U. professor develops scale to predict success of surgical laser technique on those with seizures

A Rutgers neuroscience expert released a study that developed a scale to predict the likelihood that a minimally invasive operation eliminates seizures from patients with epilepsy, according to a University article.

Robert Gross, the author of the study and a professor and chair in the Department of Neurosurgery, developed an eight-point-scale for patients to determine how effective stereotactic laser amygdalohippocampotomy (SLAH) is at making patients with mesial temporal lobe epilepsy (MTLE) becoming seizure-free.

SLAH is a minimally invasive procedure that involves sending a laser into the brain through a cartridge-sized catheter and passing a fiber optic through it. The cable then sends a light into the brain, where it burns out the amygdala, a small structure before the hippocampus, said Gross.

Gross began using laser ablations to treat MTLE in around 2011, when a company making a new laser device asked if he was interested in using it for treatment. At the time, the only other person who had been using it was a doctor in Houston, he said.

"It seemed like a good idea to me, so I jumped all in," he said.

Approximately 65 percent, or two-thirds, of the nearly 100 patients who underwent SLAH in his office became seizure-free. Gross and his team said that they sought to examine if there were any factors regarding a patient's epilepsy that predicted if that person was more likely to become seizure-free.

Gross credits Adam Dickey, a neurologist working on his team, for using logistic regression to look at predictive analytics and develop a factor scale with eight elements, including the age of the onset of seizures in patients and where in the brain these seizures occur. All of these factors are turned into positive or negative indicators, he said.

Patients who scored six or higher on the scale were more likely to be seizure-free after the operation. Conversely, patients who scored lower on the scale of factors were less likely to be seizure-free.

Gross said this scale can open up more treatment options for some patients with epilepsy.

"Not all epilepsy patients are candidates for this, but many are, and those patients that we ordinarily treat with an open surgery, … we now can treat with this more minimally invasive technique of laser," he said.

Since the procedure is less invasive, there are fewer complications and risks within the 6 to 8-hour operation. Gross said that patients can go home the same day of surgery and may not have to miss any time at work.

"This is a technique that I helped develop and have been leading an effort towards in my experience outside of New Jersey over the last several decades, but now New Jersey, which has been really underserved in terms of having access to this," he said.