For most patients with epilepsy, treatment is a matter of medication, occasionally with therapy. Surgery is a decidedly less common means of treatment.
But surgical opportunities are presenting themselves to the people affected by epileptic seizures, who number 2-3 million in the U.S. alone, thanks to advancements in laser surgery technology.
Dr. Emily Klatte is a board-certified neurologist specializing in the medical management of epilepsy in inpatient and outpatient settings, non-epileptic spells and women’s neurological issues, including epilepsy during pregnancy. With 12 years of experience in the field, Klatte has become a key part of laser treatment programs at OhioHealth.
HealthScene Ohio: What does a laser treatment for epilepsy entail?
Dr. Emily Klatte: It’s a minimally invasive technique to surgically treat seizures. The first step is figuring out where in the brain the seizures start. Then, if we feel the seizures come from a small enough area that is not a very eloquent part of the brain – for instance, the part that generates language – our neurosurgeon can insert a laser catheter through a small burr hole in the back of the brain. With MRI guidance, the surgeon can carefully guide the catheter to the area where we believe the seizures to be starting. The laser catheter generates localized heat that burns or ablates the tissue that is generating seizures. The goal of the procedure is to decrease seizure frequency or stop the seizures altogether.
HSO: How are the effects different from those of medication?
EK: If people have tried two or more anticonvulsant medications and continue to have seizures, there is a very small chance that medicine alone will allow them to be seizure-free – less than 5 percent, to be exact. When patients continue to have seizures, surgical options provide a much greater chance of potential seizure freedom. In terms of laser ablation, there is a 60-80 percent chance that seizures will be eliminated or significantly reduced. If the procedure is indeed beneficial, we eventually try to minimize the dosage or number of medications a patient is taking, in order to improve the quality of life for that individual and decrease side effects.
HSO: Can a patient, and should a patient, receive multiple treatments?
EK: We hope that the patients will have to go through only one laser ablation. If they are still having seizures after the procedure, we would have to re-evaluate where the seizures may be coming from. They could possibly then become a candidate for a second laser or craniotomy procedure (resection of brain tissue).
HSO: Is there any reason someone with epilepsy shouldn’t get laser treatment?
EK: If we can’t tell where the seizures start, or it seems they start from a very large area within the brain, laser ablation would not be an option. This treatment is very targeted, so we have to have a good hypothesis that a small part of the brain is responsible for the onset of the seizures.
HSO: How effective is laser treatment? Can it be considered a “cure” for epilepsy?
EK: So far, our outcomes are similar to what is being seen nationally, which is 60-80 percent seizure reduction or seizure freedom following the procedure. I think most of us are hesitant to say we ever cure epilepsy, as there is a chance that seizures could start up again, even later in life. But we certainly hope to at least decrease the seizure burden and render our patients seizure-free for years, allowing for improvement in their quality of life. It has been very rewarding to see several patients become seizure-free following this procedure.
HSO: Is there any potential risk during the procedure, or the possibility of future ailments?
EK: With any invasive procedure, there is a risk of infection or bleeding. There is also a risk of neurologic deficits following the procedure, such as language or memory problems. We do our very best to minimize this by conducting extensive testing before the procedure that allows us to map out memory, language and motor function, such as neuropsychiatric testing, WADA testing or functional MRI.
HSO: How long are the procedure and healing time?
EK: It usually takes 6-8 hours to complete the procedure. A large part of this time consists of ensuring that the laser catheter is pointed along a specific trajectory that will allow the laser to reach the designated target. Typically, patients go home the next day, with a goal of allowing them to return to work within a couple of weeks, in most cases.
HSO: In your opinion, why should someone with epilepsy get laser treatment?
EK: We want to help decrease seizures and improve the quality of life for patients with epilepsy. For instance, if we can reduce or eliminate seizures, the patient can hopefully be more independent, begin driving again, return to work and decrease medication side effects. Also, so far, the medical literature shows that there can be less risk of memory deficits with laser ablation compared to traditional respective brain surgeries.
HSO: Are there any other advancing forms of treatment on the horizon?
EK: We are doing stereotactic EEG procedures here at OhioHealth. This is a minimally invasive method that allows us to implant several electrodes into the brain and map out the site where seizures start. We do this procedure if we are not sure where seizures are coming from based upon our initial data from EEG monitoring with scalp electrodes. We then use this information to determine if a patient is a candidate for laser ablation or surgical resection.
We also offer outpatient EEG at several sites, along with continuous EEG monitoring throughout five hospitals within our health system. For instance, if a patient is admitted into the hospital with frequent seizures or seizures that will not stop (status epilepticus), we can conduct ongoing EEG monitoring to ensure we are treating the seizures effectively.
We have an eight-bed epilepsy-monitoring unit where we can selectively admit patients to see if their spells are indeed epileptic seizures – some spells end up non-epileptic – or determine where the seizures are starting as part of an evaluation for surgery. We also have an outpatient comprehensive epilepsy clinic where we see patients.
Alex Curran-Cardarelli is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Emily Klatte, MD, is a board-certified neurologist specializing in the medical management of epilepsy in inpatient and outpatient settings, non-epileptic spells and women’s neurological issues, including epilepsy during pregnancy. Dr. Klatte is the system medical chief of epilepsy at OhioHealth and is also the director of the OhioHealth Epilepsy Monitoring Unit (EMU).
Dr. Klatte received her medical degree from The Ohio State University College of Medicine. She completed her internship in preliminary medicine at OhioHealth Riverside Methodist Hospital. She also completed her residency in neurology at The Ohio State University Wexner Medical Center, as well as a neurophysiology fellowship with an emphasis on epilepsy. She is board certified in neurology, clinical neurophysiology and epilepsy.
