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Stereotactic Surgical Technique Effectively Controls Seizures

Michael Segreto with his parents and Drs. Warnke and Wu Michael Segreto (center) with his parents at his side, along with neurosurgeon Peter Warnke, MD, (far left) and epileptologist Shasha Wu, MD, PhD (far right)

Michael Segreto, of Saint Charles, Ill., was 5 years old when he was diagnosed with epilepsy. Yet, his condition did not require serious attention for nearly 35 years. In 2012, something changed.

Growing Up with Epilepsy

Physicians prescribed several medications over the years to help Segreto control his epilepsy. He was able to effectively manage his condition with medication until October 2012.

"I was driving home from work and was stopped at a red light when, for the first time in more than 40 years, I seized behind the wheel," Segreto recalled. "My car was stopped, so thankfully no one was injured, but this seizure led to loss of driving privileges, a vital element of my personal freedom. Little did I know, this was only the start of a long, difficult road of mayhem."

Since that incident, the quantity, frequency and intensity of Segreto's seizures dramatically escalated. The seizures that previously occurred once every two weeks eventually increased to more than once a day -- and without warning. On multiple occasions, Segreto fell while showering, walking on the sidewalk or even sitting in a chair. Nearly all of these episodes required hospitalization. Despite his physicians' best efforts to help manage his disease with various medications and dosages, Segreto's seizures never abated.

In September 2013, Segreto suffered yet another seizure. When he was hospitalized, his physician recommended a consultation with Shasha Wu, MD, PhD, at the University of Chicago Medicine. Wu, a neurologist in the Comprehensive Epilepsy Center, has subspecialty expertise in the diagnosis and management of adult epilepsy.

"Mr. Segreto has temporal lobe epilepsy secondary to hippocampal sclerosis, which is a progressive disorder and often becomes intractable to anti-epileptic drugs," Wu said. "One of the distinct clinical characteristics of this disease is a seizure-free period, or a 'latent period,' before it becomes refractory."

In order to help preserve his memory and cognitive function, Wu deemed Segreto a candidate for epilepsy surgery and referred his care to neurosurgeon Peter Warnke, MD, prominently known for his expertise in epilepsy surgery.

A Leader in Epilepsy Treatment

Proven leadership in epilepsy has garnered UChicago Medicine accreditation as a Level IV Epilepsy Center -- the highest ranking from the National Association of Epilepsy Centers. The epilepsy team is uniquely positioned to care for patients with this complex disease.

"This means we not only offer expertise in medical treatment for epilepsy but also provide surgery for those whose epilepsy does not respond to medical treatment," Wu said. "Our experts use the latest clinical technologies and research to provide the most accurate diagnoses and individualized treatment plans."

The University of Chicago Medicine offers several surgical treatment options for epilepsy, including focal resection, stereotactic surgery, corpus callosotomy surgery as well as subpial transections.

As a leader in functional neurosurgery, Warnke offers the full range of epilepsy surgical options and, in fact, was the first in Illinois to offer MRI-guided stereoelectroencephalography (SEEG) and laser ablation surgery as treatment for epilepsy. This approach is advantageous to the traditional open surgical approach, which leaves patients vulnerable to cognitive side effects.

SEEG and laser ablation surgery is possible, thanks to the advent of modern technology. During the SEEG procedure, Warnke and his team use a minimally invasively technique to implant electrodes in targeted areas of the brain. These electrodes help the team locate the focal point of the seizures. The team then analyzes the SEEG results to determine the epileptic zone in all three dimensions prior to laser ablation surgery. With real-time guidance enabled by MRI imaging, the team then destroys these focal points with a sophisticated laser applicator.

"There are several advantages to this surgical approach for severe epilepsy, and they are that submillimetric precision of laser ablation used concomitantly with real-time MRI monitoring ensures we are targeting the affected zones," Warnke said. "The data shows this approach is highly effective for those with mesial temporal lobe epilepsy."

Life After Laser Ablation

In August 2014, Segreto, 41, underwent laser ablation without incident and has been seizure-free ever since.

Although he will require continual monitoring by his team at UChicago Medicine, Segreto says he is looking forward to having his life back.

"I can perform my daily activities with far less fear that I will experience a seizure," he said. "I look forward to restoring my freedom to drive and to travel."

February 2015

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