New Treatments Bring New Hope to Epilepsy Patients

Surgery is a safe option to cure or improve epilepsy for some who can't otherwise become seizure-free



dr goodman

Oradell, NJ - November 14, 2019 - By Robert R. Goodman, MD, PhD, FAANS

As we celebrate National Epilepsy Awareness Month, I'm struck by some strides we've made in treating this challenging disease over the past few years. While epilepsy can be well controlled with medications in about 60% of patients, some of the remaining 3.4 million epilepsy patients in the U.S. benefit from surgical interventions.

Over the past decade, several new surgical treatments of epilepsy have emerged. What's especially exciting to me-as I am a firm advocate for the least invasive treatments possible that lead to the best result for my patients-is that many of these treatments, while advanced, are minimally invasive. This means patients experience less pain and faster recovery.

Some of these newer approaches use techniques to modify (or "modulate") brain function, such as electrical stimulation, to reduce the number of seizures patients with epilepsy experience. Other approaches, which entail surgery for patients that have not responded to other treatments, can even "cure" epilepsy patients, meaning they no longer have to live with constant worry of when their next seizure will occur. At North Jersey Brain & Spine, we offer the full range of treatment approaches, and we're committed to finding the one that fits best for each individual patient's needs. Before we recommend any approach, our team works with patients and their families to carefully evaluate their condition and take their unique goals and personal circumstances into account.


NEW EPILEPSY TREATMENT OPTIONS:

Stereotactic EEG (SEEG) to identify areas of the brain where epileptic seizures originate. During this procedure, which involves little or no pain, we implant electrodes in tiny holes in the scalp, then monitor these electrodes for days or weeks. SEEG leaves no scars behind that would interfere with surgery patients might need in the future.
MRI-guided Laser Interstitial Thermal Therapy - (MRg-LITT) to eliminate brain tissue that causes seizures. During this procedure, which is sometimes conducted after SEEG, we apply heat to eliminate the problematic brain tissue. Also called thermal laser ablation, this procedure enables us to complete precise "surgery" deep in the brain without injuring any surrounding tissue.
Vagus nerve stimulation to reduce the frequency, severity and length of seizures when medications alone aren't effective. During this procedure, we place a small electric stimulator near the vagus nerve. The stimulator sends mild electrical stimulations through the nerve to calm irregular electrical brain activity that leads to seizures.
Responsive NeuroStimulation (RNS) to treat drug-resistant focal epilepsy. This was developed by a company that was founded in the late 1990s. From its inception, I collaborated with the company in the development of this therapy. In 2013, this device became the first FDA-approved intracranially implanted device for the treatment of epilepsy. Similar to a pacemaker, but for the brain, the device monitors brain activity and delivers harmless electrical stimulation to reduce the number of seizures without removing or injuring any brain tissue.
Deep brain stimulation (DBS) to treat focal epilepsy. During this procedure, we implant a thin wire with electrodes into part of the brain involved in seizure generation. We then place a tiny neurostimulator under the skin of the collarbone and program it to deliver electrical pulses that reduce seizure activity. This is very low risk and patients recover quickly.
Craniotomy, also called standard or resective surgery, to cure patients with epileptic seizures. During this approach, we use a precise neurosurgical technique to remove a very targeted area of brain tissue that is causing seizure activity. While this is a more invasive approach and patients may still need to take anti-seizure medications, it is extremely effective for appropriate patients who have had incomplete relief of seizures through other methods. It essentially 'cures' their epilepsy.
For many years, we have known that about 25% of epilepsy patients who don't respond adequately to medications are candidates for surgical intervention. Thankfully, surgical treatments have improved over the past few years, and are now more targeted and involve shorter recovery times than in prior years. Still, many people don't realize that surgery is a viable option, or that they can receive some of the best care in the country for epilepsy right here in New Jersey at North Jersey Brain & Spine.

One of my biggest goals is ensuring that patients with epilepsy are aware of these new, effective treatment options. I am constantly working to stay on top of the latest in treatment developments, and to play a role in bringing them to patients. It's an exciting time to be a neurosurgeon subspecializing in epilepsy treatment, and I feel privileged to help improve my patients' quality of life.

Robert R. Goodman, MD, PhD, FAANS, has devoted his career to helping epilepsy patients. A pioneer who helped develop modern treatments for epilepsy, Dr. Goodman helped establish one of the first multidisciplinary epilepsy centers in New York City and now works with experienced neurologists to offer the same advanced care in New Jersey. He has advanced fellowship training in epilepsy surgery from the Montreal Neurological Institute and Hospital, and has spent more than 30 years caring for patients.