graphic of brain

New treatments for epilepsy, movement disorders available at UTMB Health

Research in recent years has led to new treatments for epilepsy and movement disorders that are now available at the University of Texas Medical Branch.

People with epilepsy who still have seizures despite trying at least two different medications might find relief with surgery, said a neurosurgeon who recently joined UTMB.

“Surgery for epilepsy is an underutilized treatment,” said Dr. Patrick Karas, a neurosurgeon who started at UTMB Nov. 1. “People with uncontrolled epilepsy can't drive. They shouldn’t take a bath or go swimming without supervision because they could have a seizure and drown. We can provide a surgery that can potentially change their life.”

Karas, who is an assistant professor of neurosurgery, specializes in surgical treatment of epilepsy, brain tumors, and deep brain stimulation for movement disorders.

“I'm very excited to join UTMB and offer epilepsy surgery, an option which has not been available here for many years,” he said.

The brain has billions of neurons that conduct electricity through complicated networks allowing you to think, talk, move and much more. In patients with epilepsy, some of those neurons and the cells surrounding those neurons aren’t working correctly.

“The electrical signals go awry,” Karas said. “They hijack parts of your brain and make you have these involuntary movements or vocalizations or sensations that happen because of abnormal activation of your brain networks.”

To determine where the seizures originate, Karas uses a specialized robot to implant electrodes in the brain. Along with a team of epileptologists from UTMB’s Department of Neurology, he then records the electrical activity from the brain to pinpoint where the seizures are coming from before planning surgery to stop the seizures.

Neurosurgeons have made many advances in the past decade, and surgical techniques for epilepsy are developing each year.

Another area of active neurosurgery research is deep brain stimulation, one of Karas’ specialties.

Deep brain stimulation begins with implanting electrodes in the deep nuclei of the brain. Those electrodes are connected to a small device—similar to a pacemaker—that stimulates the brain with electrical activity.

The most common applications with deep brain stimulation are treating the movement disorders Parkinson's disease and essential tremor. Deep brain stimulation can also be used to treat certain types of epilepsy, dystonia and obsessive-compulsive disorder, and research is underway on using it to treat depression, Tourette Syndrome, and several other psychological disorders.

Karas earned his medical degree from Columbia University College of Physicians and Surgeons and completed his residency in the Department of Neurosurgery at Baylor College of Medicine. He then sought additional training in epilepsy at the Cleveland Clinic after residency. But he didn’t always plan to become a neurosurgeon.

After Karas finished his bachelor’s degree in mathematics and chemistry at Dartmouth College, he worked as a strategy consultant for pharmaceutical and biotechnology companies for two years before deciding on a different path.

“Pharmaceutical and biotech companies stress maximizing profits above everything else,” Karas said. “That didn’t sit well with me. I preferred to work with people and help them with their problems. That’s more meaningful.”

In medical school, he gravitated toward surgery because he likes working with his hands. Later, he chose neurosurgery as his field.

“I was much more interested in the brain and the nervous system compared to other organ systems in the body from a research standpoint,” Karas said.

Karas is seeing patients in the Neurosurgery Clinic at the UTMB Health Clear Lake Campus. He also will run a research lab on UMTB’s Galveston Campus that will analyze the brain recordings from electrodes to understand how parts of the brain work, and hopefully improve how epilepsy can be treated in the future.

Karas will be able to find the right advanced treatment for each of his patients.

“A lot of work goes into choosing the right surgery for each patient, and making that decision is a collaborative choice with the patient,” he said. “We offer the full complement of surgeries for epilepsy, including resection, minimally invasive laser ablation, responsive neurostimulation, deep brain stimulation and vagus nerve stimulation. Some of the new tools developed for epilepsy are quite interesting. The responsive neurostimulation device both records and stimulates the brain to detect and try and abort seizures as soon as they start to happen. The field is advancing at a rapid pace.”

The Neurosurgery and the Neurology departments work collaboratively, and Karas sees that hand-in-hand working relationship as a benefit for people who need epilepsy surgery or deep brain stimulation for movement disorders.

“Providing a surgery to someone who continues to have seizures despite trying multiple medications would change that person’s life,” Karas said. “And I like that a lot.”

Dr. Patrick Karas

Dr. Patrick Karas currently serves as a full-time faculty Neurosurgeon at UTMB, operating at both Galveston and Clear Lake campuses.