard of care for epileptic patients.
TOPIC: LASERS TARGETING EPILEPSY
REPORT: MB # 3761
BACKGROUND: Epilepsy is a medical condition that produces seizures affecting a variety of mental and physical functions. It is also referred to as a seizure disorder. When a person has two or more seizures, they are considered to have epilepsy. A seizure happens when a brief, strong jolt of electrical activity affects the brain. One in ten adults will have a seizure at some point during their lifetime. Seizures can last a few seconds or up to a few minutes. Symptoms can include loss of consciousness, convulsions, lip smacking, jerking movements of arms and legs, and blank staring. (Source: www.epilepsyfoundation.org)
EPILEPSY & THE BRAIN: The brain is the source of epilepsy. Symptoms can affect any part of the body, but the electrical events that produce the symptoms occur in the brain. The location of that event, how long the event lasts, and the extent of its reach within the tissue of the brain all have profound effects. These factors determine the character of the seizure, the social consequences, and its impact on the patient. (Source: www.epilepsyfoundation.org)
NEW TECHNOLOGY: Treating brain lesions are risky. The blood-brain barrier, which normally protects the brain from harmful chemicals, also keeps out many types of drugs. Now doctors can offer people with epilepsy another option. It is a laser technology that utilizes light energy to destroy soft tissue, including damaged tissue and tumor. The energy from the laser is delivered to the lesion using a laser probe. When light is delivered through the laser probe, temperatures in the target area rise and destroy the unwanted tissue. The procedure is guided by MRI images, so it can provide precise targeting. The patient is wide awake throughout the procedure. It doesn’t require radiation or a skull flap (the large skull opening in traditional craniotomies). It is minimally invasive and causes minimal or no pain during or after the procedure. It also does not limit use of additional or other treatment options. (Source: http://www.visualaseinc.com/, Dr. Jerry Shih)
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Jerry Shih, M.D., Director of the Comprehensive Epilepsy Program at Mayo Clinic, Florida, talks about a new way to treat epilepsies.
Can you tell me a little bit about the new MRI guided procedure?
Dr. Shih: We have a new procedure nowadays called thermal ablation for treating epileptic seizures. The standard procedure in the past has been what we call an open craniotomy, which is where you actually remove a piece of the skull temporarily and then the surgeon has to go and physically remove or cut away the epileptic tissue. This new technique however doesn’t do that, it’s minimally invasive and it requires just drilling a small hole in the skull and then introducing a catheter-type device which then allows us to heat up the epileptic tissue and destroy it.
That’s a pretty huge difference to patients, right?
Dr. Shih: It is. And the goal really is that we’re going to produce the same amount of removal or destruction of the bad epileptic tissue but not have a procedure that is going to involve complications and open surgery and other issues in terms of healing and things like that.
So what can the patient expect, in terms of recovery time after the procedure?
Dr. Shih: The standard procedure itself takes approximately three to five hours in the operating room. People come out and then for about three to four days they’re at least in the hospital and recovering from the surgery. When they go home we usually require that they take about a month off from their duties. With this minimally invasive procedure, the procedure takes approximately three to five hours in the operating room or in the MRI suite and then they stay overnight. The vast majority of patients go home the following day. And many of them feel up and ready to go to work and do things within about a week.
This is an FDA approved procedure but not for epilepsy, can you explain that?
Dr. Shih: Yes, that’s correct. The actual procedure itself is basically heating up tissue and therefore destroying that tissue. And this is FDA approved and this has been done in the liver, in the kidney, and in fact in other parts of the brain for brain tumors. The FDA doesn’t have a specific approval for this procedure in terms of treating epilepsy but the FDA approval is to basically ablate or heat or coagulate tissue and so even though there is not a specific indication for epilepsy it is certainly allowed to be used for epilepsy patients.
Is this going to have an enormous impact on a lot of people who suffer from epilepsy?
Dr. Shih: Epilepsy is a significant problem in the United States and in the world. About 2 to 2 and a half percent of people have a seizure disorder or epilepsy. So if you walk in the local malls on a busy day you’re going to at least bump into several people who have seizures. Of the people who have seizures we can control about two-thirds with medication which is the great news. They have their seizures controlled. But for about a third of them they have seizures despite being treated with the best medications. And for those one-third of patients whose seizures are not controlled with medications, a surgical procedure offers a potential for a cure.
For your patients that have gone through the trial so far have they talked to you about how significant it is that they don’t need to have their head cut open the same way?
Dr. Shih: Yes, all of the patients are given the option to go with the standard procedure or with this minimally invasive procedure. And the ones who’ve chosen this minimally invasive procedure have all chosen it because of the level of minimal invasiveness. They’ve all chosen it because they don’t like the idea of having brain surgery where part of the skull is taken away temporarily and then having the healing process. So the fact that it is minimally invasive was probably the most attractive part for them.
When you compare the two, is there any downside to this one?
Dr. Shih: We’re still in the process of doing a lot more studies. At this point in time it’s a little early to tell if the new procedure will produce the same outcomes as the standard procedure. But from everything we’ve seen this procedure is well tolerated. This procedure has given us good preliminary results, but again we are waiting to see ultimately the results over years. This is a relatively new procedure. So the early data is actually very promising, but again as with everything in science we need to sort of wait to see the long term outcome.
How long do you think it will be until this will be available to the general public? Because right now it’s only an option if you’re in the study, right?
Dr. Shih: Well, because this procedure is FDA approved, technically you don’t need to be in a specific study in order to get it. The fact is that this procedure is only offered to a limited number of centers because it’s relatively new and because the people who are trying to develop this technology have very rightly decided that instead of just throwing this out to the general public let’s really study this. Let’s make sure we know what works best, what patients are helped the most, what situations we need to be paying more attention to and what patients may not benefit, and so right now this type of procedure is really only available at certain centers like Mayo Clinic.
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