GRAND RAPIDS, Mich. (WOOD) — Dr. David Burdette is a neurologist in Grand Rapids for Corewell Health. He has treated patients with epilepsy for decades and noticed a trend in treatment.
As the surgeries become more precise, doctors are doing more of them. He said about 63% of people find success with seizure medications in becoming free from seizures, which leaves 37% of patients in need of an alternative.
One option for surgery includes “identifying the group of nerve cells that intermittently develop a life of their own and take someone that was otherwise completely normal, and hijack them for a period of time in a seizure. If that part of the brain were expendable, an epilepsy neurosurgeon could open up that half of the skull and go in and physically remove that area,” he explained.
It is a major operation with a long recovery time. However, surgeons have been able to refine and localize those operations in the last decade.
“We have gone from cracking open the skull to a series of small hair-thin electrodes put through holes in the skull no bigger than the end of a ballpoint pen and just hitting those key areas of the network,” Burdette said.
Doctors are also using new technologies like a deep brain stimulator (DBS) and a responsive neurostimulator (RNS).
Surgeons can then permanently implant electrodes in those targeted areas of the brain, plugged into a generator implanted in the skull or over the chest wall. It delivers currents to disrupt seizures and train the brain not to have them.
“The person doesn’t even feel it, so it’s subtly in the background training the brain in a good way,” he said. “We know that if you have that RNS implanted in a deep part of the brain called the hippocampus, the underside of the brain, that over the next year or so, your memory capacity improves. If there are implanted electrodes anywhere else in the brain, you will have an improvement in word-finding difficulties.”
Doctors are still on the cusp of realizing the potential of those devices. They are currently targeting 37% of patients who are not able to be seizure free with the use of seizure medication.
Burdette said they are starting to think about surgical options sooner in increasing numbers of patients. He said the vast majority of insurance companies would cover both the pre-surgical evaluation and the surgery itself.
“So, what I foresee, over the next five to 10 years, is increasing numbers of individuals who are having these two devices implanted,” he added, with fewer people requiring an open skull to remove part of the brain.