Epilepsy surgery gives patient a new lease on life

Ann Rossi’s life took a devastating turn when she was a young woman. Three decades later, it took another abrupt turn. But this one — the result of a minimally invasive procedure she underwent at Penn Medicine's Comprehensive Epilepsy Center — has given her a new lease on life.

“I can go anywhere now and feel fine. It’s amazing,” she said. “This procedure has made such a huge difference for me in a variety of ways.”

A life dictated by epilepsy

For 32 years, Rossi's lifestyle was mostly dictated by her epilepsy. At age 19, she experienced an arteriovenous malformation (AVM) rupture — a knot of arteries and veins burst and bled into her brain — leaving her with significant and lasting brain damage. A year later, she began having epileptic seizures.

Rossi’s seizures gradually increased in frequency and intensity until she was having two clusters of 10 to 15 seizures a month. That equates to about 30 seizures per month, several causing her to lose awareness.

Rossi often felt euphoric at the start of a seizure. Then she would lose track of where she was and what she was doing. After the seizure, it would take about 15 minutes to regain her bearings. She was often left exhausted and would need to sleep for the next few hours.

Over the years, Rossi was prescribed more than 10 anti-seizure medications, which did little to help curb her epilepsy. All the while, she was becoming keenly aware of the variables that increased her risk of having a seizure: hormone fluctuations, many different foods and ingredients, certain artificial scents, and bright or flashing lights.

Rossi remained relentlessly positive despite the seizures, which were a way of life for her and her family. She concedes, however, that some of the ways epilepsy was affecting her were becoming more pronounced. And that scared her.

New epilepsy treatment solutions

Everything started to change when Rossi was referred to Kathryn Adamiak Davis, MD, MSTR, director of the Epilepsy Center, and medical director of the Epilepsy Monitoring Unit and Epilepsy Surgical Program at Penn Medicine.

Davis and her team ordered a wide-ranging pre-surgical evaluation that included a video EEG in the Epilepsy Monitoring Unit, PET scan, high-resolution imaging of Rossi's brain, neuropsychological testing, and a functional MRI. Ultimately, a SEEG — a test that involved a neurosurgeon making small incisions in Rossi's head and placing electrodes in targeted areas of her brain — was able to trace the origin of her seizures to a single region of her brain: the left hippocampus.

That relatively good news meant Rossi was a candidate for multiple treatment options. Davis recommended Laser Interstitial Thermal Therapy (LITT), or laser ablation, a much less invasive surgery than the most common type of epilepsy surgery.

“For many of our patients, it’s better tolerated and very effective,” Davis said.

A minimally invasive brain surgery

In certain people, LITT can destroy with pinpoint accuracy, the brain cells that were causing seizures. Laser technology delivers a set amount of energy to the targeted area of the brain — the left hippocampus, in Rossi's case. That energy changes into thermal or heat energy, which then destroys the seizure focus. The laser energy is monitored by MRI and a computer to ensure the surrounding brain tissue isn’t affected.

A laser probe is placed through a small hole in the skull, a less invasive approach than the most common type of open epilepsy surgery, which entails opening the skull and removing the part of the brain where the seizures originate.

Patients who undergo LITT usually stay in the hospital a night or two after the procedure. (Rossi stayed for two.) Patients who undergo “open surgery” are usually hospitalized for three to five days.

Studies have found LITT to be about as effective as “open surgery,” while generally having fewer side effects and a quicker recovery.

Rossi struggled with word finding for two months after her surgery, although that was true to a lesser degree since her AVM rupture. Overall, she said, “it was really surprising how normal I felt” after the surgery. She was also happy about losing only a minimal amount of hair.

LITT is a safe and effective treatment option for some people like Rossi, who found little relief from their seizures with medication and whose seizures are caused by a single focus.

Promising results from LITT

A year after her surgery Rossi hadn't had any seizures. She continued to take anti-seizure medications, in part because of the effects of the AVM rupture which could not be resolved by the LITT. However, Davis lowered the dosages since the surgery and anticipates reducing them further.

She emphasized that this shouldn’t take away from the fact that Rossi hadn't experienced any seizures following the surgery.

“That’s an enormous change in her quality of life and safety,” Davis said.

“Thermal ablation worked out for Ann because it was the best option for her,” Davis continued. “But even if it hadn’t been an option, she would have been a candidate for the newer neuromodulation device therapies that can significantly help epilepsy patients. For patients who have been told many times that they don’t have surgical options, that’s really not true anymore. Now, fortunately, there’s not a single patient who has drug-resistant epilepsy that we don’t have a treatment option for. That definitely wasn’t the case five years ago.”

Rossi said she had no trepidation about the surgery. The thoroughness of her evaluation at the Penn Epilepsy Center — she wasn’t fully aware of the extent of her seizures or their impact on her quality of life until the evaluation — and Davis herself provided the reassurance she needed.

“From the beginning, I could relate to Dr. Davis, and I felt she understood what I was talking about,” Rossi said. “She and her team couldn’t have done more to make sure I was going to come through this OK.”

Nonetheless, not having a single seizure since the surgery is well beyond what she could have imagined. As weeks turned into months, Rossi surprised herself with how quickly she adapted to a new way of life. She often travelled downtown by bus, sometimes to play piano at a rehabilitation hospital specializing in traumatic brain injuries.

“There’s no way on earth I would have been able to do this before the surgery,” she said. “Everything would have been a concern."

Rossi began noticing new clarity in her thoughts. She believes her brain is making connections it hasn’t been able to make for decades. Her short-term memory is also improving. Prior to the surgery, she was becoming concerned about how quickly she was forgetting things.

“I was lucky if I could hold on to a thought for more than a few seconds,” she said. “Now I’m retaining information for a couple of weeks. And it seems to be getting better by the day.”

A rehabilitation program is helping her learn to read a book in its entirety and do modest math equations, neither of which she had been able to do since the start of her epilepsy.

For more than three decades, Rossi made the best of life in the face of trying circumstances. Then, almost overnight, thanks to Davis and LITT, the world opened up to her.

“I’m having a hard time describing this experience as anything but life-changing,” she said.

If you or a loved one recently started having seizures or have lived them with for years, the Epilepsy Center at Penn Medicine can help. Learn more or make an appointment.