Moving the Field of Epilepsy Therapy Forward

There are now many treatment options for patients with epilepsy. Mark Richardson, MD, PhD, director of the Functional Neurosurgery Program in the Department of Neurosurgery at Massachusetts General Hospital, discusses the approaches used against medically intractable epilepsy. In this video, Dr. Richardson details when patients should consult a comprehensive epilepsy center and the ways in which Mass General tailors treatments to the patient's epilepsy.

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Transcript

In functional neurosurgery we are very privileged to have the opportunity to record and simulate in the brain as clinically indicated to help patients. And so it is our philosophy that when having this opportunity, we make the best of it. And of course, we want to do that for each individual patient. But we also want to give patients the opportunity to give something back that the disease has taken away.

Epilepsy surgery has entered a new era. There are multiple treatment options now for patients, but now we have minimally invasive approaches, and that starts with diagnostic surgery which can be done with ROSA robot, for instance, where we can implant stereo EEG electrodes and map the seizure network. And once we have defined that network, we have options that include laser ablation, so thermal ablation of the seizure focus without doing a craniotomy, as well as responsive neurostimulation, which is closed-loop brain stimulation for epilepsy. In addition, we have standard deep brain stimulation which is now FDA approved. So there really a much broader armamentarium to use against medically intractable epilepsy.

The correct time to refer a patient with epilepsy to a comprehensive epilepsy center is after they failed two medications, or whenever they have a lesion that shows up on MRI which might be the source of their epilepsy. Despite this national guideline, often patients might spend 20 years dealing with epilepsy before they're referred for a comprehensive workup.

We have a strategy that we call early neurosurgical consultation where we have a patient talk to the surgeon much earlier in the course of their workup in a comprehensive epilepsy center because with so many new tools that we have that are surgical to treat epilepsy, and we can do this in a very safe way, there are more options for patients. The important thing is to tailor this specifically to the patient's epilepsy.

I'm excited to practice at Mass General because the quality of the people is so high and the resources are so good. To really move the field of functional neurosurgery forward requires not just a single person, but whole teams of people who are dedicated to patients, to learning about the brain, to computational neuroscience, to neuro-engineering, and here all the pieces are in place to do something great.

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