Texas Children’s Hospital Leading The Way In Seizure Treatment

Dr. Daniel Curry and Dr. Angus Wilfong recently shared with the world results of their pioneering experience with stereotactic laser ablation brain surgery for hypothalamic hamartomas. Their study was recently published in the highly respected journal, Epilepsia.

There are plenty of stories about doctors doing “cool stuff”. It’s sometimes difficult to tell what is particularly innovative, or why it matters. In my book, Dr. Curry and Dr. Wilfong are not only doing fantastic work – they are game changers. They have pioneered a surgical technique and technological application that is an incredible leap forward for brain surgery, and have completely altered the way we look at treatment for certain daunting seizure disorders.

Saying something or someone is a game changer in medicine is a huge deal. The Merriam Webster dictionary defines game changer as: a newly introduced element or factor that changes an existing situation or activity in a significant way. Other definitions of game changer: a person who is a visionary. A game changer has new and different ideas that stand out from the crowd. This person has an idea that completely changes the way a situation develops.

Dr. Curry is a Pediatric Neurosurgeon and director of the epilepsy surgery program here at Texas Children’s Hospital. Dr. Wilfong is a Pediatric Neurologist/Epileptologist and director of the Texas Children’s epilepsy program. Over the past few years, they have pioneered minimally invasive stereotactic laser ablation surgery for epilepsy. I have seen them work tirelessly to develop better ways to treat medically intractable seizure disorderswhen medications are not enough to control seizures.

In fact, in 2010, Dr. Curry was the first in the world to perform stereotactic laser ablation surgery to treat epilepsy, in a child with tuberous sclerosis. In 2011, they applied the technique in a child with laughing seizures from a brain disorder called hypothalamic hamartoma. The surgery was a success, and stopped the frequent seizures that had been occurring for years. Since that time, the Texas Children’s epilepsy team lead by Dr. Wilfong and Dr. Curry has been applying stereotactic laser ablation technology (made by Visualase, Inc., Houston, TX) for seizure surgery for carefully selected patients. Our Texas Children’s team has the largest experience in the world in stereotactic laser ablation surgery in children.

There are a few parts to this name: stereotactic means finding the target in the middle of the brain in 3-dimensional space.  In neurosurgery, we use computer modeling and a frame around the head that targets for ultimate precision.

The laser system is delivered through a small skinny 1.6 millimeter fiber bundle. This means we can access even deep parts of the brain with only a small 3.2 millimeter hole in the skin and bone to accommodate the 1.6mm fiber bundle (in comparison to the large incision and temporary removal of a piece of skull bone in traditional brain surgery).

The ablation happens with delivery of a targeted thermal energy with the laser to destroy a target in the brain (in this case, the hypothalamic hamartoma connections causing the seizures) with minimal damage to surrounding brain tissue.

Hypothalamic hamartomas are deep-seated lesions in the brain that cause intractable seizures that look like uncontrollable laughter when nothing is funny. They render children and adults incapacitated in daily life with seizures. They are particularly challenging problems for surgery. Traditional open surgeries  for this type of disorder entail dissection around a lot of delicate brain structures because of where the hypothalamus is located; even in the most experienced hands, these surgeries carry very high risks including blindness, lifelong hormonal problems, memory problems, and paralysis. A weeklong hospital stay on average is needed to recover from an open surgery. Now, the revolutionary stereotactic laser ablation technique developed at Texas Children’s Hospital enables destruction of the hypothalamic hamartoma target without the trauma or side effect profile of the traditional open surgery.

To date, 15 patients have undergone this procedure for hypothalamic hamartoma at Texas Children’s– almost all have gone home the very next day! These patients have previously had ongoing seizures for years, and the procedure has successfully stopped their seizures. Overall, more than 30 patientshave had laser-guided ablation surgeries for diagnoses ranging from seizures from hypothalamic hamartoma and cortical dysplasia, to certain types of brain tumors.

Dr. Curry and Dr. Wilfong point out that none of this would have been possible without the whole team at Texas Children’s, including every pediatric epilepsy specialist in the department of neurology, the neurophysiology technicians who help with intraoperative monitoring during surgery, the radiologists, the radiology technicians who run the MRI machine, the anesthesiologists for surgery, and nursing staff both in and out of the operating room.

Because of the great results and the low complication profile, the technique has gained acceptance and interest around the country. Stereotactic laser ablation is now an almost routine part of practice and certainly for the Texas Children’s epilepsy program.

