Epilepsy is no laughing matter - except for one rare form, caused by hypothalamic hamartomas, benign masses in the brain that can cause epilepsy symptoms, unintentional giggling seizures and even early puberty.

This actual science appeared in the medical melodrama "Grey's Anatomy." The episode “Hold Back the River” featured the show’s doctors using focused sound waves to treat a hypothalamic hamartoma in a young boy, and it is being tested in a clinical trial at UVA.

It's not a tumor

They are not technically considered brain tumors. “They typically don’t grow,” says neurologist Nathan Fountain, MD, principal investigator at the University of Virginia Health System, which is conducting a clinical trial using ultrasound for treatment. “They just sit there and cause trouble.”

Hypothalamic hamartomas are usually treated using brain surgery or laser ablation, which involves inserting a probe into the brain to burn away the growth. Using the ultrasound investigational approach, Jeff Elias, MD, and his team concentrate focused ultrasound waves through the skull and into the brain to cause the targeted spot to heat up. The goal is to either kill the hamartoma tissue or, if the growth is large, disconnect it from the rest of the brain.
Caterina Scorsone as Dr. Amelia Shepherd in "Grey's Anatomy"They direct the sound waves to the appropriate spot using magnetic resonance imaging, which allows them to see inside the brain. Elias previously pioneered the use of MRI-guided focused ultrasound for the treatment of essential tremor, the most common movement disorder.

After extensive testing proved successful, the federal Food and Drug Administration approved the technique to treat essential tremor and it is now an option for appropriate patients.
Though it is still investigational, it merits some attention. Epilepsy surgery, and even just the evaluation to find suitable candidates, is very invasive and best treats superficial outside parts of the brain, while focused ultrasound is noninvasive and best treats deep parts of the brain

Next Steps

UVA is recruiting participants ages 18 to 80 for its trial investigating the use of focused ultrasound to treat hamartomas and other epilepsies caused by similar growths. For more information, visit https://clinicaltrials.gov/ct2/show/NCT02804230.