New robotic surgery transforming epilepsy treatment
More than three million Americans have epilepsy, a brain disorder that causes recurring, unprovoked seizures. Many patients have experienced successful treatment with medication, but up to a third of epileptics are resistant to seizure medications. Now, medication-resistant seizures that might have been incurable several years ago are being treated with new surgical techniques using robotics.
Dr. Alex Whiting, director of epilepsy surgery for Allegheny Health Network (AHN), is using the new technology to help patients across Southwestern Pennsylvania.
“The ROSA robot has allowed us to place electrodes into deeper parts of the brain in safer and more minimally invasive ways than ever before,” Whiting explains. “Each electrode incision is less than a few millimeters wide and small enough to close with a single stitch. We can place a significantly denser array of electrodes, which makes us much better at finding exactly where a patient’s epilepsy is coming from. More importantly, because it is so minimally invasive, the patients can go home the day after we are done with the procedure and be essentially back to their normal selves immediately.”
One patient who has benefitted from this procedure is Silas Johnson of Oakmont. After developing epilepsy at age 19, Johnson started experiencing three to four dangerous seizures a week, was unable to leave home and needed constant care. His doctors tried various medications, but nothing seemed to help. Finally, he met Whiting, who performed the robotic mapping on Johnson’s brain in October.
“Before we started the robot program, you couldn’t do this in a minimally invasive way,” Whiting says. “Now, we put these electrodes in with a robot, and place them through little holes you can barely see. And in Silas, we found that his epilepsy was coming from a part of his brain that we could treat without causing harm.”
A year and a half after the procedure, Johnson is doing well and hasn’t had a seizure in four months. He’s looking forward to taking his first vacation in years and going back to work. “If it wasn’t for Dr. Whiting, I’m telling you, I wouldn’t have known what other path to take,” he said.
How does it work?
Every patient’s epilepsy is different, and any part of the brain could be causing the seizures. For many patients with epilepsy, even extensive workups do not reveal which part of the brain is causing their seizures, which makes it very difficult to treat. Now, surgeons are using stereo-electroencephalography, or SEEG for short, to map the brain.
“During the procedure, we place electrodes throughout parts of the brain where we think the patient’s epilepsy might be starting,” Whiting said. “We then watch the patient for several days in the epilepsy monitoring unit, and when they have a seizure, we can see where it starts in the brain and where it spreads to. Once we figure this out, we have a host of tools and treatments to target that part of the brain, sometimes curing their epilepsy for good. When we have enough information, we take the electrodes out and the patient can go home the next day. Nothing stays in permanently.”
Whiting said SEEG is just one tool in the toolbox to help treat epilepsy by understanding where it is originating. “Sometimes this involves surgical resection, laser ablation or neuro-stimulation,” Whiting said. “All of them work very well for certain patients, but we have to know exactly where the seizures are starting in order to use them. Ultimately, the electrodes in SEEG help us figure out which tool is the best one to use for each individual patient.”
The SEEG program at AHN is relatively busy, with doctors performing two to three of the procedures per month. Whiting said with how safe and effective SEEG has become, he thinks it will become a much more commonplace treatment for medication-resistant epilepsy patients over the next several years.
Whiting said the new treatment is offering hope to patients whose quality of life has been impacted from the disorder.
“Having seizures is just tough on the brain,” he adds. “It’s essentially an electrical storm taking over the entire brain. Having untreated seizures for a long period of time can cause permanent damage to the brain, which can affect mood, memory and cognitive functioning. Patients with certain kinds of epilepsy are at high risk for traumatic falls, hitting their head, and other dangerous behaviors.”
Many patients’ epilepsy prevents them from doing simple things, like holding a job, going for a walk alone or driving a car. That can often lead to anxiety, depression and other health issues. Whiting sees the new procedures as a light at the end of the tunnel.
“I think the most important thing to know is that if you have epilepsy, have tried two or more medicines, and are still having seizures, the current recommendation is to have a surgical evaluation at a center like ours,” he said. “There are so many new ways to treat epilepsy, many of them minimally invasive, that it is certainly worthwhile to see if one of these new treatments could help.”