Children's Hospitals Today - Spring 2018 - 8

ROUNDS / COMMENTARY

New treatments, new promise
Surgical and clinical advances help providers and patients gain
a better understanding of epilepsy.
BY P. DAVID ADELSON, M.D.

P. David Adelson,
M.D., performs
MRI-guided
sterostatic laser
ablation surgery.

A

pediatric epilepsy diagnosis can be devastating. Parents
are all too familiar with the terror and helplessness they
feel when their child experiences a seizure. For kids, epilepsy
creates hurdles socially and academically. Classmates may not
want to befriend a child who has seizures, and anti-seizure
medications can cause side effects that impair
learning. At Barrow Neurological Institute at
Phoenix Children's Hospital, we treat some of the
toughest cases. New treatments are less invasive,
lower risk and deliver excellent outcomes-even
for kids who don't respond to anti-seizure medications. In some cases, we can eradicate the disease.
A number of medically intractable epileptic
children suffer from hypothalamic hamartoma
(HH), a rare, noncancerous brain lesion, which
causes gelastic or "laughing" seizures. In the past, treating
HH required removing the lesion through open surgery or an
endoscope. Patients with tumors in an inoperable area of the
brain had few options. But by using a laser ablation procedure,
we're curing epilepsy in children with HH and other types of
seizures with focal onset.
This minimally invasive procedure requires the expertise of
neurology, neurosurgery, neuroradiology, pediatric anesthesia
and numerous other disciplines. First, a small, flexible laser

applicator is guided to the target using a computer targeting
system. The child is then placed in an MR scanner, and MRI is
used to guide and monitor the effects of the laser on the tissue.
The laser light naturally heats and eradicates the lesion and
its connections to the seizure network. It's necessary to view
these tissue changes in real-time to prevent damage to surrounding healthy tissues.
The treatment is accurate within millimeters and requires
just a single stitch when the laser is removed. The effectiveness of the procedure, combined with careful decision-making
with HH patients, has resulted in 100 percent success; every
one of the laser ablation patients is cured.
Vagus nerve stimulation (VNS) prevents seizures by sending regular, mild pulses of electrical energy to the brain via
the vagus nerve, which passes through the neck as it travels
between the abdomen, chest and the lower part of the brain.
A pacemaker-like device under the skin generates the pulses.
Newer models transmit seizure data and allow neurologists to
adjust the strength and timing of the pulses.
Another option, responsive neurostimulation (RNS), is nearing FDA approval for children. Doctors implant electrodes
connected to a device under the scalp. Leads from the device
monitor brain waves, looking for activity that may lead to a seizure. The RNS sends pulses that disrupt seizures and normalize
brain waves, often before the patient feels symptoms. This device comes with a remote monitor
that collects brain wave data and seizure activity.
VNS and RNS work 24 hours a day, and the outcomes are astounding. In addition to reducing or
eliminating seizures, patients don't suffer any side
effects associated with anti-seizure medication.
Our ability to diagnose and treat epilepsy has
improved dramatically in recent decades. But to
continue innovating and identifying solutions, we
must first be willing to talk about the problem. Our work is in
treating epilepsy patients, and our mission is to help children
live happy, normal lives, free of the symptoms of epilepsy.

IN SOME
CASES, WE
CAN ERADICATE
THE DISEASE.

8

CHILDREN'S HOSPITAL S TODAY Spring 2018

P. David Adelson, M.D., is director of the Barrow Neurological
Institute at Phoenix Children's Hospital and chief of
Pediatric Neurosurgery.
Share your ideas. Email magazine@childrenshospitals.org.



Table of Contents for the Digital Edition of Children's Hospitals Today - Spring 2018

Contents
Children's Hospitals Today - Spring 2018 - Intro
Children's Hospitals Today - Spring 2018 - Cover1
Children's Hospitals Today - Spring 2018 - Cover2
Children's Hospitals Today - Spring 2018 - Contents
Children's Hospitals Today - Spring 2018 - 2
Children's Hospitals Today - Spring 2018 - 3
Children's Hospitals Today - Spring 2018 - 4
Children's Hospitals Today - Spring 2018 - 5
Children's Hospitals Today - Spring 2018 - 6
Children's Hospitals Today - Spring 2018 - 7
Children's Hospitals Today - Spring 2018 - 8
Children's Hospitals Today - Spring 2018 - 9
Children's Hospitals Today - Spring 2018 - 10
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Children's Hospitals Today - Spring 2018 - 16
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Children's Hospitals Today - Spring 2018 - Cover3
Children's Hospitals Today - Spring 2018 - Cover4
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