Tremendous strides are being made in the treatment of epilepsy, with improved outcomes and reduced side effects for patients. I’d like to share how neurosurgeons like myself are performing life-enhancing, minimally invasive procedures at Overlook Medical Center’s Atlantic Neuroscience Institute.
Epilepsy is a short circuit in the brain in which electrical impulses act outside normal pathways and cause seizures. The diagnosis is made only after a person has at least two seizures. About 3.4 million people of all ages in the U.S. have epilepsy, according to the Centers for Disease Control and Prevention.
Epilepsy can be caused by trauma, from a high fever in childhood to a stroke in older adults. The type of seizure depends on where in the brain it originates. Some types can cause a patient to fall to the ground and lose consciousness, while another may result in the patient staring off into space.
Anti-seizure medications, long the first line of treatment, are much better than in the past. But for patients who require high doses to control seizures, those drugs can cause serious side effects. Surgery has traditionally been an option only when the seizure originates in a portion of the brain, such as the temporal lobe, that can be removed without deleterious effects.
Technological advances now allow neurosurgeons to pinpoint the source of a seizure and implant a device that can stop the uncontrolled impulse in its tracks. This allows patients to greatly reduce their medication dosage — and the accompanying side effects.
The ROSA® robot is revolutionary
Atlantic Health System’s Overlook Medical Center — designated a Level 4 epilepsy center by the National Association of Epilepsy Centers — was the first hospital in New Jersey to use the ROSA® robot to perform a stereoelectroencephalography, or SEEG. Compared to a standard EEG, in which electrodes are places on the scalp to record brain activity, the SEEG provides far greater precision.
Using the ROSA robot, I can make tiny incisions about 2.5 mm wide in the skull. ROSA allows me to thread electrodes onto the surface and inside the brain to record brain activity and detect the exact point where a seizure originates.
A SEEG evaluation can determine whether a patient is a good candidate for a responsive neurostimulation (RNS) device — essentially a pacemaker for the brain.
The RNS procedure requires the precision of the SEEG to locate the source of the seizure. The patient's MRI and CT scan are fed into the ROSA. The robot then produces a brain map with the exact coordinates of the spot and the route to navigate me there. Using the robot arm, I attach two electrodes on leads to the seizure point of origin. They are connected to the RNS device (about the size of a car key fob, but thinner), which is implanted inside the patient’s skull. When the RNS detects a seizure, it activates an electrical impulse that counteracts the seizure.
Together, the ROSA robot and the RNS device are significantly expanding the pool of patients who can benefit from surgical procedures. There are people who’ve been on epilepsy medications their whole lives. This could really improve their quality of life. Patients typically recover in two weeks, half the time compared to traditional brain surgery, which takes four to six weeks.
Advances in computer and robotic technology continue to be made. I urge anyone with epilepsy to see a specialist for the most up-to-date treatment options.
Dr. Ronald Benitez is a board-certified neurosurgeon and chair of endovascular neurosurgery at Atlantic Health System’s Overlook Medical Center.