Worth The Trip

There were multiple stories this month about advanced technology’s impact on successful epilepsy treatments. The story that screamed out to me was about nineteen-year-old Gabi Sable, from Pennsylvania, who was diagnosed with epilepsy at age 11. Like myself, Gabi lost awareness when she had seizures. She also faced stigmatization, recounting stories of classmates’ parents asking her school’s officials to keep their children away from Gabi. Apparently, her peers got scared when they witnessed a seizure, and secluding their children from Gabi seemed like a solution. Gabi’s doctors couldn’t get her seizures under control with medications for years. They were unable to determine what triggered them until she had access to the 7 Tesla MRI, which can image tissue less than a millimeter big. These images are so much sharper than the older 3 Tesla MRI’s that practitioners can make life-saving observations and decisions that were previously impossible.

In 2020, Gabi participated in a Cleveland Epilepsy Center study, where they have a 7 Tesla MRI. With the 7 Tesla, Gabi’s pediatric neurosurgeon determined she had a tiny seizure-triggering lesion in her frontal lobe. The high-tech imaging enabled Dr. Pestana-Knight to ascertain that although Gabi’s frontal lobe contained her language and comprehension abilities, the lesion was far enough away from those centers that she could safely remove it. In November 2020, Gabi underwent robotic laser ablation therapy to have the lesion removed. She has been seizure-free since, partaking in many activities she was unable to do before, including hiking Peru’s Machu Picchu.

Gabi’s story resonates loudly with me, as I also opted for elective brain surgery to treat my uncontrollable seizures. My surgery was quite different— a surgical excision of the kiwi sized seizure-triggering portion of my brain. In 2014, the 7 Tesla MRI wasn’t around yet. My neurosurgeon had access to the 3 Tesla MRI, which is less than half as strong. Perhaps that’s why she ordered an additional test a week prior to my scheduled surgery, as the first MRI wasn’t clear enough. Had the 7 Tesla been around, perhaps she wouldn’t have needed that. More significant is that a subdural hematoma developed post-surgery, which required I have an emergency craniotomy two months after the initial procedure.

Would the subdural hematoma have developed if the surgery team had access to the 7 Tesla? I’ll never know for sure, but I am certain that anybody who chooses a treatment plan as invasive as brain surgery deserves access to precise state-of-the-art equipment. The 7 Tesla is the most powerful FDA-approved imaging machine. The Brigham and Women’s Hospital (BWH) where I had my surgery  got their 7 Tesla MRI in 2018, four years after my procedure. Now BWH’s neurosurgery website touts that their team uses cutting-edge imaging to assist with surgical laser therapy techniques, far less invasive than my 2014 temporal lobectomy. Reading these details makes me a little jealous. Mostly I’m glad to know that going forward, others with intractable seizures will hopefully have an easier experience than the one I shared in my recent memoir, Seizing Control. 

Before it was known as the first electric car, a tesla was—and still is–the international system unit used to measure magnetic fields’ intensity. One tesla (1T) generates one newton of force per electric current. So, the 7 Tesla MRI generates seven times as much as the original T1 MRI. The technological advances are fabulous and astounding. The problem is access. The machine costs $6.5 million, weighs nineteen tons, and installation requires a crane, so it’s not surprising that  only about 30 institutions in America have a 7 Tesla MRI. While it would be great to increase this number, given the high cost and difficult set up, the availability of 7 Tesla MRI’s is unlikely to expand quickly.

Gabi Sable had to travel over 115 miles to get her MRI. Given her great outcome, I would say the trip was well worth it. I’d advise anybody considering brain surgery to follow her example and seek out cutting-edge pretesting and surgical techniques, which can be transformative and life changing.