Minimally invasive laser-based surgery for epilepsy is under investigation

Minimally invasive laser-based surgery for Epilepsy

According to the Mayo Clinic researchers, patients with epilepsy can now benefit from a new minimally invasive laser-based method. Preliminary results, presented at the American Academy of Neurology, show that this new method has a quicker recovery time than open surgery while the benefits are similar.

The standard treatment for patients with epilepsy who do not respond to medical treatment is surgery. Surgical treatment consists of removal of the area of the brain that cause seizures. It should be noted that surgery is a solution when the location of the crisis is clearly identified, and the procedure is called temporal lobectomy (when the crisis are located in the temporal lobe). This type of surgery is successful in about 80% of patients, but recovery time is quite slow, that is patients need several days of hospitalization and one to three months before returning to daily activities.

Epilepsy

The new technique developed by researchers at Mayo Clinic is promising because it shortens recovery time and does not involve additional risks of open surgery. Co-author W. Richard Marsh, MD, a Mayo Clinic neurosurgeon, said that although it is still under investigation, the new method can change how epilepsy surgery is done. So far this minimally invasive laser-based method was tested on only 14 patients, but the results are positive. Five of the patients undergoing this new procedure had localized seizures occurring in the hippocampus. The most significant difference was that relating to recovery: all five required only one night in the hospital, and daily activity was resumed after only a week. Three of the patients who had mesial temporal sclerosis, a type of epilepsy that gives over 50 epileptic seizures a month, also had positive results: a few months after the procedure, two of the patients were seizure-free and one had only short auras. The minimally invasive laser-based method also resulted in improvements in patients who had localized hypothalamic hamartoma epilepsy syndrome.

This new procedure is performed under general anesthesia in a stereotactic frame. Neurosurgeons made a small hole in the skull in order to place a laser-tipped catheter with which burn a small portion of the hippocampus that causes seizures. An intraoperative MRI and another after surgery are performed to correctly identify the location and to confirm the extension of the lesion. However, patients will be investigated for one year using neuropsychological tests and MRI scans to see the differences between this new procedure and temporal lobectomy.