Innovative Surgery Proving Effective with Epilepsy Patients

MRI-Guided Laser Procedure Precise in Removing Source of Seizures

Released: 9/13/2013 9:00 AM EDT
Source Newsroom: Wake Forest Baptist Medical Center
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Newswise — WINSTON-SALEM, N.C. – Sept. 13, 2013 – Melanie Vandyke can’t wait to get her driver’s license.

“I just want to get back out in the world,” she said.

For nearly 15 years, Vandyke’s world was severely restricted by epileptic seizures during which she couldn’t control her speech or actions and didn’t know what she was doing or saying, and afterwards couldn’t remember what had happened.

These unpredictable episodes prevented her from driving, pursuing a career, having a social life, living independently and doing countless other things that most people take for granted.

But since undergoing a cutting-edge, minimally invasive surgical procedure called MRI-guided laser ablation at Wake Forest Baptist Medical Center, Vandyke is poised to reclaim her life.

“The surgery, I do believe, has turned my life around,” said the resident of Buchanan County in southwestern Virginia.

In the operation, the source of Vandyke’s seizures – a lesion on her right medial temporal lobe – was destroyed with heat generated by light from a thin laser-tipped probe inserted into her brain through a tiny hole in her skull while the surgeon viewed real-time MRI images of the process.

Wake Forest Baptist is one of only 25 medical centers nationwide, and the only one between Philadelphia and Atlanta, to perform this type of laser surgery for epilepsy with a technology called Visualase.

Introduced in 2007 and initially used to destroy tumors, the Visualase system was first employed as a treatment for epilepsy in 2010. Wake Forest Baptist performed its first epilepsy-related laser procedure in June of last year and has done 11 more since then on people between the ages of 10 and 60. The results to date have been very favorable: Most of the patients have been seizure-free since having the surgery while a few have experienced only isolated episodes.

“Our initial indications are that this is a really effective therapy,” said Wake Forest Baptist neurosurgeon Adrian Laxton, M.D., who performed the operation on Vandyke. “It’s extremely precise, with incredibly quick and powerful delivery, so it makes sense that we’re getting the results we want.”

The laser method is a much less invasive alternative to conventional surgery. That type of procedure is usually a day-long operation which involves removing part of the skull, cutting through healthy brain matter and physically removing the problem tissue, followed by a weeklong hospital stay and prolonged recovery period. The entire laser procedure, conversely, can be completed in about four hours and most patients can go home the next day.

“Based on what we’ve seen so far, it’s at least as effective as open surgery, is far superior in terms of risk and adverse effects and is minimally invasive,” Laxton said. “I’m really quite excited about it.”

More than 2.5 million Americans have epilepsy, a disorder in which abnormal electrical impulses in the brain affect a variety of mental and physical functions. But most people with epilepsy don’t need surgery, as seizures can be controlled by medication in approximately 60 percent of all patients. On the other hand, there’s no way to prevent it: In roughly two-thirds of all cases, the onset of the seizures cannot be explained.
That’s how it was with Melanie Vandyke. She had her first seizure, out of the blue, at age 22. But because she didn’t have any muscle contractions or spasms that are commonly associated with epilepsy, that wasn’t the initial diagnosis.

“At first it was diagnosed as blackouts,” Vandyke said. ”And I was in denial. I didn’t want to believe it was seizures.”

Subsequent tests indicated that Vandyke did have epilepsy. Despite seeing specialists at hospitals in three states and taking a variety of medications, she continued to have seizures, often twice a day.

In 2010 – 12 years after her first seizure – she was referred to Wake Forest Baptist’s Comprehensive Epilepsy Center. As a patient of neurologist Cormac O’Donovan, M.D., Vandyke underwent an extensive series of scans, tests and assessments through which Medical Center specialists were able to identify the source of her seizures. Vandyke was presented with the two surgery options and chose the laser technique.

She underwent the operation April 15. Since then, she has had just one seizure, in late May, and that was caused by a drug interaction.

“I’m doing fine,” she said. “I’m getting my feet back on the ground and my life going again.”

Vandyke, now 37, is appreciative of the care she has received at Wake Forest Baptist (“It’s a great place; everybody there has treated me very well right from the start”) and of the sacrifices made by her parents (“They have altered their lives to help me, and I can never thank them enough or repay them”). But she’s also looking forward to not being dependent on others, to feeling comfortable around other people, to engaging in conversation, to getting a job. And to visiting the local Virginia Department of Motor Vehicles office in late November.

“You have to be seizure-free for six months to get a license,” she said. “I’m halfway there and counting the days.”


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