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Three-stage brain operation for severe seizures appears promising - study

11 May, 2006

A new three-stage
brain operation to perform epilepsy surgery has been hig

hlighted as a
success in a report published in the journal Pediatrics.

The
study followed 25 children with the condition tuberous sclerosis, all
operated on in the last six years by paediatric neurosurgeon Dr Howard
Weiner, associate professor of neurosurgery and pediatrics at New York University School of Medicine.  

Nearly
all of the children, aged between 7 months and 17 years and all with
severe epilepsy, underwent three separate brain operations over a 2½
week period.

Tuberous
sclerosis produces tubers (growths) on many organs in the body,
including the skin, kidneys, lungs, and eyes. In the brain, the hard
calcified growths can cause seizures.   Many children with the
condition aren't usually considered suitable for brain surgery because
it is difficult to identify which tubers are causing seizures using
electroencephalography (EEG).  To overcome this problem, neurosurgeons
place electrodes directly on the brain itself, which requires removing
a portion of the cranium and cutting through the dura mater, the tough
fibrous tissue covering the brain. The implanted grid of electrodes,
attached to an EEG machine, is used to continuously monitor seizure
activity over several days, providing a map for the surgeon to the
location where the seizures arise. In the second operation, the surgeon
removes the seizure-causing tissue in the brain.

Dr
Weiner, in this new surgical technique, places another set of
electrodes in the brain after the second operation in order to locate
any other areas that may be causing seizures. Children are again
monitored with a grid of electrodes over a period of days, and then
undergo a third operation to remove any tissue that still may be
causing seizures.

Two
or more years after the operations, 17 of the 25 children were free of
seizures or had only mild non-disabling attacks. Six children still
experienced more severe non-disabling seizures but the number of such
seizures was reduced by more than 90 per cent. In two children the
number was reduced by 50 per cent to 90 per cent.

Despite
the risks of brain surgery, Dr Weiner and his colleagues report that
the multiple surgeries did not cause serious infections or permanent
damage to the brain.

'We
have established that this type of surgery is safe.  Certainly this
type of surgery should only be reserved for the toughest cases -
children with tuberous sclerosis who are having uncontrolled seizures
in association with developmental delay or even regression.'