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Katelyn Dougherty celebrated an anniversary in April that she won’t soon forget. It marked one year since specialists at the Epilepsy Center at UPMC Children’s Hospital of Pittsburgh performed life-changing less-invasive brain mapping and surgery to prevent epileptic seizures that had plagued her for most of her teenage years.
New capabilities introduced at UPMC Children’s Hospital in January 2019 make less-invasive brain testing and laser ablation surgery an option for some children and young adults like Miss Dougherty who seek treatment for epilepsy in western Pennsylvania.
Miss Dougherty and her family say access to this type of treatment in the Pittsburgh region made the process of deep brain testing and surgery less daunting. “The trust was there (at UPMC Children’s), so it definitely made it a lot easier. We could not ask for a better team — and all of them work together,” says her mother, Kimberly Dougherty.
Taylor Abel, MD, joined the Epilepsy Center at UPMC Children’s Brain Care Institute in 2018 as surgical director of the Pediatric Epilepsy Surgery Program and began to assemble the specialized equipment needed to perform robot-enhanced procedures for epilepsy — treatment offered at a limited number of pediatric health care centers in the United States.
In a procedure known as stereoelectroencephalography (SEEG), Dr. Abel implants approximately 16 electrodes deep into the brain using tiny incisions through the scalp and skull. The electrodes can record and track epileptic seizures to pinpoint the part of the brain where the seizures originate. He spends hours planning the exact trajectory to place electrodes for each patient with the help of a Robotic Operating Surgical Assistant.
This technique is less invasive than traditional deep brain monitoring, which requires a craniotomy to attach a subdural grid of electrodes directly on the brain. For SEEG, the incisions are smaller, which reduces pain, the chance of infection, and recovery time. SEEG electrodes can be left in the brain twice as long as the subdural grid, which gives doctors more time to map seizures.
“Some studies show that SEEG is associated with higher rates of seizure freedom after resection than subdural grids. Evidence suggests that it is safer and potentially better at identifying seizure foci,” Dr. Abel says. “Patients also are more open to having less-invasive procedures than they are to having traditional surgical techniques.”
Cables attach the electrodes to a portable EEG to monitor brain activity. Patients spend the first night in the hospital’s Intensive Care Unit before entering the Epilepsy Monitoring Unit for an average of five to 14 days. Brain activity is continuously monitored by technicians and epileptologists in the specialized eight-bed unit where children stay with a family member.
Miss Dougherty, 20, was among the first of 16 patients to undergo SEEG at UPMC Children’s. She began having seizures at age 14. “I went to a summer camp and I got hit with a wooden swing on the back of my head. A few days later I started having seizures,” she recalls.
Although initial testing after the accident showed no signs of brain injury, the Dougherty family traces the seizures to that fateful experience. She went to camp on Sunday, was hit on the head on Wednesday, and had her first seizure the following Saturday, says her mother. Her mother and father, Joseph Dougherty, initially took her to a hospital where they live in Titusville, Pa., and then to her local pediatrician. She continued to have two to three seizures per week, so they brought her to UPMC Children’s Emergency Department.
Miss Dougherty’s seizures usually lasted about 60 to 90 seconds. “She never knew when they would come on, they would just happen. Towards the end we started to notice the signs,” her mother says.
“I would stare off into space and start moaning and someone would get behind me and get ready to catch me,” Miss Dougherty says. “My whole body would shake. I gasped for air and bit my tongue, and my eyes rolled back.” Afterward, she experienced extreme fatigue. “I struggled a lot in school because I’d forget a lot of stuff after I had a seizure,” she adds.
The seizures have caused Miss Dougherty to lose many memories. However, she remembers quite vividly how it felt to have a seizure at her senior prom, be carted to an ambulance in front of her classmates, and leave her friends — and her shoes — behind at the dance. “They carried me out on a stretcher in my dress. It was two hours into prom, and when we got back to grab my shoes they were packing up and just announcing prom queen,” she recalls.
UPMC Children’s doctors started her on medication to try to reduce or eliminate the seizures, which showed initial success. Miss Dougherty even was able to get her driver’s license, something forbidden for people who have ongoing epilepsy. In 2017, just before her senior year of high school, the seizures began again. “Her seizures were escalating and becoming more involved, and she was missing more school. When I saw her she was failing her second drug — that’s why I recommended evaluation for epilepsy surgery,” says Shelley Williams, MD, a pediatric epileptologist at UPMC Children’s.
Once two drugs have failed, there is only a 10% to 20% chance that a patient will respond to the next drug, says Dr. Williams. “Surgery is the only chance at cure, so that’s why we push kids to consider it once they have tried two drugs. We try to encourage kids to do it before they launch into their adult life.”
Christina Patterson, MD, director of Epilepsy and the Epilepsy Monitoring Unit, and medical director of the Pediatric Epilepsy Surgery Program, says: “Not only can we offer this procedure to children who would have had more invasive surgery previously, but now we can provide surgical treatment for kids who would not have had the option before. With the minimally invasive procedure we can monitor both sides of the brain for children who have a very difficult-to-pinpoint seizure focus.”
Nationally, there is a shortage of the high-level epilepsy care offered at UPMC Children’s, says Dr. Patterson. “There just aren’t that many medical centers that have doctors who do this type of work, and facilities with equipment to do it.”
Dr. Patterson began managing Miss Dougherty’s treatment in 2018 during Phase 1 of pre-surgical testing, which involves non-invasive neurological imaging over several months. The evaluation pointed to the right side of Miss Dougherty’s brain, but evidence wasn’t definitive enough to safely move forward with surgery. “When it became possible to do an SEEG, she was a perfect candidate for it,” she says.
In April 2019, Miss Dougherty spent 19 days at UPMC Children’s — many in bed attached to monitors in the Epilepsy Monitoring Unit — during Phase 2 testing. “I was tired of having the seizures. I trusted that they knew what they were doing. I put all my faith in them,” she says.
Dr. Patterson and Dr. Abel worked together to determine where to place the SEEG electrodes. Dr. Abel surgically implanted them. Dr. Patterson used the electrodes to stimulate and observe various areas of Miss Dougherty’s brain and determine how her seizures developed. After the initial SEEG confirmed seizures were coming from the right side of her brain, she underwent a second procedure to move more electrodes to that side and fine-tune plans for removal of the seizure focus.
On April 26, Dr. Abel removed the electrodes and used a laser guided by magnetic resonance imaging to ablate the dime-size area of the brain causing her seizures. “I was really excited. Most people would be scared but I was just ready to get it done and over with,” Miss Dougherty says.
She was discharged two days later. “Physically and mentally, she didn’t seem to have any problems with it afterwards,” says her mother.
Miss Dougherty needs to follow up annually with her doctors, who may eventually eliminate her epilepsy medication, but it’s all part of the post-surgery process. Still seizure-free today, she has her driver’s license back, bought herself a used Volkswagen Beetle, and is looking forward to driving it to nursing school.
For more information about the Epilepsy Center or to make a referral, schedule an appointment, or request an evaluation for a child, call 412-692-6928.
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