Inside Pediatrics Winter 2017

Laser surgery proves effective for some epilepsy patients

By Cassandra Mickens Photos by Denise McGill

It is a wise father who knows his own child.

– William Shakespeare

I t was a shift gone unnoticed by everyone but Robert Struble. His then- 12-year-old daughter, Robin, would stare into space and cease to speak. The episodes would end as soon as they began, each one fleeting, over in a flash. “As time went by, it became more noticeable,” said Struble, who booked Robin an appointment with a neurologist to find answers. “He kept saying she didn’t have epilepsy and I never said she did, but I knew there was something wrong with her and I needed to find out what it was.” Robin’s symptoms worsened despite her initial electroencephalogram (EEG) coming back clear. Struble recalled

trademarked as Visualase. It’s touted as less invasive than an open brain surgery or craniotomy, and boasts a quicker recovery time. Visualase uses a flexible laser fiber that is guided through a “nick” scalp incision and small hole in the skull – 3.2 millimeters to be exact or about the width of a coffee stir stick. The laser heats and destroys abnormal brain tissue, leaving the surrounding healthy tissue unharmed. The entire procedure is viewed in real time on magnetic resonance imaging (MRI) to ensure safe and successful target treatment. Thermal maps show the extent of the tissue being destroyed. Finally, the laser is removed and the incision is closed with minimal sutures, typically one stitch. Robin was deemed an eligible candidate for Visualase, and on Valentine’s Day 2017, she became the first patient

immediately got off the bus and returned home. She lost track of time and assumed it was afternoon. “Over time, the seizures became longer and occurred more often,” Struble said. “It began to affect her schooling. The children made such bad fun of her, and the teachers didn’t want to deal with her.” Robin did indeed have epilepsy, which led Struble to contact Children’s of Alabama. Robin underwent a series of EEGs to monitor the electrical activity in her brain. She also underwent surgery to implant a vagal nerve stimulation (VNS) device that, paired with medication, may help lessen the number and intensity of seizures. Robin’s seizures persisted. Now at 18 years old, Robin turned her attention to a new procedure at Children’s called thermal laser ablation,

an episode when Robin boarded the school bus one morning, then

11