Help­ing Epilepsy in Chil­dren

Min­i­mally in­va­sive tech­nique is hav­ing promis­ing re­sults

Wellness Update - - Hiv -

Epilepsy spe­cial­ists at Mi­ami Chil­dren’s Hospi­tal are the first in the South­east--and the sec­ond in the na­tion-to of­fer min­i­mally in­va­sive laser surgery for chil­dren with seizures that don’t re­spond to an­ti­con­vul­sant med­i­ca­tions.

Ap­prox­i­mately one in five chil­dren with epilepsy (to­tal­ing thou­sands of chil­dren a year) ex­pe­ri­ence fre­quent seizures that don’t stop with med­i­ca­tion. Mi­ami Chil­dren’s Brain In­sti­tute has long been a leader in help­ing th­ese chil­dren with med­i­cally re­sis­tant (or “in­tractable”) epilepsy. The Mi­ami Chil­dren’s Hospi­tal (MCH) pro­gram has been ranked among the top pro­grams in the na­tion for pe­di­atric neu­rol­ogy and neu­ro­surgery by U.S. News and World Report.

Due to the hospi­tal’s rep­u­ta­tion and its case ex­pe­ri­ence with more than 850 epilepsy surg­eries, the man­u­fac­turer of a new im­age-guided laser tech­nol­ogy ap­proached Mi­ami Chil­dren’s in 2010 to es­tab­lish pro­to­cols for use of the new tech­nol­ogy, called Visu­alase. The first pa­tient at MCH was suc­cess­fully op­er­ated on in May of 2011. Prior to laser surgery, the pa­tient was ex­pe­ri­enc­ing one or two seizures per week. Since the pro­ce­dure, she has been seizure free for nine months and has an ex­cel­lent prog­no­sis, ac­cord­ing to Dr. Ian Miller, Di­rec­tor of Neu­roin­for­mat­ics at Mi­ami Chil­dren’s Hospi­tal, who is spear­head­ing the Visu­alase ini­tia­tive.

The Visu­alase sys­tem works by plac­ing a laser probe at the sur­gi­cal site us­ing stereo­tac­tic, 3D-com­puter guid­ance in the op­er­at­ing room. The pa­tient is then moved to the MRI scan­ner where the laser re­moves the tar­get brain tis­sue us­ing heat un­der con­tin­u­ous MRI mon­i­tor­ing. This al­lows a very pre­cise re­gion of tis­sue to be treated and min­i­mizes risk of in­jury to other parts of the brain.

Doc­tors hope this method (as com­pared to tra­di­tional brain surgery for epilepsy) will al­low a very small in­ci­sion (so that very lit­tle hair needs to be re­moved), less post­op­er­a­tive pain, re­duced risk of in­fec­tion, faster re­cov­ery time and no need for re­mov­ing por­tions of the skull, which re­duces the chance of jaw prob­lems later on.

To date, three pa­tients have un­der­gone the new treat­ment at Mi­ami Chil­dren’s, in­clud­ing one child who came from out of state for the pro­ce­dure. Among th­ese chil­dren, the long­est hospi­tal stay was three days, com­pared with a seven to 10-day stay re­quired for con­ven­tional surgery.

Dr. Miller ex­pressed op­ti­mism about the tech­nol­ogy. “This is one of the new­est tools in our tool­box to help chil­dren with epilepsy. It is per­fectly suited for small, well-de­fined le­sions in the brain that cause seizure ac­tiv­ity,” he noted. He ob­served that there are many causes of epilepsy in chil­dren and that “this ther­apy is a par­tic­u­larly good fit for con­di­tions such as cor­ti­cal dys­pla­sia, hy­potha­la­mic hamar­toma and tuber­ous sclero­sis.” -This in­for­ma­tion pro­vided courtesy of Mi­ami Chil­dren's Hospi­tal

Twelve year-old Jessie Fer­nan­dez un­der­goes the first Visu­alase pro­ce­dure at Mi­ami Chil­dren’s Hospi­tal

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