It is not surprising that many surgeons around the U.S. and the world have developed interest in this technique. Since it is a new procedure, it is very important for surgeons, neurologists, and scientists to pool their knowledge and experience, and learn together.  To this end, Dr. Curry and I are organizing the world’s first central registry of laser ablation brain surgeries to be coordinated at Texas Children’s Hospital. The goal is to develop and share this knowledge for the future, and for many more surgeons to be able to safely and effectively help patients with seizure disorders.

Texas Children’s Hospital offers a comprehensive epilepsy and epilepsy surgery program – from initial workup, diagnosis, and medical management to surgical interventions ranging from minimally invasive stereotactic laser ablation to vagus nerve stimulator implantation to open surgeries such as subdural grid monitoring, resection of seizure foci, corpus callosotomies, and hemispherectomies. For further information or for an appointment, please call (832) 822-3950.

References:
Wilfong, AA, Curry DJ. Hypothalamic hamartomas: optimal approach to clinical evaluation and diagnosis. Epilepsia, 2013 Dec:54 Suppl 9: 109-14. doi:11.1111/epi.12454

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About Dr. Sandi Lam, Pediatric Neurosurgeon

I am a pediatric neurosurgeon at Texas Children’s Hospital and assistant professor of Neurosurgery at Baylor College of Medicine.
Posted in Neurology, Neuroscience, Neurosurgery, Research, Surgery

4 Responses to Texas Children’s Hospital Leading The Way In Seizure Treatment

  1. Traci Flanagan says:

    Our son was one of your Hypothalamic Hamaratoma patients treated at TCH in 2012! Our son is doing amazing and has been seizure free since the laser ablation! We will always be grateful for the miracle Dr. Wilfong and Dr. Curry has given our son! We have shared with everyone that in August 2012 Christopher got his life back. People could not understand why we traveled from NJ to TCH. We told them we wanted the best for him and after learning that you offered this ground breaking treatment we had all confidence that he would get the best treatment available, and he did! So from the bottom of our hearts Thank You TCH and Drs. Curry and Dr. Wilfong!! See you in August for our 2 year check up!! With deep gratitude The Flanagan Family!!

  2. Corrie Eksteen says:

    Hello
    We live in sunny South Africa, my daughter Danielle is now 25 years old, she was diagnosed with HH at the age of 11, she had many difficulties such as Gelastic seizures, emotional problems, obesity etc and only got Grand Mal seizures once every 3 to 4 years but now the last few months she already had 3 Grand Mal seizures and I am so worried about that.
    Our life’s has changed since December 2013, Danielle now no longer functions as well as she did in the past, the fear of her getting Grand Mal seizures now has limited her ability to drive, work, and being at home on her own etc. it really is so scary. We used to feel so proud of her progress and there were no signs or symptoms showing determination until now. She and her husband Jean-Pierre have a beautiful little girl Jeanelle aged 2. The little one is so traumatised when my daughter gets these seizures.
    We have enquired about dr. Curry’s procedure and it will cost us more than a million ZAR to get Danielle to Texas and back to South Africa. We are not going to give up we hope and pray that we can manage to start with fund raising and or that something awesome will come our way. Maybe the doctors from America can visit sunny South Africa and perform the operation here or maybe one of our top Neurosurgeon’s from South Africa can get trained and perform this procedure on all the South African’s. Now that would be awesome.
    Do you have any recommendations of options that we might have and what type of medication should we consider to use in the mean time in order to minimize the Grand Mal seizures.
    Your feedback would be valuable and well appreciated.
    Thank you
    Greetings from South Africa
    Corrie Eksteen mother of Danielle Dry Castanho

  3. Becky Olson says:

    My daughter has been an epilepsy fighter since infancy. We have tried many meds and diets. Some work for a little then stop. It is a constant battle. Now she is 11 and dealing with puberty which is affecting her seizures. Due to insurance we are in a battle. We just had an appt this week at TCH. Not feeling great about the visit, but i have since talked to a neurosurgeon there who has turned this outcome around and made us feel hopeful. I am anxious to visit with this neuro team to see what they can do for my daughter so she can experience seizure freedom or significant reduction.

  4. surinder k mehta says:

    Hi,
    All the world is one and there is no difference.All the countries should strive for to remove all these problems from the surface of this earth.The little flowers should be saved from such problems,every flower ,the child has the right for it and the elders of his/her should jointly work for this deem.without spending money on the Nuclear weapons now the whole world should come forward this straight one mission.
    sincerely I always with my flowers of the mankind.

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