For nearly 50 years, there were few options for patients who suffer from medication-resistant temporal lobe epilepsy. The most effective procedure was temporal lobectomy, a highly invasive surgery that involves removing a large section of the brain and can result in loss of vision, speech, memory, and neurocognitive abilities.
The SLATE clinical trial will study the effectiveness of minimally invasive laser surgery using the Medtronic Visualase system. This approach uses an MRI-guided laser probe, approximately the width of a guitar string, to target and destroy the scar, tumor, or malformation that causes seizures. The procedure is revolutionizing the surgical treatment of epilepsy, previously a large and invasive surgery with numerous potential side effects, which may now be performed in a minimally invasive procedure requiring an overnight hospital stay.
“We are privileged to be on the forefront of offering minimally invasive, safer options for patients who wish to avoid large, open surgery,” said Chief of Epilepsy Surgery and Hoag neurosurgeon Vik Mehta, M.D., who is the principal investigator of the trial. “In order to meet the needs of people with epilepsy, we need to modernize approaches that are more patient-friendly. This is one of the promising options to replace an invasive approach that had a lot of side effects, and we are excited by the data so far.”
Hoag is the only site in the national study to employ Surgical Theater, which combines the use of virtual reality and augmented reality to “rehearse” surgery. This ensures the safest and most effective approach during the procedure.
Of the 14 patients that Hoag has treated with the Medtronic Visualase MRI-guided laser ablation system, 11 are completely seizure-free. One of these patients, Lisa Egli, suffered from temporal lobe seizures since childhood, but is now seizure-free for more than a year since undergoing laser ablation surgery with Dr. Mehta. She has been steadily reducing the amount of anti-seizure medication she takes under the direction of David Millett, M.D., Ph.D., Epilepsy Program Director at Hoag.
“At work, I stand up in front of people and present, and I was always paranoid about having seizures. I am not anymore,” she said. “I feel like my memory has improved, as well. I’ve been surprised how much better the quality of my life is.” Indeed, early data also suggest that laser ablation also drastically reduces the risk of side effects.
Nearly one million people who have epilepsy either don’t respond to anti-seizure medication or find medication gradually becomes ineffective at controlling their seizures. For these patients, temporal lobectomy has proven effective, but it is so invasive that only a small fraction of patients elect to undergo the surgery. Hoag’s multidisciplinary epilepsy program at the PFNI is using this new minimally invasive approach to open a new avenue of effective treatment to patients who have had limited options.
“Over time, people with medication-resistant epilepsy become progressively more disabled. They’re not able to keep their jobs, or drive or maintain relationships,” said Dr. Millett. “If we can cure them of their seizures, we can give them their life back.”
The PFNI at Hoag has consistently ranked among the top one percent of hospitals in the nation for neurology and neurosurgery. The hospital has been designated a Center of Excellence in Robotic Surgery (COERS) from the Surgical Review Corporation. And Hoag is accredited by the National Association of Epilepsy Centers as a level 4 epilepsy center, meaning it has the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.
The hospital’s track record of excellence is one reason Hoag was chosen to participate in the study.
“Patients need a well-trained epileptologist to tease out what types of seizures they are having and what treatments they need,” said Dr. Millett. “For some patients, surgery is the best option. Hoag was chosen to participate in this study because our expertise in identifying and treating epilepsy is among the most trusted in the nation.”
Drs. Millett and Mehta said they hope the study will result in a sea change for patients whose epilepsy cannot be controlled by medication.
“The goal is to achieve high rates of seizure-freedom with minimal side effects, a very low risk profile and short hospital stay,” Dr. Mehta said. “We are excited to be a part of this study and to pioneer an effective option for patients with seizure disorders.”
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