Epilepsy Talk
The Gamma Knife — Non Invasive Surgery | September 12, 2012
Neurosurgeons continue to explore the less invasive Gamma Knife radiosurgery for elimination of temporal lobe abnormalities and brain lesions.
The Gamma Knife itself has been around for quite a while, so there’s a history of its use. But its application specifically for this form of epilepsy hasn’t really been done before. Therefore, the purpose of recent research was to see if the advantages of this minimally invasive tool could provide an alternative to standard surgery.
In one clinical Gamma Knife surgery trial, researchers found the number of seizures was dramatically decreased from a media of 92 seizures per month pre-operatively to 6 seizures per month after the procedure. And another smaller study showed, 66% of patients to be seizure-free following 18 months of treatment.
The term “Gamma Knife” connotes that it delivers radiation treatment as though it were an actual knife, offering the kind of precision and targeting as actual surgery. Indeed, it uses radiation in much the same way as a surgeon uses a knife.
The Gamma Knife “blades” are actually 201 beams of gamma radiation, with the precision of less than 1 mm, tightly focused to target the brain lesions. The aim is to impair the lesion and inhibit it from causing further seizures. Computer software guides the surgeon to the correct vantage points during the process and the lesion is carefully damaged.
Over time (several months to one year), most lesions slowly decrease in size and dissolve. The radiation exposure is brief and only the tissue being treated receives a significant dose, while the surrounding tissue remains unharmed.
When the entire lesion can be targeted, radiosurgery more than reduces the seizures, plus there are encouraging effects on cognition and quality of life. And although at this point, the procedure has shown to be ineffective for large lesions, Gamma Knife surgery could be a first-line surgical therapy to “blast” small tumors such as hamartomas — associated with partial gelastic (“laughing”) seizures.
Published reports indicate that the Gamma Knife may be used as an alternative to standard neurosurgical operations or as an adjunct therapy in the treatment of residual or recurrent lesions left unresected by conventional surgery. And the fact that it is a single treatment, usually done as an out-patient procedure, makes it especially appealing for those who are qualified.
“Epilepsy surgery probably is underutilized, and an alternate method may bring the benefits of surgery to a wider group of patients.” — Mark S. Quigg, M.D., Neurologist at University of Virginia School of Medicine
Let’s hope so.
References:
http://www.medicalnewstoday.com/articles/242556.php
http://epilepsysurgery-rosetrial.com/rose_002.htm
http://epilepsyinanutshell.blogspot.com/2008/02/gamma-knife.html
http://www.irsa.org/gamma_knife.html
http://www.uhn.ca/about_uhn/programs/KN/gamma_knife_radiosurgery.asp
http://www.fortherecordmag.com/archives/052112p24.shtml
http://www.thelondongammaknifecentre.com/questions.php
Tags: alternative, brain lesions, cognitive, decrease, dissolve, Gamma Knife, improvement, less invasive, out-patient, precision, psychiatric, radiation, radiosurgery, Research, seizure-free, surgery
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I’m concerned about abuses of this practice, such as: who do they “practice” on; would they use it on inmates in prisons, and would it become a weapon to torture or erase a persons memory? Also, could its use be covered up (like the rubber hose beatings which don’t leave outer marks). I think today’s unethical and irresponsible practices may make this a dangerous tool. We do need more options, but this one is disturbing. Am I too cynical?
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Comment by kim — September 12, 2012 @ 3:45 PM
Yup. I think you’re a bit cynical.
First and most importantly, this and all procedures, drugs and innovationations must going through clinical trials.
Before any clinical trials can begin, the med or procedure goes through rigorous testing and must be accepted as viable by the FDA.
The clinical trials are done on volunteers whose conditions qualify for the test and there is full disclosure of the benefits and liabilities involved. (Pages and pages and pages.)
Moreover, the clinical volunteer is monitored very carefully by medical specialists, every step of the way.
Their health and seizure status is checked and closely followed. So, if there’s any adverse effects, specialists know immediately and the testing is stopped.
Moreover, clinical trials are conducted in a series of four steps or phases. Each step or phase builds on the results of the phase before it.
Phase I trials are the first trials to involve people. They may be addressing such questions as: the best way to give a new treatment (as an injection or as a pill) or the highest dose that can be given safely, without serious side effects…
Phase II trials look at how effective the new treatment is. Researchers start with the dose and method of giving the new treatment that were found to be best in Phase I. The Phase II participants are given the new treatment and the researchers watch to see if the treatment has some benefit.
Phase III trials compare the safety and effectiveness of the new treatment to the current standard of care. A Phase III trial is the last step a new treatment goes through before the U.S. Food and Drug Administration considers approving it for general use.
Phase IV trials usually look at whether the treatment offers benefits or produces long-term side effects that weren’t studied or seen in the Phase II or Phase III trials. Phase IV trials usually are done after a treatment has been approved for use by the U.S. Food and Drug Administration.
http://www.breastcancer.org/treatment/clinical_trials/phases.jsp
I hope this puts your doubts/fears to rest.
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Comment by Phylis Feiner Johnson — September 12, 2012 @ 5:25 PM
They only do it in small areas not in a large area. Patients generally that have not had surgery before. THey are being really strict depending on the hospital practice. I was confronted about this proceedure in 1999. My abnormality was below temporal lobe in the ventricle. I had previous surgery. There were to many if’s in the picture or expanse.
I met one person with this type of surgery before and she found after a year a success.
Mine has spread and the surgeon basically said regular surgery would be better but another surgeon said it was possible. Hmm? I left it alone. After 2 surgeries in not quite the right place. I will leave it alone.
It might be great for others though!
Toni!
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Comment by Toni Robison — September 12, 2012 @ 9:49 PM
So what was the result of your two surgeries? And why were they “not in the right place?”
I’m kind of clueless about this, but wasn’t there any brain mapping or guidance during your surgeries?
I probably should ask Charlie the same question. But his first — unsuccessful surgery — was done in Florida. And his second was done by a surgeon at NYU who’s part of Orin Devisky’s group.
I met her. What a wonderful human being. Not to mention the fact that she gave Charlie a new lease on life! (Who wouldn’t love her for that!!!)
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Comment by Phylis Feiner Johnson — September 12, 2012 @ 11:21 PM
[…] Continued at: https://epilepsytalk.com/2012/09/12/the-gamma-knife-non-invasive-surgery/ […]
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