ROSA Robot Assists in CHOC Patient’s Successful Epilepsy Surgery

Five-year-old Ian Higginbotham recently enjoyed his best summer yet.  He experienced his first family vacation. He learned to swim and ride a bike. He got himself ready for kindergarten.  These are milestones most kids and parents, alike, eagerly welcome.  But there was a time when Ian’s parents weren’t certain their son, who was born seemingly healthy, would enjoy such happy pastimes.

Ian began talking and walking in his sleep as a toddler.  When the episodes, including night terrors, increased in frequency and severity, his mom Lisa made an appointment with the pediatrician.  One day, Lisa knew something just wasn’t right and didn’t want to wait for the appointment to get Ian checked out.  She and her husband Derek took him to the Julia and George Argyros Emergency Department at CHOC Children’s Hospital.  To her surprise, doctors diagnosed her son with epilepsy.    Ian’s “sleepwalking” and “night terrors” were actually seizures.

The family was referred to CHOC’s comprehensive epilepsy program.  A national leader in pediatric epilepsy care, CHOC’s comprehensive epilepsy program offers cutting-edge diagnostics, innovative medical approaches and advanced surgical interventions.  CHOC was the first children’s hospital in the state to be named a Level 4 epilepsy center by the National Association of Epilepsy Centers, signifying the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.

CHOC Children's

Ian’s neurologist Dr. Andrew Mower suspected he was experiencing complex partial seizures, which was confirmed by video EEG monitoring.  Complex partial seizures start in a small area of the temporal or frontal lobe of the brain, and quickly involve the areas of the brain affecting alertness and awareness.  The pattern of Ian’s seizures suggested they were originating from the right frontal lobe.  Dr. Mower knew Ian and his family were in for a tough journey.

“I really don’t think the general public understands the impact epilepsy has on a child and his family.  Its effects are multifaceted and extensive.  Our team’s goal is to reduce or eliminate our patients’ seizures, helping improve their quality of life,” explains Dr. Mower, who placed Ian on a series of medications.

The medications reduced Ian’s seizures, but did not control them.  Dr. Mower was concerned about the seizures affecting Ian’s development, and presented his case to the epilepsy team.   The multidisciplinary team agreed Ian was a candidate for epilepsy surgery.  For children who fail at least two medications, surgery may be considered early in treatment versus as a last resort.  Surgery can result in an improvement in seizure control, quality of life, and prevent permanent brain damage.  Ian’s surgery was going to be performed by CHOC neurosurgeon Dr. Joffre Olaya.

While the thought of surgery was frightening to Lisa and her husband, they were confident in the team and comforted to know their son was going to benefit from innovative technology, like the ROSA™ Robot. Considered one of the most advanced robotized surgical assistants, ROSA includes a computer system and a robotic arm.  The computer system offers 3D brain mapping to aid surgeons in locating the exact areas they need to reach and planning the best surgical paths.  The robotic arm is a minimally invasive surgical tool that improves accuracy and significantly reduces surgery/anesthesia time.

Dr. Olaya used ROSA to accurately place electrodes in the area of Ian’s brain suspected to be the source of his seizures.  By using the robot, Dr. Olaya avoided performing a craniotomy.

“ROSA is an amazing tool that yields many benefits for our patients, including less time under anesthesia in the operating room.  It reduces blood loss and risk of infections.  Patients tend to recover faster than they would if they had craniotomy,” says Dr. Olaya.

Lisa was amazed at the outcome. “I couldn’t believe how great Ian looked after the placements of the electrodes with ROSA.  He wasn’t in any pain, there was no swelling.  It was wonderful!”

She and her husband were also amazed at how well Ian did following his epilepsy surgery.

“We got our boy back,” says Lisa. “There were no more side effects from medication and, more importantly, no more seizures!  He started developing again and doing all the things a child his age should do.”

Ian’s care team isn’t surprised by his recovery.

“Children are resilient, and their brains are no different.  In fact, the plasticity of a young brain allows it to adapt to changes and heal more easily than an adult brain,” explains Dr. Mower.

Learning to ride a bike and swim were among the first of many milestones Ian quickly reached following surgery.  He enjoys playing with his younger brother and his friends.  And, whether inspired by his experience with ROSA or not, Ian loves robots.

National Prescription Drug Take Back Day is October 22

Orange County residents can help prevent prescription drug abuse by anonymously disposing of expired, unused or unwanted prescription medications as part of the U.S. Drug Enforcement Administration’s “National Take Back Day” on Saturday, Oct. 22 from 10 a.m. to 2 p.m. at locations throughout the county.

The most common source for the last prescription pain medication misused by people over 12 years old belonged to a friend or relative, according to the 2015 National Survey on Drug Use and Health. To help prevent this, practice these medication safety tips year-round, and share them with your patients and their families:

  • Remove expired, unwanted or unused medications from your home as quickly as possible, preferably through an authorized collection site.
  • Store medication in a cool, dry place. Keep it out of reach and out of sight, and in a locked location. Do not store it in a purse or nightstand, or other locations children can easily get into.
  • Don’t put medication away in front of children or take medication in front of them, as they tend to mimic adults’ behaviors.
  • Remind children that medicine is not candy.
  • Remember that child-resistant medication containers do not necessarily mean child-proof.

