SSM Health Medical Minute – Robots being used in epilepsy patients

Medical Minute
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ST. LOUIS - Epilepsy is a condition that causes unprovoked, recurrent seizures. The seizures result from abnormal electrical activity in the brain, which can cause strange sensations, loss of muscle control or loss of consciousness. This common neurological disorder can affect people of all ages, but doctors at SSM Health Cardinal Glennon Children’s Hospital have recently started using a robot in some patients, which helps them accurately identify the area of the brain causing seizures and therefore cure their epilepsy.

“When we talk about these surgeries for epilepsy, we have to talk about who is a candidate for surgery," said Dr. Philippe Mercier, chief of neurosurgery at SSM Health Cardinal Glennon and SSM Health St. Louis University Hospital, and also the SLUCare Pediatric Surgeon. "What we first have to describe is patients who need surgery at all. Out of everyone who has epilepsy, about a third of those patients will become retractable, meaning no matter what medication you give them, they will continue to have seizures.”

These patients will go through a multi-disciplinary program where doctors try to identify where the seizures are coming from. And some of those patients are a candidate for having the area that is causing epilepsy removed.

Traditionally, over the past 25 years, doctors could offer medications, EEG, MRIs, PET scans, nuclear medicine scans. If there was an operation, it included a large incision in the brain, taking off a significant amount of bone and placing electrodes on the target and place a sheet of electrodes around the target, wrap electrodes around the brain to measure activity from around the surface or under the brain. An operation by hand has a high risk of inaccuracies and would be a 12-14 hour surgery.

“What robotics allow us to do is to place depth electrodes inside the brain in a planned fashion – we know the trajectory, we know our target – we plan that out on a computer - and the robot allows us to put in the electrodes in safely, and quickly and most importantly, very accurately,” Mercier said.

Using robotics, the surgery is reduced to three hours.

The robotic procedure is a first step, an investigative surgery for the purpose of finding the location of the seizure and to determine if the patient is a candidate to remove the area of the lesion causing seizures. The surgery is very well tolerated, it involves little tiny small scalpel incisions the size of the electrodes.

In a few hours, the patient is awake, in very little pain and then the electrode activity is monitored for the next week while the patient is having seizures. The data collected gives doctors precise information about the location of the seizures. Once the location is identified, the electrodes can be taken out bedside with a very simple procedure and putting on a band-aid before the next steps to remove the lesion through surgery is planned.

Robotic surgery is, “exceedingly accurate and minimally invasive. The electrodes accurately identify where the seizure is coming from. In almost all cases, we’ve been successfully able to remove that lesion and have dramatic improvements in their seizures and epilepsy.”

SSM Health Cardinal Glennon has been very successful using the robot. Patients and their families who have used this new technology are thrilled.

“Parents are elated. They go from having a child they cannot leave alone, they can’t let them have a shower or bath, they can’t go out with their friends, now get to basically having a normal life,” Mercier said.

According to the doctor, the purchase of the robot was made possible by contributions and donations made to the Glennon Foundation and thanked those who give.

To learn more about epilepsy treatment, click here.

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