Janet Rickey of Arlington, Va., was only 4 years old when she was knocked unconscious in a freak accident. She was watching a neighbor chop down a tree when, suddenly, the ax head flew off and the flat side struck her head. The little girl came to and, miraculously, seemed fine to her parents and doctors.
Until she was in second grade, that is, when Rickey recalls her first instance of feeling heavy, falling down and not being able to get up. That marked the beginning of 45 years of epileptic seizures, tests, medications and hospitalizations that came to an end only when she was referred to Georgetown University Hospital in 2006.
“Janet’s seizures were clearly visible to the naked eye, even though her electroencephalograms (EEGs) were normal,” says Gholam Motamedi, MD, a neurologist and director of the Epilepsy Program at Georgetown. “In the absence of definitive proof, many physicians often attribute seizures to psychological rather than physical factors. But I suspected that Janet’s seizures were coming from deep down in her brain, in a tricky area where traditional EEGs don’t work.”
Georgetown’s Center for the Treatment of Epilepsy and Related Disorders is designed specifically for complex cases like Rickey’s. It is the most complete, comprehensive adult epilepsy program in the area, with an emphasis on both clinical care and research. Experts in neurology and neurosurgery work together to ensure the most accurate diagnoses and optimal outcomes for each patient. A state-of-the-art epilepsy monitoring unit (EMU) offers a battery of diagnostic tests—including EEGs, imaging studies, neuropsychological evaluation, brain mapping and other procedures—to determine the origin of seizures and whether patients are candidates for surgery.
Dr. Gholam Motamedi notes that Janet Rickey’s recovery is ahead of normal by more than a year.
In Rickey’s case, Dr. Motamedi first ordered high-resolution MRIs that detected an abnormality in her frontal lobe, a possible cause of the problem. To delve further, Dr. Motamedi brought in Georgetown Neurosurgeon Christopher Kalhorn, MD, who implanted electrodes in key areas of Rickey’s brain. She was then admitted to the EMU for seven days of round-the-clock observation.
“Her seizure activity was just astounding,” says Dr. Motamedi. “We documented 120 instances over the course of her stay, roughly one every 90 minutes. Unfortunately, the test also confirmed our fears. The seizures were originating from a hard-to-reach and delicate part of the brain—the supplementary motor area that controls movement in the legs and feet. Many physicians just won’t touch it.”
Despite the chance that she might lose strength in her legs from the knee down, Rickey elected to undergo epileptic surgery this past February. As it turned out, a tumor was the source of her problem, quite likely triggered by the incident with the ax.
Today, Rickey’s seizures have subsided almost completely. She is working on regaining strength in her left foot—her procedure’s only lingering side effect.
Approximately 2.8 million Americans have epilepsy. While the majority of patients respond to conventional medical management, approximately 36 percent do not, making it difficult to drive, hold a job or otherwise live a normal life. Dr. Motamedi estimates that between 150,000 and 300,000 patients with epilepsy could benefit from surgery. Yet, nationwide, only approximately 2,000 procedures are performed each year.
“It’s an extraordinarily safe surgery today,” says Dr. Kalhorn. “Dramatic improvements in technology allow us to map out exactly what bodily or speech functions might be involved and weigh the benefitsand risks. The evaluation is as critical to a good outcome as the procedure itself.”
Janet Rickey (right) suffered through 45 years of epileptic seizures, tests, medications and hospitalizations that came to an end only when she was referred to Georgetown University Hospital in 2006. Recently Janet’s daughter Diane (top) stopped by to share a makeover. Princess, her dog, tried to participate.
If medications have not produced the desired result within a year, patients with epilepsy should seek a second opinion at a tertiary medical center, like Georgetown, where they can be evaluated for surgery. Four months after her procedure, Rickey agrees wholeheartedly and would urge anyone suffering with seizures to consider it.
“I have a totally new life now,” she says. “For the first time, I can walk my dog by myself! My hardest adjustment has been getting accustomed to sleeping all night, without being jolted awake by seizures every hour or so. I just believe everything’s going to get better and better.”
For more information about the full range of epilepsy treatments available at Georgetown or to make an appointment, call GeorgetownMD at 202.342.2400 or toll-free at 866.745.2633.
