Ground-breaking procedure helps many risky cases

A new technique is helping those with debilitating epilepsy who were previously considered too risky to be safely operated on.

A new technique in which probes are placed deep in a person’s brain is overcoming debilitating epilepsy for Victorians previously considered too risky to be safely operated on.

Almost 40 patients have so far been treated with the ground-breaking stereoelectroencephalography – or SEEG – procedure at Melbourne’s The Alfred hospital, with more than 60 per cent now living seizure-free.

The cases were previously considered too complex for traditional brain surgery techniques, but may now be among the first of up to 10,500 Australians who could benefit from brain-monitoring advancements.

By drilling small holes into a patient’s head and inserting up to 13 electrodes into their brain for up a week, Melbourne neurologists are building up unprecedented levels of detail about the misfiring sections driving their epilepsy.

In some cases, the doctors can then use the same probes to burn the misfiring sections of the brain in a minimally invasive technique that prevents the patient having surgery.

Robyn Nolan had the new SEEG technique at The Alfred in 2021 and is now seizure-free. Picture: Jake Nowakowski

For others, Alfred neurologist Dr Andrew Neal said the detailed information recorded by the electrodes could be used to guide surgeons through operations that would not otherwise be considered.

“The goal of this SEEG procedure is to work out where the seizures are coming from, what is the function of the brain around that area, and then design an operation to remove that part of the brain,” Dr Neal said.

“For a long time, these people with epilepsy were considered too hard. But now, with these newer techniques like SEEG we’ve only recently got access to in Australia, we can insert electrodes into the brain around the regions where we think the seizures are coming from and record the seizures from within over a period of time.”

Of the 90,000 Australians with focal epilepsy, a third cannot control their seizures with medications.

Of those, about 10-15 per cent are candidates for traditional epilepsy surgery, which uses MRI scans to identify the problematic areas of their brain, which are then painstakingly removed. But the remaining 12,000-15,000 cases are too complex to be accurately pinpointed with MRI scans, making surgery too dangerous.

12 intracranial stereo-electrodes inserted into the right side of the brain to record seizures.

Since using SEEG for the first time in 2019, the Alfred team has helped 37 patients with the technique, including 35 who had areas of their brain burnt by the probes before surgery. The unit recently gained approval to increase the technique’s use to 20 cases a year, including some patients from interstate.

The Alfred has quickly gained the most experience with the minimally invasive burn procedure, known as thermo coagulation. After drilling small holes through a patient’s skull, neurologists insert 8mm electrodes into different areas of their brain.

By passing small amounts of electricity through the electrodes, the team can also induce seizures to see which areas react, as well as which sections of their body are affected, to identify vital areas they need to avoid.

Despite having a tumour removed from her brain in 2018, massive doses of epilepsy medications were powerless to stop Robyn Nolan, 26, suffering up to 15 seizures a week.

After Dublin surgeons removed as much of the Irish native’s tumour as they safely could, small sections remained and her partial seizures continued after she moved to Australia.

“I just felt trapped by epilepsy,” Ms Noble said.

“They weren’t your typical convulsive seizures. I would just go blank and I would start talking. I’d ask what time it was or just talk gibberish, and then I could end up vomiting, snap out of it and come back to the world.”

After initial tests at The Alfred in January 2021 indicated Ms Noble might be a candidate for SEEG, she returned eight months later and had several holes drilled into her head so probes could be implanted to map out where the misfiring signals were coming from.

“It was very, very successful – it was super,” she said.

“They did it little bit by little bit and asked me what I was feeling and that kept me calm. Then they put me out and actually removed them.

“I went into it with the expectation of ‘maybe it will reduce my seizures, I might be able to reduce my medication’ – and then I got rid of them altogether.”