In the summer of 1990, Jason Putnam was a sophomore in college preparing to play Division I tennis at the University of North Texas. His college sports career, however, was abruptly cut short after he was hit in the head at a concert. Jason suffered a traumatic brain injury (TBI) that had an immediate and long-term impact on his brain health.
“I was in a coma for a week. My speech was gone, and my memory was gone,” explained Jason. “It took me a decade to fully recover cognitively.”
Nearly 25 years later, that same injury threatened to derail his life again when the scar tissue from his TBI developed into epilepsy.
Epilepsy triggered by TBI
Epilepsy is a neurological condition caused when abnormal brain cells that are hyperexcitable short-circuit the brain and spark unprovoked seizures. One in 5 people who suffer a TBI will later develop epilepsy.
“This is one of the most common causes of what we call acquired epilepsy,” explained Samden Lhatoo, MD, a UT Physicians epileptologist at UTHealth Houston Neurosciences — Texas Medical Center and co-director of the Texas Institute of Restorative Neurotechnologies at UTHealth Houston.
Following a TBI, the brain will begin a process of rewiring to heal, but that isn’t perfect, and during the healing process, epilepsy can slowly develop.
“It’s not unusual for epilepsy to present many years or even decades after the original injury,” said Lhatoo, a professor and the John P. and Kathrine G. McGovern Distinguished Chair in the Department of Neurology at McGovern Medical School with UTHealth Houston.
Texas Comprehensive Epilepsy Program at UTHealth Houston
By the spring of 2022, Jason was having up to six complex partial seizures a day.
“I was nonfunctional,” said Jason. “I was going through medication after medication, and nothing was working.”
He turned to the Texas Comprehensive Epilepsy Program (TCEP) at UTHealth Houston, where Lhatoo works alongside a multidisciplinary team of highly trained epileptologists, neurosurgeons, neuropsychologists, neuroradiologists, and others in one of the busiest epilepsy surgery programs in the country.
Focal onset seizure
Jason’s seizures were focal onset, which means the seizure originates from the same side of the brain each time. These are the most common types of seizures in people with epilepsy.
“His epilepsy was in a part of the brain called the hippocampus, which controls memory and learning,” said Lhatoo. “Once we determined the seizures were originating in the right hippocampus, we knew we had the option to laser it.”
Jason was a textbook candidate for laser interstitial thermal therapy (LITT) surgery.
Laser interstitial thermal therapy
In April 2022, Jason underwent LITT surgery performed by Nitin Tandon, MD, a UT Physicians neurosurgeon at UTHealth Houston Neurosciences — Texas Medical Center and chief of epilepsy surgery at TCEP.
LITT is laser brain surgery. The procedure occurs inside an MRI scanner to precisely monitor the laser’s work.
Tandon began the surgery by creating a small hole in the skull, where he inserted a very thin plastic probe carrying a laser fiber into the brain. The fiber emits infrared laser light.
“We carefully map out the trajectory of the probe,” said Tandon, a professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School and founder of the Texas Institute for Restorative Neurotechnologies. “The probe is so small the brain doesn’t even know it’s there.”
Over several hours, Tandon and his team carefully mapped the route to maneuver the probe through his brain, and then he used laser ablation to destroy the cells that spark seizures.
Tandon has completed more than 250 LITT surgeries since 2013 for patients with tumors and epilepsy.
“Laser ablation carries a high rate of success with a low risk of causing collateral damage to the brain and minimizes the neurocognitive impact,” said Tandon, who holds the BCMS Distinguished Professorship in Neurological Disorders and Neurology at the medical school and the Nancy, Clive and Pierce Runnells Distinguished Chair in Neuroscience of the Vivian L. Smith Center for Neurologic Research. “It is minimally invasive brain surgery that has changed the landscape for patients who want to avoid craniotomy.”
Benefits of LITT
Patients who undergo LITT surgery have a 70% chance of never having a seizure again, and another 20% of patients will be vastly improved.
“About 90% of patients benefit from this operation,” said Tandon.
“Ten years ago, the only recourse for patients like Jason was to do open brain surgery. We now know in carefully selected individuals that we don’t need to put them through such an invasive procedure,” said Lhatoo. “With laser surgery, we minimize risk, shorten their hospital stay, and improve overall recovery.”
Risks of LITT
While the risks associated with this particular brain surgery are low, depending on which side of the brain the laser ablation targets, there could be some impact.
On the right side of the brain, there are minimal risks to memory.
On the left side of the brain, there is a small risk of reduced peripheral vision or reduced memory for complicated tasks like listing objects.
Care and recovery
Jason’s surgery was a success.
“This was a miracle surgery for me. They burned away the epilepsy that was created from a TBI,” said Jason.
Within weeks of LITT brain surgery, Jason returned to his daily routine and spent a year weaning off seizure medication.
“He has done extremely well,” said Tandon.
Now off medication and seizure-free, Jason continues follow-up care with Lhatoo once a year.
Epilepsy surgery options
“When you have ongoing uncontrolled seizures, it is very important to be assessed by an expert. There are surgical options available for epilepsy that can help people become seizure-free,” said Lhatoo.
“We treat people from around the U.S. and the world,” said Tandon. “We want to give people their lives back. This minimally invasive procedure enables people to return to normal, healthy, independent living.” “This team is extraordinary,” said Jason. “Before surgery, I was so restricted from having a life. Dr. Tandon, Dr. Lhatoo, and their team gave me my life back.”
