NeuroNews
(Return to Newsletter Index)
Approaches to Epilepsy: A Case Study
by Sean S-F Hsu, M.D., Division of Neurological Surgery,
and Greg Lipshutz, M.D., Division of Neurology/Epileptology
Patients with epilepsy are benefiting from the latest treatments at the New England Epilepsy Institute, Inc. (NEEI). A joint venture of New England Neurological Associates and the Holy Family Hospital, NEEI offers both surgical and medical interventions and utilizes an integrated, multidisciplinary approach to epilepsy diagnosis and treatment.
The NEEI Program
Patients receive a comprehensive, focused approach to their seizure disorder, with access to utilizing the specialized resources of both New England Neurological Associates and Holy Family Hospital. Services include inpatient and outpatient electrodiagnostics, 24-hour EEG with video monitoring, neuropsychological testing, and counseling. The NEEI is directed by a neurologist/epileptologist who specializes in the diagnosis and management of seizure disorders.
A Case Study in Epilepsy Care
The following case study illustrates a recent success in epilepsy care, utilizing surgical techniques as well as the utility of a multidisciplinary, team approach.
Frank K. (not his real name) developed temporal lobe epilepsy more than ten years ago. He was treated with multiple anti-epilepsy drugs. Despite the use of three separate medications at doses that made him extremely tired, he continued to have several seizures each week. When a seizure was about to begin, he would have a strange feeling (aura) that he came to recognize as a warning sign. He would then lose consciousness, and turn his head in one direction. This was followed immediately by uncontrolled movements of the arms and legs. He could not predict when these seizures would occur.
Frank was referred to Dr. Greg Lipshutz, a New England Neurological Associates neurologist/epileptologist who is the Director of the NEEI. Dr. Lipshutz attempted treatment with medications, but Frank did not respond and continued to have frequent seizures. When medical treatment failed, Dr. Lipshutz consulted his surgical associated, Dr. Sean Hsu for a neurosurgical evaluation.
Epilepsy Surgery
Approximately 10% of epilepsy patients are refractory to medical treatment and become candidates for epilepsy surgery. The surgical principle for treating epilepsy is to remove the area of the brain that causes seizures without affecting any functional areas. This involves diagnostic and imaging studies which may include EEG, MRI, PET scanning, speech and language testing, and cortical mapping of brain function. The surgical management of epilepsy requires the collaborative efforts of a neuroscience team.
Tests revealed that Frank's seizures were arising from the mesial temporal lobe and hippocampus. Luckily, the tests also revealed that this area did not support any significant neurological function. Thus, Frank was a good candidate for surgery to remove that small area of brain tissue responsible for his epilepsy. Electrodes were first placed over the brain surface to define the exact location of the seizures and to precisely map the functional regions of the brain. With this information, the area of the brain causing the seizures was microsurgically removed, while adjacent functional areas remained unharmed. Frank had no neurological deficits from the surgery.
Conclusion
Frank's surgery took place almost two years ago, and he has not had any seizures since that time. His medications have been cut back and he no longer feels tired all the time. Frank works full time and is leading a new and normal life. For certain epilepsy patients, surgery can provide hope for relief from a disabling disease.
The multidisciplinary resources of New England Neurological Associates and the New England Epilepsy Institute are available for the comprehensive assessment and treatment of epilepsy, with surgical approaches available for those likely to benefit from this approach.
|
