“There’s no way on earth I would have been able to do this before the surgery.”
Ann Rossi’s life took a devastating turn when she was a young woman. Three decades later, it took another abrupt turn. But this one — the result of a minimally invasive procedure she underwent at the Comprehensive Epilepsy Center — has given her a new lease on life.
“I can go anywhere now and feel fine. It’s amazing,” she says. “This procedure has made such a huge difference for me in a variety of ways.”
For 32 years, Ann’s lifestyle was mostly dictated by her epilepsy. At 19, she experienced an arteriovenous malformation (AVM) rupture — a knot of arteries and veins burst and bled into her brain — leaving her with significant and lasting brain damage. A year later, she began having epileptic seizures.
Ann’s seizures gradually increased in frequency and intensity. Most recently, she was having two clusters of 10 to 15 seizures a month. That equates to about 30 seizures per month, of which several would cause her to lose awareness.
Ann says she often felt euphoric at the start of a seizure. Then she would lose track of where she was and what she was doing. After the seizure, it would take her about 15 minutes to regain her bearings. She was often left exhausted by the experience and would need to sleep for the next few hours.
Over the years, Ann was prescribed more than 10 antiseizure medications, which did little to help curb her epilepsy. All the while, she was becoming keenly aware of the variables that increased her risk of having a seizure: hormone fluctuations, many different foods and ingredients, certain artificial scents, and bright or flashing lights.
Ann remained relentlessly positive despite the seizures, which she says, were just a way of life for her and her family. She concedes, however, that some of the ways epilepsy was affecting her were becoming more pronounced. And that scared her.
Finding a silver lining
In September 2021, Ann was referred to Kathryn Adamiak Davis, MD, MSTR, director of the Penn Epilepsy Center, medical director of the Epilepsy Monitoring Unit and Epilepsy Surgical Program at Penn Medicine.
Dr. Davis and her team submitted Ann to a wide-ranging presurgical evaluation that included a video EEG in the Epilepsy Monitoring Unit, PET scan, high-resolution imaging of her brain, neuropsychological testing, and a functional MRI. Ultimately, an SEEG — a test that involved a neurosurgeon making small incisions in Ann’s head and placing electrodes in targeted areas of her brain — was able to trace the origin of her seizures to a single region of her brain: the left hippocampus.
That was relatively good news because it meant that Ann was a candidate for multiple treatment options. Dr. Davis recommended Laser Interstitial Thermal Therapy (LITT), or laser ablation, a much less invasive surgery than the most common type of epilepsy surgery.
“For many of our patients, it’s better tolerated and very effective,” Dr. Davis says.
A gentler brain surgery
In certain people, LITT can destroy the brain cells causing seizures with pinpoint accuracy. Laser technology delivers a set amount of energy to the targeted area of the brain — the left hippocampus, in Ann’s case. That energy changes into thermal or heat energy, which then destroys the seizure focus. The laser energy is monitored by MRI and a computer to ensure the surrounding brain tissue isn’t affected.
A laser probe is placed through a small hole in the skull, a less invasive approach than the most common type of epilepsy surgery, which is often called an “open surgery” because it entails opening the skull and removing the part of the brain where the seizures are coming from.
Patients who undergo LITT usually stay in the hospital for a night or two after the procedure. (Ann stayed for two.) For comparison, patients who undergo “open surgery” go home after an average of three to five days.
Studies have found LITT to be about as effective as “open surgery,” while generally having less side effects and a quicker recovery.
Ann says she struggled with word finding for two months after her surgery, although that’s been the case to a lesser degree since her AVM rupture. Overall, she says, “it was really surprising how normal I felt” after the surgery. (She was also happy about losing only a minimal amount of hair during the surgery.)
LITT is a safe and effective treatment option for some people who, like Ann, have found little reprieve from their seizures through medication and whose seizures are caused by a single focus.
The dawn of a new era
It has been nearly a year since Ann had her surgery and she hasn’t had a seizure since. She continues to take antiseizure medications, in part because of the effects of the AVM rupture, which could not be resolved by the LITT. But, Dr. Davis has lowered the dosages since the surgery, and she anticipates lowering them further in the near future.
She says this shouldn’t take away from the headline: No Seizures in Nearly a Year.
“That’s an enormous change in her quality of life and safety,” Dr. Davis says.
“Thermal ablation worked out for Ann because it was the best option for her,” she continues. “But even if it hadn’t been an option, she would have been a candidate for the newer neuromodulation device therapies that can significantly help epilepsy patients. For patients who have been told many, many times that they don’t have surgical options, that’s really not true anymore. Now, fortunately, there’s really not a single patient who has drug-resistant epilepsy that we don’t have a treatment option for. That definitely wasn’t the case five years ago.”
Ann says she had no trepidation about the surgery. The thoroughness of her evaluation at the Penn Epilepsy Center — she wasn’t aware of the full extent of her seizures or their impact on her quality of life until the evaluation — and Dr. Davis herself provided her with all the reassurance she needed.
“From the beginning, I could relate to Dr. Davis, and I felt like she understood what I was talking about,” she says. “And she and her team couldn’t have done more to make sure that I was going to come through this OK.”
Nonetheless, not having a single seizure since the surgery is well beyond what she could have imagined beforehand. As weeks turned into months, Ann’s surprised herself with how quickly she’s adapted to a new way of life. She travels downtown by bus often, sometimes to play piano at a rehabilitation hospital that specializes in traumatic brain injuries.
“There’s no way on earth I would have been able to do this before the surgery,” she says. “Everything would have been a concern. Actually, it wouldn’t have been a concern. It would have been absolute. I absolutely would have had a seizure.”
In recent weeks, Ann’s noticed a new clarity in her thoughts. She believes her brain is making connections it hasn’t been able to make for decades. Her short-term memory is also improving. Prior to the surgery, she was becoming concerned about how quickly she was forgetting things.
“I was lucky if I could hold on to a thought for more than a few seconds,” she says. “Now I’m retaining information for a couple of weeks. And it seems to be getting better by the day.”
A rehabilitation program is helping her learn to read a book in its entirety and do modest math equations, neither of which she’s been able to do since the start of her epilepsy.
For more than three decades, Ann made the best of life in the face of trying circumstances. Now, almost overnight, many of those walls have crumbled down and the world is opening up to her.
“I’m having a hard time describing this experience as anything but life-changing,” she says.