Health & Fitness

Epilepsy surgery can help with seizures

The same page: Nicholas Fotopoulos talks about his most recent operation to treat his epilepsy with Dr. Tarek Zakaria, a Memorial neurologist.
The same page: Nicholas Fotopoulos talks about his most recent operation to treat his epilepsy with Dr. Tarek Zakaria, a Memorial neurologist. FOR THE MIAMI HERALD

When Alejandro Hernandez was 6, he had his first grand mal seizure. He lost consciousness, control of his body and every single memory he had.

By the time he was 23, he had had two more grand mal seizures — one in his teens and another in his early 20s — but no further loss of memory.

“At that time, I just had just been diagnosed with migraines. I didn’t really know where exactly it was coming from,” said Hernandez, now 32, whose infrequent seizures over a 24-year span led him to believe he wasn’t a “seizure person.”

That is, until he began experiencing petite mal seizures, which were smaller and more frequent, in the last decade.

“I would have a seizure, but I didn’t go into convulsions,” Hernandez said, adding that he would feel chills or déjà vu before the event. “I would just stop talking, and it was like I zoned out for a little bit.”

Nearly three million Americans have epilepsy, a neurological brain disorder defined by the repetition of unprovoked seizures, which may stem from head injuries, infection and tumors, among other issues.

For about 70 percent of epileptic patients, seizures are controlled with medication or a rigorous diet. The other 30 percent have intractable epilepsy and do not respond to medication.

“If you have been tried on two anti-epileptic medications and you continue to have seizures, the probability that other anti-epileptic medications we have available in the market will render you seizure-free is less than 5 percent,” said Dr. Andres Kanner, chief of the epilepsy division at the University of Miami Miller School of Medicine.

Hernandez was one of the first patients at the International Center of Epilepsy at UM to undergo Visualase, a procedure that utilizes laser light and heat to target seizure areas.

Since February 2014, he has been seizure-free.

His neurosurgeon, Dr. Jonathan Jagid, called the surgery the “future of helping patients with epilepsy.”

“This has changed the way you can get to these deep areas of the temporal lobe,” Jagid said. “You can remove exactly what you’re trying to remove without that collateral damage.”

At Nicklaus Children’s Hospital, formerly Miami Children’s, doctors have pioneered epilepsy surgery since the mid-1980s, operating on patients as young as 6 weeks old who have brain abnormalities associated with epilepsy.

“We are one of the few centers in the world that operates on children with normal MRI scans,” said Dr. Michael Duchowny, director of the Comprehensive Epilepsy Center at Nicklaus Children’s. “There’s no focus that you can see from the MRI imaging, but we are able to operate and produce seizure freedom in a significant percentage of the cases.”

The hospital recently received a grant to set up a cognitive neuroscience program, where doctors and researchers will study the relationship of the brain and behavior, particularly in children with medically resistant epilepsy, among other issues.

Meanwhile, physicians at Memorial Neuroscience Institute in Hollywood recently performed their first craniotomy, a two-pronged surgery to remove a portion of the brain causing seizures, on Nicholas Fotopoulos.

Given the choice of receiving Vagus Nerve Stimulation therapy, a pacemaker-like device that sends signals to the brain via the vagus nerve, or the craniotomy, Fotopoulos went with the latter. The 33-year-old, who also has a congenital heart defect and a pacemaker, didn’t want any more devices put in his body.

“It’s wonderful that I’m not going to have a seizure again,” Fotopoulos said. “I have a new chance in life.”

Prior to the surgery, he had lost jobs and the ability to drive his car due to his seizures, in which he would zone out for a brief period of time, twitch and have violent movements if the events lasted long enough.

The surgery, he added, has given him the opportunity to start fresh. He’s now engaged and wants to have kids.

“In the whole West Palm, Broward and north Miami-Dade County, there’s no single advanced epilepsy center that is capable of providing basic services for patients with epilepsy,” said Dr. Tarek Zakaria, a neurologist at Memorial Healthcare System who was formerly with the Mayo Clinic College of Medicine. “Most of these patients will have to go somewhere else to have very basic epilepsy workups and treatment.”

While surgery is the only way to cure chronic epilepsy, other therapies are being developed to treat patients who are ineligible for surgery and do not respond to medication.

In November of 2013, the FDA approved Neuropace, a device implanted onto targeted brain tissues. The device works like a pacemaker to monitor brain activity and stimulate electricity before a seizure.

“In patients where an ablation is not an option, that’s where Neuropace becomes a possibility,” said Kanner, who said the stimulator can be connected to two parts of the brain where seizures are active.

Studies have shown the device decreases the frequency of seizures by about 44 percent.

“This is not considered a curative procedure,” Kanner said. “But in general, it decreases significantly the seizure frequency in a patient.”

While Neuropace has been approved for use, it has not yet been implanted in any patients. Kanner, however, confirmed there is already a waiting list of eligible patients.

“It’s cool stuff,” he added.   

 

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