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Laser surgery shows promise in halting seizures in epilepsy

August 25, 2014


PLEASANTON, Calif. — Justin Wan is not one to radiate unfettered optimism or make bold statements about his future.

More than 10 years of battling epilepsy will do that to a person who never knows when the next seizure will strike. Wan can’t drive, swim alone or live by himself. Crossing streets, taking a bath, riding a bike and new environments in general can pose unforeseen perils and pitfalls.

This time last year, Wan, 20, often couldn’t make it more than week without an epileptic attack and his senses were dulled by heavy doses of anti-seizure medications. But today, the only outward sign that he suffered from debilitating seizures is a small staple scar on the top of his head, hidden by a headful of thick black hair — where surgeons in December inserted a tiny laser that zapped out a lesion in his brain. He hasn’t had a seizure since.

"It was on this side somewhere," the San Jose State University junior said, feeling around with his fingers on his cranium’s right side.

"I was prepared for anything to backfire, but so far, everything is fine," Wan said, reaching for his family’s wooden coffee table to give it a good knock with his hands — then, with both feet, jokingly. "I don’t want to jinx myself."

Although a new laser surgery treatment is not the answer for every epilepsy patient, it is showing promise in cases such as Wan’s, in which the seizures stem from an identifiable area localized deep in the brain.

About three million people nationwide have epilepsy, with symptoms that range from mild spaciness or unconsciousness to a person falling over into violent, shaking or spasms. The seizures begin when an abnormal burst of electrical impulses in the brain spread to nearby areas, causing the neural system to short-circuit. Often, the misfiring’s origins are a mystery and difficult to pinpoint.

Wan is among the one-third of people with epilepsy whose seizures can’t be controlled with medication. Fewer than half of them are potential candidates for open-brain surgery. But only a small number of the procedures are performed annually due to the associated risks, according to the National Association of Epilepsy Centers.

Laser surgery could be a safer option and the first choice in treatment for patients like Wan, said Angus Wilfong, director at the Comprehensive Epilepsy Center at Texas Children’s Hospital in Houston and a pioneer in the minimally invasive procedure.

"It’s become a real game-changer," he said. "In some cases it’s been completely transformative. It can change the trajectory of a child’s life."

The new technology — a laser probe guided by MRI imagery — is placed directly in the brain to destroy the localized area or lesion that is causing the brain to misfire. It leaves the healthy surrounding tissue — within a millimeter or less — unharmed.

The whole procedure can be done through a tiny hole in the skull, leaving two stitches or temporary staples on the head. It takes about three hours, most of it to precisely position the laser and about 15 minutes for the actual surgery itself — versus the three to six hours for traditional brain surgery to treat the condition.

As a result, risks are reduced, damage to surrounding brain tissue is minimized, and patients can go home the next day, rather than endure the typical three-to-five-day hospital stay.

Wan was one of the first three patients to undergo the procedure at University of California San Francisco Medical Center.

Wilfong performed the first-ever such surgery with colleague Daniel Curry in 2011. Since then, about 400 such surgeries at more than 40 medical centers have been performed nationwide. 

California Pacific Medical Center in San Francisco performed its first procedure in June, and Stanford Health Care in Palo Alto began offering the surgery in March, although it hasn’t yet performed one.

About a dozen patients have undergone the surgery at UCSF, and so far they have all remained seizure-free as of August 20,, said Dr. Edward Chang, the chief of epilepsy and pain neurosurgery who performed Justin Wan’s operation. 

"Justin went home from the hospital the next day, with not much bleeding — maybe a few drops," he said. "And he looks great so far, though we’ll still need more time to know the long-term outcomes."

Things look promising. The nearly eight months this shy accounting student has been seizure-free are the most since being diagnosed. Wan previously underwent two Gamma Knife radiosurgeries — where part of the brain is zapped with tiny radiation beams — to shrink the offending lesion, but the seizures, during which Wan zones out and his body becomes unresponsive, started again within three to seven months.

According to studies by Emory University School of Medicine, one of which was funded by a grant by the manufacturer, findings six months after surgery show the laser procedure had a 59 percent seizure-free rate versus 69 percent for traditional surgery, but results in better memory and cognitive function. 

"But the million-dollar question is how well does it control seizures long-term?" said Daniel Drane, an assistant professor of neurology whose study was funded by the National Institutes of Health. Studies focused on answering that critical question are ongoing, he said.

Wan’s family pondered for months the hazards of becoming a pioneer for such a new and untested an operation. But once the decision was made, Wan did not want to wait.

"I think we were really brave to do this," said Melinda Wan, Justin’s mother. "But then, I think we had no choice, because we saw Justin was miserable."

Justin is communicating better all the time as he gradually weans off his anti-seizure medications. And after years of putting his dreams on hold, Wan is starting to compile a wish list: drive a car, land a job, change his major, find a girlfriend and have a family.

Huge baseball junkie that he is, though, one dream rises to the top. Wan would really like to travel to every big league ballpark in the country — Yankee Stadium, Camden Yards, Fenway Park, Wrigley Field are high on the list. Before, his seizures would have made such a trek impossible, if only for the stairs he’d have to climb in each venue.

Wan’s boyhood glove and bat are also still waiting for him, sidelined in the garage, because his coaches worried it was unsafe. He is eager to pick them up again.

But no matter what happens, "we just always believe that it’s going to be cured," his father Kevin Wan said, "if not tomorrow, sometime in the future, and this tells us there’s always hope there."

 

 


McClatchy-Tribune Information Services