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Brain Surgery Technique Zaps Farhana’s Seizures

May 05, 2020

For the first two years of her life, Farhana’s days were consumed by seizures.

The toddler endured several 10-to-20-second-long episodes each hour. Worse, the seizures came at night, too, continually waking the little girl and her entire family.

Farhana was suffering from epilepsy and what’s known as gelastic seizures, which caused spontaneous bouts of energy, usually accompanied by uncontrollable and unnatural laughter. The disruptions made for difficult days and long nights.

“No one could sleep anymore,” said Farhana’s mother, Siradjatou.

Farhana was only eight months old when she was diagnosed with a rare brain tumor known as a hypothalamic hamartoma. The noncancerous tumor, located deep inside her head in front of her brain stem, was about the size of mandarin orange, much larger than most hamartomas. It was causing the epilepsy and gelastic seizures along with other severe symptoms, including early onset puberty.

Gelastic seizures from hypothalamic hamartomas can be very difficult to treat with standard anti-seizure medications, which was the case for Farhana, said Rebecca Garcia-Sosa, MD, neurologist and epilepsy specialist at Ann & Robert H. Lurie Children’s Hospital of Chicago.

“It was a very difficult and scary time,” said Siradjatou.

Advanced technologies at Lurie Children’s

The Chicago family found hope for Farhana’s condition nearby. A few months after her brain lesion and epilepsy diagnosis, neurosurgeons at Lurie Children’s performed a minimally invasive technique to help destroy the tumor and disconnect the seizure networks. The treatment included laser interstitial thermal therapy (LITT), otherwise known as stereotactic laser ablation, which is better tolerated and can be more precise than traditional surgery. A laser fiber is placed to the target in the brain, and the tiny wound only requires one stitch. This technique has the potential for increased safety with few side effects, and patients go home within 24 hours.

The method allows surgeons to exactly target the part of the tumor causing the seizures. It can also be applied more than once, with two or three minimally invasive procedures over several months if needed. In patients with challenging diagnoses, this step-by-step, staged approach is a measured way to disconnect complex seizure networks. It can be much easier on patients and their overall recovery when compared to one big surgery.

“The procedure is especially useful for patients with hypothalamic hamartoma, like Farhana had, because these tumors are hard to reach and too deep in the brain for open surgery,” said Tord Alden, MD, a pediatric neurosurgeon and associate professor of pediatric neurosurgery at Northwestern University Feinberg School of Medicine who performed the technique on Farhana. “Laser ablation is significantly less invasive, requires fewer stitches, reduces post-surgery pain and provides less scarring than open procedures. I’m honored to be part of such a great institution that offers comprehensive treatment from amazing experts in brain tumors and epilepsy.”

Farhana was able to go home the day after the six-hour procedure, her mom remembers, and, for one of the first times ever, her daughter slept through the night.

“I knew right away things were improved,” said Siradjatou.

A good night’s rest and a hopeful future

It has been about five months since Farhana’s laser ablation procedure with Dr. Alden. Now, she regularly sleeps without waking up at night. Her seizures, which used to occur about 10 times an hour, have dramatically decreased to just a few per day.

The little girl in the coming months may undergo a second laser ablation procedure that has the potential to make her seizures stop completely, said Dr. Alden.

“Laser ablation gave family hope by dramatically improving their quality of life,” said Dr. Garcia-Sosa. “We have not yet achieved seizure freedom, but we’ve already taken a big step forward and we remain optimistic that a second procedure could make things even better for her and her family.”

“I’m very happy we have all the people who helped us at Lurie Children’s,” Siradjatou said.