Robotic brain surgery at Texas Children’s offers chance at normal life

Brielle Langford’s life was a series of worries and “watch outs.” The 11 year old from New Braunfels had her first seizure when she was 4 days old after having hyperglycemia and then a stroke. 

Her epilepsy continued to worsen, leading up to almost daily seizures, sometimes more than one a day. By last year, she wasn’t allowed to play on the playground at school for fear that she would have a seizure and fall. She could go swimming, but only with a life jacket on and an adult right by her side. 

Sometimes the seizures would feel like a fog would come over Brielle and that she just wasn’t there mentally. Other times, the seizures were much worse.

“It felt as if I was holding my breath and then I would fall,” Brielle said. “And when I wake up, I’m on the floor.”

She would be very disoriented, her mother Lindsey Langford said. 

Trips to stores or to events often ended with Langford holding Brielle on the floor or the ground of wherever they were, waiting for a seizure to pass. The seizures led to many falls and injuries as well as heightened anxiety for the whole family. Brielle also became withdrawn as her interactions with her peers now had limitations. 

“We couldn’t live daily life anymore,” Langford said. “We were all so overwhelmed, and she quit wanting to do things that she loved.”

The Langfords had been seeing a neurologist at Texas Children’s Hospital in Houston, but after a move from Houston to New Braunfels two years ago and the opening of Texas Children’s Hospital in North Austin, they started seeing a neurologist in Austin and neurosurgeon Dr. Meena Vessell. 

Brielle became the hospital’s first patient to undergo a procedure using the ROSA robot for brain surgery. ROSA, which stands for robotic surgery assistant, allows Vessell to place electrodes inside the brain with more precision than in a traditional surgery.

The ROSA was purchased for the new hospital even before it opened. For Vessell, this was an essential piece of equipment needed to offer a full range of advance epilepsy care during advanced brain surgeries.

Vessell had to figure out which areas of the brain were causing Brielle’s seizures. After some initial testing earlier this year, Brielle came to Texas Children’s on July 9 for the first of three surgeries. 

Using the ROSA, Vessell placed a grid of electrodes inside Brielle’s brain during a diagnostic surgery called stereoelectroencephalography. The stereo EEG is similar to a regular EEG, except instead of the electrodes being on the scalp, they are in the brain. 

Doctors left the electrodes in Brielle’s brain for a week as they watched for signs of seizures to try to detect within a millimeter the origin of Brielle’s seizures within her brain. 

Without having the robot, this would have been a much bigger surgery, Vessell said, and would have involved removing a large part of her skull to get a grid of electrodes in place.

The stereo EEG revealed that Brielle’s seizures were centered primarily in her visual cortex in the occipital lobe at the back of the brain. The brain tissue that was involved was the area of the brain the impacts sight. 

The thalamus also was involved in the seizures, which is very typical. The thalamus is like the TSA of the brain, Vessell explains. The brain signals have to go through it before they can get to their destination in the other areas of the brain.

Knowing that Brielle’s seizures were coming from an essential area of the brain, the risk of Brielle losing her sight were too great for Vessell to feel comfortable with removing tissue in that area.

After a second surgery to remove the stereo EEG electrodes, Brielle rested while her team came up with a plan.

Vessell opted to install a repetitive nerve stimulation device with one wire lead sending signals to the affected area of the occipital lobe and another wire lead sending signals to the area of the thalamus. Think of this Responsive Neurostimulation System (RNS) like a pacemaker for the brain instead of for the heart.

When seizures happen, the affected area of the brain is receiving confusing electrical signals or excessive electrical signals. The RNS sends its own electrical signals when it detects conditions for a seizure and scrambles the confusing or excessive signals. “It calms everything down so the seizure can’t take place,” Vessell explains.

Using the ROSA robot again, on July 24, Vessell installed the RNS in Brielle. 

If the team had not done anything, Vessell said, Brielle’s seizures would continue and could potentially get worse. “Every time a child has a seizure, there is some micro damage to the brain,” Vessell said. “When they repeatedly have seizures, they can no longer concentrate.” 

Vessell and Brielle’s parents tried to present realistic expectations to Brielle about what the device might do. It might lessen the strength and frequency of the seizures, it might prevent them, or it might not work at all. 

“She wanted so badly to help her situation,” Langford said of her daughter. “She was willing to try.” 

The Langfords have seen amazing results in the past two months since the device has been installed. Brielle has only had one mild seizure.

“Honestly, it’s phenomenal,” Langford said. “We are kind of living a somewhat normal life for the first time in 11 years.”

This year, in fifth grade, Brielle is doing much better in school because she can concentrate more. She also has a good group of friends because she can build true relationships, Langford said, instead of being on the sidelines. 

“It’s given her a confidence boost,” Langford said. “She’s bringing her personality out. I missed it.” 

Brielle says she can feel the device working. Sometimes she can hear a buzzing sound, like a little bee in her ear. Sometimes she can see a flicker in her left eye because that’s the area of the brain the RNS is targeting.

The device is learning Brielle’s body and activating when a seizure is coming. The settings can be adjusted as the device and the doctors learn more about Brielle’s seizures and the impact of the device.

The Langfords will need to wait a year before they will know the full effect of the device while Brielle’s brain heals and gets used to the RNS. If it continues to work, Brielle will only need a surgery years from now to replace the device battery.