A brain surgeon describes the innovative methods that The Neuro introduced in Canada
Ultimately a surgical option is the only chance we have for curing drug-resistant epilepsy. Sophie Jodouin handled the stress of the risks involved exceptionally well.
We proposed the robotic implantation of intracranial electrodes to be certain that the area identified by MRI scans was indeed the focus of her seizure disorder. Electrodes have been implanted by other methods for nearly 50 years, but in 2011, The Neuro was the first in Canada to employ robotic-guided surgery of this kind. Intracranial electrodes have a much greater precision and accuracy than scalp electrodes in which deep-seated epileptic foci need to travel through the brain tissue, the bone and the scalp before the electrical activity can be recorded on the surface.
Dr. Satyakam Baruah, a neurosurgeon from India, came to The Neuro specifically to learn these sorts of procedures. He and I implanted the electrodes and Sophie then went to the Epilepsy Monitoring Unit to confirm the location of the active focus, which was close to the area controlling the sensorimotor region of her leg and foot.
A new technique available in Canada only at The Neuro over the past five years called thermocoagulation involves passing an electrical current through the active electrode contacts to destroy the epileptic focus. The patient is kept awake to avoid any complications. It is much less risky than open surgery. Sophie agreed to this procedure and performed exceptionally well with no complications.
She enjoyed a seizure-free period for the first time in a long while. We were all overjoyed. Unfortunately, the size of the lesions was quite small because they are related to the size of the electrodes, which are only 0.8 mm. in diameter. Eventually, her seizures re-occurred; however, we had solid proof that we had located the long-sought source of her epilepsy. Without this crucial information, I would not have proposed an open operation.
We had a lengthy discussion about an open craniotomy, a procedure performed under general anaesthesia with image guidance so I could be sure to perform a larger removal of the seizure focus around the electrode contacts. We were also able to perform an MRI technique called “tractography” to help avoid, as much as possible, the fibres responsible for the motor movement of her leg and foot. Sophie bravely accepted the risk it implied. Following surgery, she did have some weakness in her leg. Sophie co-operated so well with our inpatient team of occupational and physiotherapists that she did not require outside rehabilitation. I was overjoyed to see her jogging on the spot during her latest visit. Given her exceptional determination, I have no doubt that she will continue to improve.
It was my profound pleasure to have been involved in her care. She and patients like her are the reason why we in the Epilepsy Team at The Neuro continue to push the frontiers of what we can offer patients with intractable seizure disorders.
March 27, 2019