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Safer Epilepsy Surgery Can Turn Around Lives

As a leader in epilepsy treatment, Barnes-Jewish and Washington University Physicians offer a range of therapies, including the latest medications with fewer side effects, and a safer surgery for life-changing relief from seizures.

In a high-tech suite at Barnes-Jewish Hospital, an epilepsy patient is wired to monitoring equipment, waiting for a seizure to begin. Doctors have weaned him off his medication so they can find the focal point of his severe seizure problem, somewhere within his brain. By the end of this assessment, they will likely know whether surgery – performed by experienced Washington University neurosurgeons at Barnes-Jewish Hospital – can bring him life-changing relief.

Not every epilepsy patient is a candidate for this surgery, since seizures come in different shapes and sizes. While “grand mal” seizures are big and dramatic, others involve only a brief staring spell. This broad spectrum means epilepsy is a complex problem to treat, requiring a range of therapies, from simple lifestyle changes to the latest medications to skilled surgery.“Epilepsy is an area of neurology in which we have a lot of things to offer patients to help them get better,” says R. Edward Hogan, MD, a Washington University neurologist at Barnes-Jewish. “We can offer options for treatment of seizures that will improve seizure control and enable people to be as active and productive as possible.

A Range of Treatment Options

At Barnes-Jewish, a multidisciplinary team of Washington University physicians and surgeons treats patients 18 and older. With about 3,000 patients, the hospital is one of the largest referral centers in the Midwest. Its strength lies in the range of options it offers to patients – including its expertise in highly successful surgical techniques.

Epilepsy originates from an electrical abnormality in the brain. In mild cases, simple remedies – avoiding stress, getting enough rest – may be enough to control it. Most often, Washington University physicians see more serious cases that require medication. They prescribe a new generation of anti-epilepsy drugs with fewer side effects. But for about 30 percent of patients, these medications don’t control seizures effectively. In these cases, other treatment options such as epilepsy surgery offer the possibility of seizure control.

When Surgery Is the Solution

“Epilepsy surgery can make a huge difference for patients,” says Washington University neurosurgeon Joshua Dowling, MD, a specialist in this form of surgery. “The turnarounds that some people experience are just tremendous.” Hogan agrees. “A lot of times these are people who have had seizures their whole lives. They can’t drive, and there have been issues with employment. With surgery, we’re giving patients the strong chance of having their seizures go into remission, which is a nice thing to be part of.” The path toward surgery begins in the monitoring suite, where a range of tools helps the team pinpoint the region where the seizures originate. Patients may wear electrodes on their scalp to trace the source of the electrical impulses and also undergo CT scans, a PET scan or an MRI. While a seizure is in progress, they may have ictal SPECT scanning, which traces changes in blood flow to the affected area.

Sometimes the root cause of the epilepsy is difficult to find. In such cases, surgeons may need to do invasive monitoring, which involves a surgery to lay grids of electrodes directly on the surface of the brain. These are referred to as intracranial grid electrodes. Not only does this technique allow for very precise mapping of problem areas, but it also helps physicians identify critical areas of the brain, such as those controlling speech, that they will need to avoid during surgery.

Ending Years of Seizures

Intracranial grid electrodes helped localize the problem in the brain of John Bridegroom, a St. Louis electrical engineer who began having seizures in 1994. Three years earlier, when he was only 13, he had suffered a compressed skull fracture in a light plane crash. As time went on, the seizures got worse despite medication.

In 2004, he came to Barnes-Jewish for a weeklong evaluation and then had surgery. Dowling discovered and removed the source of the problem – a three-inch bone fragment left behind from the accident. Since the surgery, Bridegroom has been free of seizures.

“For the first year after surgery, I was worried that I could go into a seizure at any moment,” Bridegroom says. “Now I don’t worry about having them – and that’s a great relief.”

A Safer Surgery for a Seizure-free Future

Unfortunately, Dowling says, surgery is “vastly underutilized,” mostly because patients and their physicians don’t realize how safe it has become. The mortality risk during this procedure is less than 1 percent. “We are in an excellent position to do this kind of surgery because of our strength in all aspects of the evaluation,” Dowling says. “By the time we decide to do surgery, we’re already 90 percent there.”

Fact: Epilepsy and seizures affect more than 3 million Americans

Fact: Epilepsy surgery can make a huge difference for patients

Fact: 10% of Americans will experience a seizure in their lifetime

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