Two recent studies were presented at the American Epilepsy Society 66th Annual Meeting in San Diego, US. Both have shown developments in using ‘laser ablation’ surgery to treating epilepsy.
Laser ablation is less invasive than traditional surgery for people with epilepsy. The procedure has quick recovery times, involves little pain and causes minor tissue disruption. This lowers the risk of unintended side-effects after the operation.
During the procedure, a surgeon drills a tiny hole into the skull. This is where a probe is inserted, which combines a fibre optic device with a surgical laser. The procedure is monitored using magnetic resonance imaging (MRI), while the fibre optic probe allows the surgeon to guide the laser inside the skull.
The surgical laser burns away a selected area of brain tissue, where seizure activity usually starts. A water system is used to keep the nearby tissue cool. EEG monitoring is used to observe brain activity throughout the procedure.
Michael G Chez MD is Director of Child Neurology, Sutter Neuroscience Group in Sacramento, California. He led these research projects and reported on the findings of both during the annual meeting in San Diego.
Research from Sutter Medical Center
Dr Chez’s team at Sutter Medical Center, Sacramento, tested laser ablation in four people (all children or young adults ranging between ages eight and 19 years old). All of them were pain-free and moving around within six to eight hours after the procedure.
The results show that following the surgery, three of the patients were seizure-free. The fourth patient, who has a complex genetic disorder, showed reduced epileptic activity. Although this participant did not achieve seizure freedom, their seizures were still successfully reduced from four seizures a day to just one a week.
Dr Chez said: “We have had very good outcomes with no complications in children who are now two months to 12 months post-surgery. Once patients recover, they go home within 24 hours and even within hours of surgery most are up, eating, talking and walking.”
Research from Miami Children’s Hospital
Another research group from the Miami Children’s Hospital showed results from laser ablation on five young adults, aged between 11 and 18 years. Two of the patients had not responded to previous attempts to control their seizures with traditional surgery.
The research showed that the mean length of hospital stay was only 1.6 days, compared to “three to five days for typical craniotomy (traditional surgery)”, according to Dr Chez. Also, there were no complications from infection, bleeding or neurological injury.
Researchers used the Engel Class scheme to classify the results. After the procedure, two of the children were ‘Engel Class I’, which is completely free of disabling seizures. Two were ‘Engel Class II’, which is almost seizure-free. One child was seizure-free, but only after traditional resection surgery, not after just laser ablation.
Laser ablation can also be beneficial to children with cognitive or behavioural problems, or people who might not tolerate traditional surgery. However, laser ablation will not completely replace conventional surgery. Dr Chez said: “Craniotomy is still the gold standard, and we don’t have any data saying [laser ablation] is better long-term. What we’re saying is that for patients who may not tolerate craniotomy or would like to try this first, it might be an option.”