At those moments, Noreli Viedma-Jimenez, 27, knew she was slipping into another epileptic seizure. As she blacked out, her son and her boyfriend would anxiously watch her mumble prayers in Spanish to the Virgin of Guadalupe, crossing herself again and again to protect herself from the coming seizure.
But she hasn’t had to say those prayers recently, because she hasn’t had a seizure in more than a month — and counting.
Viedma-Jimenez is on the mend from a revolutionary laser brain surgery she underwent last month at Robert Wood Johnson University Hospital in New Brunswick. And although she is still cautious, she’s also hopeful.
“I haven’t been getting seizures,” she said. “I haven’t said those prayers. Little things have changed.”
The technique, called laser ablation, threads a fiber-optic cable into a small hole in the skull, and then, using guided imagery, delicately threads it past blood vessels and healthy gray matter into the targeted brain lesion — an alternative to removing part of the skull and cutting through healthy brain matter.
Instead, the laser ablation winds in to the lesion and then burns out the unwanted tissue — in this case, on the right side of the hippocampus where the majority of Viedma-Jimenez’s seizures originated. She is just the second epilepsy patient to undergo the surgery in the Northeast, though the device has been used for various kinds of brain tumors over the last two years, surgeons say.
The new technology’s boundaries are still being pushed to see how far the tool can go, according to experts.
“We don’t yet fully understand what its benefits are going to be in the long term,” said Shabbar Danish, the director of stereotactic and functional neurosurgery at UMDNJ-Robert Wood Johnson Medical School. “The advantages are clear. The disadvantages so far are very vague — if you put the laser in and it doesn’t work, you can still do the open surgery.”
Epilepsy is a seizure disorder caused by abnormal electrical currents in the brain, according to the U.S. Centers for Disease Control and Prevention. About 2 million people in the country have epilepsy, and nearly 140,000 more develop it annually. About two-thirds of cases can be fully controlled with medications; cases like Viedma-Jimenez’s cannot. Since the seizures are unpredictable some patients can’t drive or do other routine tasks.
Before doctors could do the surgery, they had to pinpoint the lesions in her brain, drill a hole and then target the path of the laser using a clamp and a probe, perfecting the angle and approach down to fractions of a millimeter. After hours of preparation, a two-centimeter stretch of her hippocampus was burned out in a matter of minutes by the red-hot tip of the laser as it pulled out of her skull by degrees. The MRI readings showed the heat from the laser. At the end of several minutes, her surgeon stared up at the monitor, nodding at what he saw.
“That looks beautiful,” Danish said.
Stephen Wong, a neurologist who specializes in epilepsy at UMDNJ-Robert Wood Johnson Medical School, said the new technology was the ideal choice for Viedma-Jimenez. Traditional surgery would involve a craniotomy, removing a part of the skull and cutting more of the brain than is necessary.
“You’re not going to shear the brain — so it results in a better outcome,” Wong said.
The laser ablative tool has been around for several years.
Originally, it was used in urological functions on the kidneys and liver, Danish said. But he’s been using it for two years on 48 patients’ brain tumors that are often considered “inoperable” because they are so deeply embedded in the brain. He’s had varying degrees of success.
Epilepsy is a newer use for the laser technology, made by Visualase.
Some 30 patients in the United States have had the laser therapy to treat their seizures, according to Angus Wilfong, director of Texas Children’s comprehensive epilepsy program and associate professor of pediatrics and neurology at Baylor College of Medicine.
The first epilepsy patient went under the ablative procedure at Texas Children’s in August 2010, after Wilfong heard about the tumor applications and decided the technology would be ideal for brain surgery. Since then, the Texas Children’s team has operated on eight patients, six of whom are seizure-free, and they’re in the process of publishing their early findings, the doctor said.
“We’ve had very, very good results,” Wilfong said. “We’ve just started to scratch the surface of what we can do with this technology.”
Viedma-Jimenez was the second epilepsy patient to go under the laser at Robert Wood Johnson. The first, a man in his 60s, has not had a seizure for three months. He still has the “auras” — the warning signs — that a seizure is coming, but it never does, he said recently.
Viedma-Jimenez, however, had several seizures immediately after the laser procedure, although doctors say they could have been due from post-surgery swelling.
Wilfong said Viedma-Jimenez’s immediate seizures after the surgery were not necessarily a bad sign for her long-term recovery.
“That doesn’t mean the surgery wasn’t successful,” he said. “We’ve had patients in the exact same position who have become seizure-free.”
Still, the patient maintains her routine of medications, mostly staying in the house because she can’t drive, still even tentative about taking a walk outside.
“You get better — but you keep thinking,” she said. “I’m just waiting. I just want good things to happen.”