15 Years of Hope: How Texas Children’s Changed Epilepsy Surgery

Fifteen years ago, Texas Children’s Hospital became the first hospital in the world to perform MRI-guided laser ablation for epilepsy. This surgery uses a thin laser fiber and MRI imaging to precisely destroy problem areas in the brain that cause seizures.

Before this procedure was available, epilepsy surgery required a large operation that involved removing part of the skull. Recovery could take weeks, and the risks were high. With laser ablation, children often go home the next day and the risk of complications is significantly lower.

“This changed everything for families,” said Daniel Curry, MD, director of Functional Neurosurgery and Epilepsy Surgery at Texas Children’s. “The laser gave us a safer way to stop seizures, and children can recover much more quickly.”

How it started

The idea for laser ablation didn’t begin in the operating room. Engineers in Texas designed a cooled laser system to treat tumors in the body. When they brought the technology to Texas Children’s, Dr. Curry and his colleagues saw a new possibility: using it to reach deep areas of the brain that caused epilepsy.

The first patient was a child with tuberous sclerosis complex, a condition that leads to many seizures. After the laser procedure, the child went home the next day, seizure-free. Encouraged by that success, the team treated another child with temporal lobe epilepsy successfully. They then began treating hypothalamic hamartomas, a very difficult condition to cure with open surgery. Not only did that patient experience freedom from seizures, but he also remains seizure-free to this day.

“In the past, the philosophy was to do one big surgery,” said Dr. Curry. “With the laser, we can treat epilepsy in smaller, safer steps.”

A safer approach

For many children, laser ablation has meant a higher chance of living without seizures and fewer side effects.

When doctors used the traditional open surgery for hypothalamic hamartomas, children had a 50% chance of memory problems and/or significant weight gain from damage to the hypothalamus. With the laser, those risks dropped to less than 2 percent.

“Families want to know the chances their child will be free of seizures and what the risks are,” said Dr. Curry. “For many diagnoses, laser ablation has better outcomes than open surgery, and the risks are much lower.”

Training hospitals around the world

Because Texas Children’s performed the first procedure and has now treated more than 500 children, other hospitals look to its team for training. Surgeons from across the United States — and from around the world — have traveled to Houston to watch the surgery and learn the techniques.

“From the beginning, we’ve had an open-door policy,” said Dr. Curry. “We wanted other centers to be able to offer this option, too, so more children and families can benefit.”

What families can expect

Every child’s epilepsy is different. The team at Texas Children’s uses diagnostic tests to find out exactly where seizures start. If medications fail to provide seizure relief, often children are candidates for surgery.

“One size doesn’t fit all,” said Dr. Curry. “Our goal is to find the right approach for each child.”

Looking ahead

Texas Children’s continues to improve the procedure. Today, doctors can combine laser ablation with other tools such as robotic guidance and even neuromodulation, which uses small electrical signals to calm seizure activity. Doctors can use diagnostic tools to identify the areas where seizures are originating and then treat those areas at the same time.

“We’re still learning and pushing forward,” said Dr. Curry. “The future is about combining techniques so we can personalize surgery even more.”

A legacy of hope

Over the past 15 years, MRI-guided laser ablation has given thousands of children a safer path to seizure control. Texas Children’s has led the way from the very first case, and its doctors continue to shape the future of epilepsy surgery.

“What started as an experiment has become standard care,” said Dr. Curry. “Fifteen years in, we’re still pushing the boundaries to make epilepsy surgery safer, less invasive and more effective for every child.”

Learn more about our Epilepsy Surgery Program and treatment options for your child.