Less invasive procedure to reduce epilepsy seizures

For individuals with drug-resistant temporal lobe epilepsy, open brain surgery is the current standard of care to reduce seizures, and four of every five patients remain seizure-free after the procedure.

But perceived risks of a craniotomy make many patients and referring physicians hesitant. More than 90 percent of U.S. patients who could benefit don’t pursue the option, which involves drilling through the skull into the brain to destroy the small area in the hippocampus where the seizures originate.

A project to develop a less invasive procedure got a big boost this year with a $2 million National Institutes of Health grant to further refine a needle-size robotic surgery system with real-time MRI guidance for drug resistant temporal lobe epilepsy. The eventual goal is to provide a minimally invasive way to achieve the benefits of surgery but use a steerable needle delivered through the patient’s cheek, with thermal therapy to the brain.

The grant is from the National Institute of Neurological Disorders and Stroke, one of about 20 specialized institutes within NIH. The project’s research components include demonstrating that the system accurately targets a defined amount of tissue, monitors the temperature, and treats the proper volume of tissue.

“This will pave the way for clinical translation of this technology in collaboration with industry partners, bringing a potentially curative treatment for epilepsy to many more patients,” said Eric Barth, professor of mechanical engineering.

The project builds upon earlier work in which the team validated the idea of helical ablation needles and safe pneumatic robots and integrates those subsystems with MRI guidance. Seizures originate in the hippocampus, which is located at the bottom of the brain, and the robotic system can direct a special needle through the cheek and enter the brain much closer to the target area and avoid having to drill through the skull.

Barth and Robert Webster III, Richard A. Schroeder Professor of Mechanical Engineering, are the principal investigators. The team also includes William Grissom, associate professor of biomedical engineering, Dario Englot, VUMC assistant professor of neurological surgery and electrical engineering, and two former VUMC neurosurgery faculty. Barth, Webster, Grissom, and Englot also are faculty affiliates with the Vanderbilt Institute for Surgery and Engineering.

“Our goal is to develop a treatment approach that will prove effective at stopping seizures while minimizing discomfort and recovery time,” Englot said.