Jerry J Shih: Advancements in Epilepsy Surgeries and Treatments

AUGUST 04, 2017
MD Magazine Staff

Shih: 
The field of epilepsy is such that there are multiple things that are going on right now. There are multiple unmet needs and there are multiple new avenues of research and information coming out. I'm just going to list a couple.

So I think one of the more just interesting developments over the last several years is the shift towards what we call minimally invasive surgery to treat epilepsy. So we've known for the last 50 years that in patients with certain types of seizures, surgical treatment, or surgical removal of the seizure focus is the best way to make that patient seizure-free. But surgical removal meant brain surgery, means that the surgeon has to shave the hair, has to do what we call a craniotomy, and basically temporarily remove a portion of the skull, go in and remove the seizure focus, then put the skull back on, healing et cetera.

So it was a major ordeal, and patients oftentimes, you know, needed 4 to 6 weeks to recover from that type of surgery, which ultimately was helpful because it made them seizure-free. But it was, you know, a pretty tough experience to go through.

Over the last several years there have been techniques developed for what we call minimally invasive surgery. One specific one is what we call laser ablation therapy, and that's where, when we know where the seizure focus is, instead of doing this large craniotomy, or you know, half the skull being removed, there's a little, little hole that's drilled –  3 millimeters, 3 millimeters hole that's drilled on the skull, and then a catheter is inserted through that skull, or through that hole, and into the area where the seizures are, where the seizure focus is. And then using heat energy – laser heat energy – we basically thermal coagulate that seizure focus. Knock it out.

The catheter is withdrawn. That little hole, you know, the surgeon puts a stitch or two, and the recovery time is much shorter. In fact, for laser ablation therapy to treat epileptic seizures, patients usually go home after one day. The length of stay is one day after laser ablation therapy, compared to anywhere from 3 to 5 days for traditional open craniotomy procedures.

And the other thing is, as opposed to sort of taking 4 to 6 weeks to heal, most people are up and about in several days. In fact, I had one patient, a young man who had this laser ablation treatment, and a week later his dad calls me up and, you know, every time I get a call from a dad a week after surgery I'm always thinking “Oh heck, hopefully nothing bad has happened.”

Well he called them and he said, “I just had a question. We were just outside playing basketball for a couple of hours, and I didn't even realize it, and I'm just calling to say, is there something I should do?”

And I'm like, “Well, is he okay?”

“Oh yeah, yeah he's fine. He once got and play again, but I just realized that we just had surgery last week!”

And I said, “Do not play basketball. I'm glad to hear he's doing great and feeling well enough that he wants to play basketball, but do not play basketball, okay? At least not for another couple of weeks.”

My point is, is that, you know, people just heal up very quickly, and they recover quickly, and their quality of life comes back quite a bit faster than if you had an open craniotomy. So laser ablation therapy is one of those newer therapies that are out there.

I think there are also a couple of fascinating research avenues now that are being used in patients with epilepsy. The area of what we call brain computer interface, or brain-machine interface. Now this type of research doesn't specifically help seizure patients, but with the assistance of these patients we’re actually able to get great information on how the brain works.

So just to give you an example, right now patients can type words on a computer screen without speaking or moving their arm. So we can actually decode brainwaves to the point where patients can spell words on a computer screen without ever talking or writing. And it gets us into the realm of almost science fiction. But it's not. This is reality now.

And with epilepsy patients and some of the studies we do, we're also able now to try to decode how the brain processes certain types of information. Also, how speech processes work. So there's a project in my lab that really looks at the potential for decoding speech and getting to a point in which you can talk through a computer without ever speaking, so that's another avenue of research.

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