An illustration of brain pathways. PHOTO COURTESY OF SCIENCE PHOTO LIBRARY / TOM BARRICK, CHRIS CLARK, SGHMS
BY Ilima Loomis
Functional neurosurgery—surgical interaction with the brain to improve function—was pioneered to treat people in need of pain relief, often those suffering with terminal cancer. Simple early procedures included surgically creating tiny lesions, also called ablations, in specific areas of the nervous system linked to pain.
The field has come a long way since those early days, says Jon Willie, MD, PhD, Washington University neurosurgeon at Barnes-Jewish Hospital. “What we know about the brain is expanding exponentially. New information and advanced methods of investigating the brain offer us new approaches to treating neuropsychiatric disorders.”
Parkinson’s disease, essential tremor, epilepsy, chronic pain, depression, obsessive compulsive disorder: These are among the conditions for which functional neurosurgery can provide significant relief. “For a person with essential tremor—whose tremor impairs activities of daily living such as cooking, dressing and writing—we often can alleviate up to 90% of the tremor in the dominant hand,” Willie says. “That provides a tremendous improvement in quality of life.” Likewise, some people with Parkinson’s see a 70% to 90% reduction of symptoms such as tremor and freezing of gait.
Advances in functional neurosurgery include deep-brain stimulation, a technique that involves inserting electrodes into specific areas of the brain and using gentle pulses of electricity to pace neurological activity. While this technique has been used for years to treat movement disorders, the newest iteration of the procedure, often called responsive neurostimulation, uses electrodes to detect changes in the brain’s activity and adjust stimulation levels in real time. And it is used to treat a variety of disorders, including epilepsy and certain psychiatric conditions.
Parkinson’s disease, essential tremor, epilepsy, chronic pain, depression, obsessive compulsive disorder: These are among the conditions for which functional neurosurgery can provide significant relief.
Willie says innovations such as this are “like going from black-and-white television to high-definition color television with unlimited channels.”
He also notes that the field of functional neurosurgery is seeing exciting changes in epilepsy treatment. Advanced imaging, brain-circuit mapping and improved diagnostics provide better ways to localize and treat seizures. When combined with minimally invasive ablative therapies, these treatments can help a significant number of people with epilepsy achieve freedom from seizures without undergoing open surgery, or craniotomy. And people with difficult-to-localize epilepsy or generalized epilepsy can benefit from new brain-stimulation therapies that reduce seizures by an average of 80% long-term, Willie says. “These therapies not only reduce seizures and the risk of unexpected death but can also improve thinking, memory and mood.”
Many people, and even some physicians, are unaware of how safe, tolerable and effective functional neurosurgery has become. “Many of these therapies are performed using tiny incisions—some so small they require a single stitch—and electrodes and probes smaller than the diameter of a pencil lead.” And as is true for other minimally invasive procedures, hospital stays are often very brief.
For people with neurological disorders, the results of such treatments can be life-changing. Willie recalls numerous patients who, despite decades spent with epilepsy, went on to live life without symptoms after treatment. One such patient with refractory epilepsy had seizures that could not be controlled by medication. She couldn’t work, drive, ride a bike or finish school and, well into her 40s, was being cared for by her aging mother. Working with epilepsy neurologists, Willie mapped her brain to locate the seizures and safely remove the involved tissue. “She sends me a card every Christmas to tell me she is seizure-free,” Willie says.
Research helps move the field of functional neurosurgery forward. For example, Willie’s most recent study involves treatment of post-traumatic stress disorder, or PTSD. He began to look closely at the disorder after noting that some epilepsy patients’ PTSD symptoms were eliminated by ablation of an area of the brain called the right amygdala. “This is ongoing research, and we have much to learn, but progress is constantly being made.”