Health & Medicine

Epilepsy surgery pioneered at Sutter Health in Sacramento can be a life-changer

Evan Justinich spends an afternoon playing with toy trains at home Wednesday in Elk Grove. The 10-year-old laser ablation surgery for epilepsy several months ago and went from suffering multiple seizures a day to none at all. In the past few years, Sutter Health has been a pioneering leader in laser ablation surgery for epilepsy. The minimally invasive surgery uses a long laser needle to zap the point in the brain at which seizures start. The entire procedure takes a fraction of the time of traditional brain surgery and patients generally go home the next day.
Evan Justinich spends an afternoon playing with toy trains at home Wednesday in Elk Grove. The 10-year-old laser ablation surgery for epilepsy several months ago and went from suffering multiple seizures a day to none at all. In the past few years, Sutter Health has been a pioneering leader in laser ablation surgery for epilepsy. The minimally invasive surgery uses a long laser needle to zap the point in the brain at which seizures start. The entire procedure takes a fraction of the time of traditional brain surgery and patients generally go home the next day. lsterling@sacbee.com

Evan Justinich, a 10-year-old from Elk Grove, sometimes had 50 seizures before lunch. His head fell back, his eyes blinked rapidly and he dropped any object he was holding.

At times, Evan would collapse, making it dangerous for the tall, outgoing boy to be left alone or even leave the house, said his mother, Stacy Justinich. Different anti-seizure medications would help at first and raise the family’s hopes, though not for long.

“We’d think maybe this is the one that will work,” but two weeks later the seizures would return, she said.

Today, Evan, who has epilepsy and cerebral palsy, is seizure-free after undergoing a relatively novel and quick procedure last November that was pioneered in the Western United States by Sutter Health physicians in Sacramento.

The technique, called laser ablation, is much less invasive than traditional brain surgery, requiring physicians to drill a tiny hole in the skull and use computer imaging to guide a long, thin probe to the spot where uncontrolled electrical activity in the brain erupts, causing seizures. Then the laser zaps the malfunctioning cells.

Patients typically stay one night in the hospital and go home the next day. In Evan’s case, he had only a single stitch in his forehead and a staple on the back of his scalp after the procedure, his mother said.

Sutter doctors said the cutting-edge surgery has helped dozens of patients in the area who previously would have been treated only with drugs or undergone more invasive forms of brain surgery.

It’s the latest and most effective therapy for some patients in a centuries-long effort to understand and treat epilepsy, one of the most common serious brain diseases. Various ways to control seizures have been used over the past century and a half, starting with bromide salts, then later barbiturates, Dilantin and other drugs. But the laser technology now available can let surgeons excise seizure-causing cells in a short operation with hardly any side effects.

Michael Chez, head of pediatric neurology at Sutter who treated Evan, said the technique replaces potentially damaging operations with an approach that zeroes in on the locus of seizures while minimizing harm to other tissues.

“Instead of opening up your brain and cutting (part of) it out, we’re precisely burning an area,” and, in most cases, eliminating seizures or greatly reducing their frequency, he said.

One woman treated by Sutter had suffered seizures for six decades but was afraid to undergo traditional brain surgery, Chez said. After the laser ablation, it was the first time she was seizure-free in 56 years, he said.

Candidates for the procedure, mostly children, must suffer seizures starting from a specific, identifiable point in the brain, rather than from general electrical activity.

One of only two such machines in the state that can identify the source of the seizures, a magnetoencephalography, or a MEG scan, is at the University of California, San Francisco.

During the operation, surgeons rely on computers to guide the placement of the probe and watch on a magnetic resonance imaging display, or MRI, to ensure the laser burns the targeted area.

Sutter doctors first used the procedure in November 2011 on a boy from the Arden Arcade area of Sacramento County who, like Evan, had epilepsy and cerebral palsy, both products of a malformed brain.

Another member of Sutter’s laser surgery team, neuroradiologist Azad Ghassemi, said that within two or three weeks of the surgery, the boy for the first time was able to enter the security code on his iPad and operate the microwave.

“These simple things are normal to you and me, but you can’t describe what it means to parents,” Ghassemi said.

Ghassemi said about 65 patients have been treated so far. Most had epilepsy, but the laser procedure has also been used on a handful of patients with cancerous brain tumors, he said.

Stacy Justinich said that in addition to cessation of the seizures, Evan was weaned off three of the five anti-seizure drugs he was taking, which had personality-dulling effects.

“He came out from a fog of medication” and has been more his normal, rambunctious self, she said.

Though Evan can speak only a little, he likes to run, swim and ride horses. On a recent afternoon, he joked with visitors and gestured for them to sit beside him on the sofa.

Burdened with seizures and dulling medicine before the surgery, Evan was enjoying being a boy.

Hudson Sangree: 916-321-1191, @hudson_sangree

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