An Epilepsy Patient Gets Her Life Back After a Successful Procedure

Getting Her Life Back

Epilepsy team’s comprehensive evaluation and surgery cure a patient’s seizures

A 21-year-old female patient presented with seizures, resulting in total blackout lasting two to three minutes at a frequency of two or three times daily. She also suffered from mood disorder and was depressed, irritable and subject to fits of rage. She had been receiving treatment for epilepsy since the onset of symptoms at age 16 but had failed three different epilepsy medications.

Evaluation and Treatment

The patient was referred to University Hospitals Neurological Institute Epilepsy Center and cared for by Tanvir Syed, MD, neurologist and epileptologist0 at University Hospitals Case Medical Center; and Assistant Professor, Neurology, Case Western Reserve University School of Medicine. Dr. Syed first performed an epilepsy protocol MRI scan and a video/EEG; based on the results, he went on to perform a PET scan and a functional MRI scan. In addition, the patient underwent neuropsychological testing and a Wada test. “This patient had medically intractable epilepsy,” says Dr. Syed. “We believed her to be an excellent candidate for surgery because her MRI scan demonstrated a lesion in the left mesial temporal lobe and because the seizures we observed during the video/EEG appeared to arise from the same region as the lesion was located. Thus, she had a high probability of a good outcome.”

A team led by Jonathan Miller, MD, Director, Functional and Restorative Surgery, UH Case Medical Center; and Assistant Professor, Neurological Surgery, Case Western Reserve University School of Medicine, performed the surgery, a procedure lasting nearly three hours. “The lesion was in the left [dominant] hemisphere, so initially we were concerned about loss of memory or language,” notes Dr. Syed. “But because we saw the hippocampus sclerosed and damaged, and because the neurospsychology testing confirmed that the lesion had already destroyed any function in that hippocampus, we knew it would be safe to remove it without any risk of memory loss afterward. Also, we knew that as long as our resection preserved areas posterior to where the central sulcus meets the Sylvian fissure, we could preserve her language as well.”

Outcome

The patient’s seizures and mood disturbances completely resolved immediately after surgery, and she is seizure-free a year later, Dr. Syed says. “She is no longer angry or depressed. Also, she had been abusing alcohol and marijuana, but with the constant stress of the seizures gone, she gave up both drugs. She is now very happy and animated, and delighted to be a productive member of society.”

Discussion

“This patient could have been cured of her epilepsy through surgery years ago if she had been evaluated by an epileptologist,” says Dr. Syed. “Her physicians kept trying different medications, but, in fact, patients should be considered for surgery if they fail two medications. Her mood disturbances were probably due to her constantly having seizures; she was in great distress because two or three times a day she would randomly black out and never really recover from it.”

In addition to consulting an epilepsy specialist, it’s important for patients to have access to a comprehensive epilepsy center, Dr. Syed maintains. “We couldn’t have made the decision to just go ahead and operate in the dominant hemisphere without having a team of epileptologists and a neuropsychologist evaluate the patient. Having state-of-the-art imaging technology is very important, but to be able to integrate all the information and come up with a formulated hypothesis and a decision to operate, that’s where the epilepsy center is critical.”

Living with seizures is like living with substance abuse, Dr. Syed believes. “Being seizure-free means everything to these patients. They regain their normal personality and their moods. This patient had no aspirations before; now she wants to be a Hollywood actress. The surgery gave her her life back.”