First Surgery on the East Coast; Second to be Performed in the U.S.
Jun 9, 2004
A surgeon-scientist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center implanted a device that will allow deep brain stimulation (DBS) to be conducted on a patient with epilepsy. For the second time in the United States, an electronic pacemaker was implanted into the brain of a patient afflicted with the disease.
The device, known as the Intercept Epilepsy Control System, is part of the first ever clinical trial where DBS is being used to treat epilepsy. Physicians theorize that this ability to directly stimulate the brain might be the initial step towards a cure for the disease.
Medication is the standard treatment for epilepsy, points out Dr. Douglas Labar, who is the principal investigator of the trial at NewYork-Presbyterian/Weill Cornell, however, in one-third of patients, medicine alone is not effective in stopping seizures and, therefore, other treatment options need to be explored. Dr. Labar is also director of the Comprehensive Epilepsy Center at NewYork-Presbyterian/Weill Cornell and a professor of neurology and neuroscience at Weill Cornell Medical College.
The four-hour procedure, in which two electrodes were implanted into the patient's brain and a battery pack into his chest, was performed on April 15 by Dr. Michael G. Kaplitt, who is director of Stereotactic and Functional Neurosurgery at NewYork-Presbyterian/Weill Cornell and an assistant professor of neurological surgery at Weill Cornell Medical College.
The patient was asleep during the procedure and his head was fitted in a stereotactic frame to prevent movement. After a CT scan pinpointed the target area, the surgical team drilled two small holes, about the size of quarters, in his skull. Through these openings, the two electrodes were implanted into the anterior nucleus of the thalamus, a region of the brain, slightly behind the hairline, which is believed to regulate his epileptic seizures.
The electrodes were then each connected to a lead that runs under the scalp, down the back of the patient's neck, and over the clavicle to a pack that Dr. Kaplitt, towards the end of the surgery, implanted in the patient's chest. The pack, measuring about the size of a deck of cards, supplies electrical impulses to the brain.
During the following months, Dr. Labar will monitor the patient's progress and adjust the pack's output to peak its effectiveness in diminishing the frequency and severity of seizures. We need to look at how DBS affects the rate of seizures, the intervals between them, and how it interacts with medication the patient is taking, says Dr. Labar. All of these factor into how the pack will be programmed.
With the device, the electrodes and leads are permanent; the pack's battery has a life-span of roughly five years, and is designed to be replaceable.
Under the direction of Dr. Labar, NewYork-Presbyterian/Weill Cornell was also involved in testing of the Vagus Nerve Stimulator, an earlier implant for epilepsy, which works by stimulating a peripheral nerve in the neck. Like the Intercept, the Vagus Nerve Stimulator emits a consistent signal designed to keep brain activity stable. However, the Intercept system delivers a stimulus directly into the brain, whereas the Vagus Nerve Stimulator targets a peripheral nerve (with the idea that the nerve will transport stimulus to the brain).
In addition to NewYork-Presbyterian/Weill Cornell, 11 other medical centers are currently involved in the Intercept Trial, including NewYork-Presbyterian/Columbia.