People with drug-resistant epilepsy are gaining freedom from seizures through Georgetown's Epilepsy Program, which employs state-of-the-art brain imaging and diagnostic tests to identify patients who could benefit from several safe and effective surgical procedures for epilepsy treatment that are available at Georgetown.
"Epilepsy patients who are not 100 percent seizure-free after trying three or four medications should consider being evaluated for surgery," says Dr. Chris Kalhorn, who is the Director of Epilepsy Surgery at Georgetown.
About 2.8 million Americans have epilepsy, which is caused by abnormal electrical activity in the brain, leading to seizures that can affect both consciousness and bodily control. While two out of three epilepsy patients can live seizure-free with the help of medication, one in three patients will continue to experience seizures, often despite multiple regimens of anticonvulsant drugs.
Dr. Gholam Motamedi, who is Director of the Epilepsy Program and the Epilepsy Monitoring Unit at Georgetown, estimates that about 150,000 patients with drug-resistant epilepsy would be good candidates for surgery to remove the "seizure focus," the small area in the brain where their seizures originate.
"We have a lot of experience with challenging cases of drug-resistant epilepsy – and we have all the elements of service that are needed to treat the tough cases," says Dr. Motamedi. "We begin with EEG monitoring and imaging studies of the brain to pinpoint the location of the seizure focus, then perform neuropsychological evaluation and Wada testing to determine whether this area of the brain can be safely removed without impairing speech or cognition."
"In more complicated cases, we may need to place grid electrodes directly on the brain to pinpoint the seizure focus," he continues. "In these cases we will do brain mapping in order to tailor the surgery to avoid any damage to critical areas of the brain during surgery."
Northern Virginia resident Ann Barbour had been contending with multiple seizures each week for nearly two decades, when she checked in to the Epilepsy Monitoring Unit at Georgetown early in 2003. After ten days of diagnostic procedures, Barbour learned that she was a candidate for resection surgery to the temporal lobe of her brain, which Dr. Kalhorn performed in March of 2003.
"Before the surgery, I was taking 25 pills a day and having seven to 10 temporallobe seizures a week, and I'd also started having Jacksonian seizures on my left side every five to seven seconds," says Barbour. "Now I only take five pills a day, and I haven't had a seizure in more than a year."
Since the surgery, Barbour has enrolled in college and earned an AA degree, and she is now pursuing a BA in architectural interior design at Marymount University in Arlington, Virginia.
"When seizures take over your life, it's hard to do normal things like going to school or making friends, and you deal with rejection and discrimination every day," she says. "Now I'm able to get an education and to enjoy life."
"I'm happier than I've been since I was eight years old, when I was first diagnosed with epilepsy," she continues. "The surgery really changed my life, and I'm tremendously grateful to Dr. Kalhorn and the team at Georgetown."
For some epilepsy patients, the incidence of seizures can also be reduced through the surgical implantation of a pacemaker-like device in the chest, which is attached to an electrode that stimulates the vagal nerve in the neck.
"Vagal nerve stimulation, or VNS, can reduce the frequency of seizures in patients who are not good candidates for surgery to the brain," says Dr. Motamedi. "Although there is a low chance of becoming completely free of seizures, there are no long-term side effects associated with VNS."
The epileptologists at Georgetown also specialize in the medical management of epilepsy during pregnancy. Since some anticonvulsant drugs would be harmful to fetal development, women with epilepsy may need to transition to other medications before becoming pregnant.
"Many women come to us for help in determining the type and the dosages of medication they'll need while they're pregnant," says Dr. Motamedi. "Depakote, for example, is very effective in controlling seizures, but it should not be taken during pregnancy. Women with epilepsy may need to allow for a period of time before they become pregnant, to work with us on identifying and stabilizing on the right medications."
For more information about Georgetown's Epilepsy Program, call Georgetown MD at 202.342.2400 or toll-free 866.745.2633 to speak with a nurse counselor.
