New surgery can relieve epileptic seizures

08/22/2014 1:52 PM

08/23/2014 11:56 PM

When Andy Salazar Sr., was 3, he was playing with a ball in the back of a parked pick-up truck and when the ball bounced out, he jumped out with it and landed on his head.

That fall would cause him to develop epilepsy and have seizures for the rest of his life. Until now.

Salazar, 39, of Palm Beach, is one of 11 patients who recently had the Visualase MRI-guided laser surgery at the University of Miami’s Miller School of Medicine under the care of neurosurgeon Dr. Jonathan Jagid. Salazar had been asking doctors if there was something he could do besides take medicine for his epilepsy.

“I was relieved and happy as a pig in you know what,” he said, when he learned of the surgery.

The Visualase MRI-guided laser surgery offers patients, what doctors hope, the same benefits of the more-drastic open brain surgery that’s been around for more than a century, but with fewer risks and less recovery time. Unlike the open-brain surgery, the Visualase surgery involves making a 3-millimeter hole in the skull through which a laser passes. The laser is then used to remove the area of the brain that is causing the seizures.

According to the Epilepsy Foundation, a seizure is a disturbance in the electrical activity of the brain. A person is said to have epilepsy if they have two or more seizures separated by at least 24 hours.

“Once you have failed two medications, two good anticonvulsants, you are pretty much intractable,” Jagid said. Only then are patients eligible for surgery, he said.

Salazar definitely fit the bill.

“I was on so many different meds and on such high doses, that I would take the meds in the morning and by 7:30 that morning I looked like a drunken fool because my body was so overintoxicated,” he said.

Salazar, like the other patients who received this treatment, still has to take some of his medications post-surgery, but now the medications are actually being effective, he said.

Salazar hasn’t driven for the last seven years because of his seizures, which he said were very sporadic. At times, he would have them for a month, and then have up to eight in a single day. Today, he has been seizure-free for six months since the surgery. He’s looking forward to driving and starting his life again.

“I woke up feeling like a new man. I woke up with the on button going and me hauling butt with it,” he said.

Before doing the surgery, doctors perform an extensive work-up on the patients to make sure they are fit for surgery. Jagid explained that an EEG is placed on a patient’s scalp and they are often admitted for up to a week in the hospital before the procedure. This way, neurologists can monitor them while their medications are slowly taken away and they are allowed to seize. The EEG records the brain activity and doctors can see where the electrical disturbances are coming from within the brain.

If doctors can’t get a clear reading, sometimes the patients must undergo open-brain surgery just so doctors can place the same type of EEG electrodes on the brain to read the activity.

“What these patients have to go through is truly unbelievable,” Jagid said.

While the Visualase surgery is a new FDA-approved treatment for epilepsy, it’s been used for years to treat other ailments outside of the central nervous system, Jagid said. And until its development, open-brain surgery was still considered the most-effective treatment for seizures.

“It’s a new thing, there’s no long-term data here. But it seems that it closely approximates the seizure-free rates of the more invasive procedures.”

For Sarah Quick, 32, another one of Jagid’s patients, seizures have been part of her life since she was 6 months old. She inherited her condition from her aunt, who died while having a seizure.

“What’s hard is that you see people who are working or getting together and you can’t drive and you can’t hop on the bus because you might have an episode,” she said. “Sometimes you feel left out.”

So when Quick, who lives in Tamarac, found out she was a candidate for the Visualase surgery, she was excited about the possibility of a seizure-free life. Her father, on the other hand was a little nervous, she said.

“My dad was paranoid with a capital P, but that’s only because he cares and was concerned.”

Quick went to Florida Atlantic University, but didn’t finish her degree in music education because of epilepsy. And because she couldn’t drive, her mother would take her every day.

“My mom would drive me to my classes and stay there all day in the cafeteria and wait for me to finish and then drive me home,” she said.

On June 25, Quick underwent the surgery with Jagid. Unlike Salazar, Quick felt some of the predicted post-operative stresses, such as headaches and fatigue.

“I’m just now getting back into the swing of things because I felt really tired,” she said.

But like Salazar, and Jagid’s other patients, Quick hasn’t had any seizures. Quick’s new seizure-free life has also brought her another gift: self-confidence.

“I’m most excited that post surgery I sense more confidence in myself and I’m looking forward to working and being more independent in my life,” she said.

For those with epilepsy in South Florida who do not qualify for the Visualase surgery, Memorial Regional Hospital offers the Neuropace, which may be an option.

The Neuropace is an implantable neuro stimulator that is placed in the skull. The Neurospace is connected to two electrodes, which are placed on the brain, said Dr. Tarek Zakaria, director of the Neurology and Epilepsy programs at the Neuroscience Institute at Memorial Regional Hospital.

The way it works is that two minute holes are made in the skull. Two wires pass from the Neuropace to the brain, where the electrodes are placed. The device records all brain activity so that it can be monitored by physicians, and it also responds to any early brain activity that could be provoked by an oncoming seizure, stopping a full-blown seizure from occurring.

Zakaria makes the distinction in treatment options: “If the seizure is coming from a specific area of the brain, then the patient may be a candidate for Visualase, but if the seizures are coming from multiple areas, then the patient may be a candidate for Neuropase.”

Zakaria explained that with Neuropase, only about 10 percent to 15 percent of patients become seizure free. As more time passes, it seems more patients become seizure free, he said.

Jagid made clear that the Neuropase is not a cure for epilepsy since it is an implantable device and not a surgery.

As medicine makes strides, family members also have to make adjustments to their loved one’s newfound lives and sources of energy.

“Well, I’m a dad, and all dads go through this phase of, ‘Oh my God, it’s going to be time for her to fly the coup,’ but I’m going to be happy for her,” said Tom Quick, 77, Sarah’s father.

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