Femtosecond Laser Surgical Therapy for Neocortical Epilepsy (Optical Cutting, Microsurgery)

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Seizures evolve in three stages: initiation, propagation, and termination. Surgical strategies for stopping seizures attempt to interrupt either seizure initiation or propagation. These strategies date back more than 50 years and have not changed even as our understanding of seizure physiology as well as our technology has dramatically progressed.

Epilepsy lab researchers introduce a new method which they have developed using a special kind of laser to make very fine cuts in the cortex that are localized within the brain without cutting the surface of the brain. A combination of in vivo two-photon imaging, ultrafast femtosecond laser cutting, electrophysiological recoding, laser Doppler flowmetry, oxygen microsensor, and optical mapping will be used. The advantage of these ultrafast laser pulses is their ability to evaporate an extremely small volume of tissue without heating or damaging the surrounding tissue. Tightly focused femtosecond laser pulses provide a unique means to make micrometer-scale cuts more than a millimeter within the bulk of a tissue that cause minimal collateral damage. The idea is to use this new laser scalpel to stop seizures from starting or spreading without damaging the brain's ability to process information. Essentially, the laser serves as a very sharp scalpel that can cut inside a tissue without affecting overlying tissue.

A primary goal of this study is to evaluate whether laser cutting influence the acute focal ictal discharges induced by 4-aminopyridine (4-AP) and in what geometric pattern to maximally interfere with seizure initiation and propagation while minimally affecting normal function. The results from this research should provide a great precise surgical therapy to treat neocortical epilepsy and lead to clinically useful approaches of femtosecond laser technology.