If you are unable to attend this annual community event, follow these easy steps to dispose of most medications in your home:

  • Mix medicines (do not crush tablets or capsules) with an inedible product such as dirt or used coffee grounds
  • Place the mixture in a sealed plastic bag
  • Dispose of the bag in your household trash
  • Remove all personal information from the prescription’s label

To participate in National Take Back Day on Oct. 22, anonymously drop off unused medications at any of the more than 30 participating locations throughout Orange County.

Academic Day for Neonatologists Conference set for November 10 at CHOC

Differentiation between newborn screening, conventional molecular diagnostic testing and genome sequencing; genetic diseases in newborns; and common indications to refer for fetal interventions due to congenital anomalies, are among the various topics featured at an upcoming CHOC Children’s conference.

The 14th Annual Academic Day for Neonatologists Conference will be held on November 10, at 8 a.m. – 4:30 p.m., at CHOC’s main campus, at 1201 W. La Veta Ave., Orange, CA, 92868, in the Harold Wade Education Center (CHOC Clinics building, second floor).

Neonatologists in academic and community practice, critical care specialists, pulmonologists, neonatal-perinatal fellows, maternal-fetal fellows, and other healthcare workers who provide care to neonatal patients, are invited to attend.

CHOC designates this live activity for a maximum of 7.0 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

Learn more and register here.


Nanthealth Partners with CHOC to Revolutionize Pediatric Cancer Care

In an effort to accelerate and improve the course of pediatric cancer care, NantHealth, Inc. announced a research agreement with CHOC Children’s. Through its Hyundai Cancer Institute, CHOC will utilize GPS Cancer – the leading molecular test for personalized medicine, to generate, analyze, and annotate the molecular profile characteristics of children, adolescents and young adults with rare, recurrent, or refractory tumors. NantHealth is a leading next-generation, evidence-based, personalized health care company; CHOC, one of the nation’s premier children’s hospitals, is a founding member of the Pediatric Consortium of Cancer MoonShot 2020.

GPS Cancer, available through NantHealth, is a unique, comprehensive test integrating whole genome (DNA) sequencing, whole transcriptome (RNA) sequencing, and quantitative proteomics to provide oncologists with a comprehensive molecular profile of a patient’s cancer to inform personalized treatment strategies and identify therapies that may have clinical benefit for the patient.

Throughout the partnership, CHOC’s participant samples and data will be collected under the hospital’s Institutional Review Board (IRB) to ensure that all research will be conducted in accordance with all federal, institutional, and ethical guidelines. From there, NantHealth will conduct GPS Cancer testing in the CLIA-certified, CAP-accredited laboratories and will deliver results to CHOC within about three weeks from receipt of tissue. The collaboration will allow both NantHealth and CHOC to carry out epitope discovery to identify factors that inform actionable diagnostic and therapeutic targets and prognostic indicators. NantHealth will enable the Hyundai Cancer Genomics Center at CHOC to house and manage its genomic research data in a cloud-based storage setting.

“Often times, pediatric cancer care is overlooked when it comes to innovation in diagnostics and treatment, which is something we must correct. As the industry continues to put a strong emphasis on personalized healthcare, it is essential to consider how we can apply the best and most ground-breaking treatment options that will fit the needs of children who are impacted by the disease,” stated Patrick Soon-Shiong, MD, founder and CEO of NantHealth and founder of the Cancer MoonShot 2020 program.

“Through this partnership with CHOC, we now have the ability to investigate the molecular profiling of pediatric cancer patients in order to understand the cause of rare cancers, which will then help us develop effective treatment options. With the unique needs of pediatric oncology, we are confident that GPS Cancer will enable the hospital to accelerate its research efforts to discover how pediatric and young adolescent cancer patients can be treated in a way that is unique to each patient,” he added.

CHOC Metabolic Specialist Profiled in Science Magazine

The work of a CHOC Children’s metabolic disorders specialist and is highlighted in a recent Science magazine article.

The article hinges on Dr. Raymond Wang’s work to help a patient with a rare condition called Niemann-Pic Type C, a condition that causes cholesterol to accumulate in the brain, lungs, liver and spleen, leading to deterioration and early death.

Not only is the young girl doing well after Dr. Wang began an experimental treatment, but her family’s foundation also provided funding that allowed Dr. Wang to continue research that could help children with a rare metabolic diseases called mucopolysaccharidoses, or MPS.

To that end, the piece examines the tug of war felt by some physicians when balancing patient care and research. Despite a physician’s strong interest and commitment, research eludes many due to a lack of time and funding.

Read the full article in Science magazine.