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ROSA technology helps ease patient’s violent seizures

Dec. 5, 2019, 10:22 AM

Pediatric neurologist Kevin Ess, MD, PhD, left, and pediatric neurosurgeon Robert Naftel, MD, follow up with patient Daniel Lookabaugh, who has epilepsy.
Pediatric neurologist Kevin Ess, MD, PhD, left, and pediatric neurosurgeon Robert Naftel, MD, follow up with patient Daniel Lookabaugh, who has epilepsy. (photo by Anne Rayner)

by Christina Echegaray

Daniel Lookabaugh, a 20-year-old electrical engineering student, has never driven a car because of violent seizures, and at one point last year had to put his schooling on hold.

His seizures began about age 3. They became more frequent as he got older, then became so intense he would dislocate his shoulder and jaw. He has epilepsy, a condition of recurring seizures.

“About two years ago, my seizures became more violent and that’s when my jaw and shoulder started popping out,” Lookabaugh said. “It gets annoying, and I hate that I have to depend on other people.”

In the span of a month in December 2018, he suffered six severe seizures, requiring hospitalization at Monroe Carell Jr. Children’s Hospital at Vanderbilt each time to have neurological care as well as intervention from Pediatric Orthopaedics to reset his jaw and shoulder.

With the help of new technology at Children’s Hospital, a device known as the ROSA (Robotic Stereotactic Assistance) Robot, Lookabaugh’s doctors at Children’s Hospital, pediatric neurologist Kevin Ess, MD, PhD, and pediatric neurosurgeon Robert Naftel, MD, believe he will get the chance to be able to drive and will miss a lot less school.

The ROSA is a robot that assists in inserting EEG electrodes into patients’ heads, helping neurosurgeons precisely identify seizure hotspots safely, effectively and efficiently. Using the device, they can pinpoint the precise location seizures start — all without having to perform a craniotomy, removal of the skull, by monitoring his brain activity.

Doctors with the Epilepsy Program at Children’s Hospital are able to use this technology as another tool in their diagnostics arsenal for pediatric patients. The robot was first purchased by Vanderbilt University Medical Center, an acquisition championed by Peter Konrad, MD, PhD, professor of Neurological Surgery, with a second one subsequently acquired for Children’s Hospital.

Lookabaugh was among the first Children’s Hospital patients to have the ROSA procedure, and subsequently was able to have life-changing brain surgery after the ROSA helped identify that his seizures were coming from the left temporal lobe. He is now five months seizure free.

“For epilepsy surgery this has been a paradigm shift in the way we do invasive monitoring,” said Naftel, associate professor of Neurological Surgery. “The robot allows us to do epilepsy monitoring in the safest, most precise, high tech way available. For our patients that means they are getting the highest level of care available to determine their epilepsy surgery needs.”

Lookabaugh’s seizures stem from a prenatal stroke that damaged about one-sixth of the left side of his brain. As that portion of his brain is unused and mainly causing seizures, functions like language that would normally exist there relocated to the right side as his brain developed, a phenomenon known as plasticity, notes Ess, who is chief of the Division of Pediatric Neurology at Children’s Hospital.

Ess knew that the only way to help him was to find a way to lessen or stop the seizures.

“He was initially well controlled. Then he was having more seizures, even with increased medicines. I knew that he was a potential candidate for surgery because he had an old, focal lesion from birth and his brain had the opportunity to reorganize itself and have normal function. But to do the surgery, we needed better technology and more information to help nail down the area causing the seizures,” said Ess, the Gerald M. Fenichel Professor of Neurology.

At Children’s Hospital, before surgery is an option, doctors also consider diet interventions as well as medication options to treat seizures. The National Association of Epilepsy Centers identifies Children’s Hospital as Middle Tennessee’s only Level 4 center, offering the highest level of care for epilepsy, which affects about six in 1,000 children.

In the past, Naftel and other neurosurgeons removed portions of the skull to insert subdural electrodes attached to a grid — more invasive and providing less detail and data than the ROSA. The patient is then monitored for seizures with invasive electrodes in place during a hospital stay. Children’s Hospital is the only facility in the Mid-state with video-EEG monitoring for the evaluation of children for epilepsy surgery.

When other treatment paths don’t work, Ess looks to the neurosurgery team for surgical options. Naftel and Ess create a detailed plan using EEG, MRI and PET scans and patient history to then input into the ROSA computer, which precisely guides where each electrode should be placed.

“With this technology, we can create a personalized plan for every patient,” Naftel said.

Small holes less than 0.8 mm in diameter are drilled and each electrode (which varies in number for each patient) is inserted. Lookabaugh had eight electrodes for a total of 96 contacts inside the brain to record data.

Two weeks passed before a seizure occurred.

“For Daniel, he is no longer having seizures or dislocating his arm and his jaw, and he has a chance now where he could drive,” said Ess. “It’s life changing at this point, but we’re not promising a cure yet. He has had seizures for many years, but his current status is so much better that we are all optimistic for Daniel’s future.”

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