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The NHS (National Health Service) is to offer people with epilepsy a new form of laser therapy and it could be life-changing for people with uncontrolled focal seizures for whom surgery is considered too risky.

Professor John Duncan, former medical director at the Epilepsy Society, has welcomed a new fibre optic laser beam therapy for epilepsy, as one of the most exciting steps in the treatment of the condition.

For the last three years, John has been working as clinical lead on the project to introduce cutting-edge laser beam therapy as a treatment option for NHS patients.

He said: “This is significant news for people with refractory epilepsy whose seizures are not controlled with anti-seizure medication and for whom epilepsy surgery may be high risk.

“The therapy is already available in the US and it is excellent that NHS England and NICE have now agreed that it should also be available for people with epilepsy in this country. This will offer hope to thousands of NHS patients who we see in our clinics whose lives are dominated by seizures and the side effects of medication.”

How laser therapy works

Laser beam therapy is carried out during continuous, real-time MRI scanning.

Laser therapy targets the part of the brain that causes seizures without the need for invasive surgery. The laser requires just a 1.5mm-wide probe to be passed through the skull and brain with the fibre optic laser at the tip of the probe reaching and destroying the epilepsy-causing brain tissue from the inside by heating it.

The life-changing treatment uses a sophisticated navigation system EpiNav – developed by Professor Duncan and his colleagues using high resolution imaging at the Epilepsy Society’s MRI Unit – to visualise and safely navigate to the exact area in the brain that is to be targeted, avoiding blood vessels and critical structures.

Laser therapy is performed during continuous, real-time MRI scanning and enables the clinical team to monitor the temperature of the surrounding areas to ensure healthy brain tissue does not overheat.

High resolution images allow for precision targeting of the area of the brain causing the seizures.

Under computer guidance, laser energy is applied to the target area. The laser is switched off and removed when the appropriate volume of tissue has been ablated (surgically destroyed). After the procedure, an MRI is carried out to verify lesion location and volume of the tissue ablated. The aim is to precisely destroy, rather than remove, the target tissue while minimising damage to the surrounding area.

A 1.5mm probe is passed into the skull with the fibre optic laser destroying the part of the brain that causes the seizures.

The small wound heals quickly meaning patients can go home the next day with minimal risk of infection or other side effects and can return to their usual work and activities within a week.

Saving NHS money

Professor Duncan continued: “Current neurosurgery is far more invasive, requiring an operation to both skull and brain, with a week’s stay in hospital and three months recovery at home. This is  far more costly for the NHS and society than laser therapy which requires an overnight stay in hospital with the patient returning to normal activities and work within days.”

There are around 600,000 people in the UK with epilepsy. For one third of them, their seizures are not controlled with current medication.

However, of this group, only around 10,000 are candidates for conventional surgery. This may be because the source of the seizure is not able to be localised to a single area of the brain or the seizures are not frequent or intense enough to warrant the risks of surgery.

Latest, most effective treatments

The first laser beam surgeries are expected to take place in 2023 and will be offered to those people whose focal seizures have not been controlled by other forms of treatment. This could benefit up to 150 people every year.

Surgery will take place at two as yet unidentified hospitals – one in the south and one in the north of England.

This is the latest example of the NHS delivering on the Long-Term Plan commitment to ensure patients across the country have access to the latest and most effective treatments available.

NHS national medical director Professor Sir Stephen Powis said: “This pioneering laser beam treatment for epilepsy patients is life-changing and will offer hope to hundreds of people every year who have not had success in preventing seizures with traditional drugs.

“By replacing invasive neurosurgery with a cutting-edge laser therapy, allowing clinicians to better target the parts of the brain causing the epilepsy, we not only dramatically reduce risks to these patients, but drastically reduce their recovery time both in and out of hospital.”

NHS medical director for specialised services Professor James Palmer said: “The NHS is committed to rolling out cutting-edge treatments as quickly as possible – it is just one of seven new innovations that the NHS is making available to patients across the country following the latest review of treatments and technologies that should be prioritised for investment.”

Source: epilepsysociety.org.uk, Nicola Swanborough

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