Posted: 7/18/2016
Treating complex condition demands ‘never give up’ approach
Jose Benitez, 33, of Dallas began having seizures when he was 15 years old. Although they didn’t happen frequently, they did affect his quality of life.
“I was prohibited from driving,” Benitez said. “And in addition to the seizures, I sometimes had this sensation, a feeling like I was trembling.”
Benitez eventually sought help at the Epilepsy Outreach Clinic at Parkland Memorial Hospital where he underwent extensive evaluation. He tried numerous anti-seizure medications without success before his condition was diagnosed as medically intractable, a type of epilepsy that affects only about 20 percent of all epilepsy patients. Parkland neurologists told him he might benefit from seizure surgery.
“Of course I said yes,” Benitez stated. He became one of only 12 patients to undergo the rare surgery in 2015 at Parkland. Since the surgery, Benitez has been seizure-free. “The operation was a great success,” he said.
Damian Diaz de Leon began having seizures when he was 16 years old. While his high school classmates started driving, Diaz de Leon found himself restricted by epilepsy seizure precautions from many routine activities that teenagers take for granted.
“I fell behind in school because I had memory loss and trouble concentrating. I couldn’t drive. I couldn’t do sports. I loved playing soccer, but suddenly my life changed and was all about seizures, medical tests and procedures.”
Neurologists found that Diaz de Leon had a type of vascular malformation within his brain’s right frontal lobe. He had a convulsion when the vascular malformation hemorrhaged. At age 18 he underwent brain surgery and was seizure-free for one year, but then the seizures returned.
Diaz de Leon credits his parents with continuing their research looking for medical resources to help their son. “They found out that Parkland has one of the best epilepsy teams and made an appointment for me.”
At age 21 Diaz de Leon underwent evaluations in Parkland’s Epilepsy Monitoring Unit. Routine EEGs when he was having seizures confirmed his seizures were localized to the region of the vascular malformation. The second study involved implanting multiple electrodes directly into his brain, surrounding the site of his previous resection.
“This technique, called SEEG (stereo electroencephalography) uses sophisticated computer and robotic technology to allow multiple electrodes to be implanted deep into the brain safely. “Parkland’s state-of-the-art diagnostic technology allowed us to pinpoint the precise area that was the source of Diaz de Leon’s seizures to determine a treatment plan,” said Mark Agostini, MD, Medical Director of the Epilepsy Program at Parkland and Associate Professor of Neurology & Neurotherapeutics at the University of Texas Southwestern Medical Center.
A few months later, he underwent surgery to remove the part of his brain triggering the seizures.
“I haven’t had a seizure in the past eight months,” Diaz de Leon said. “My memory is improving and I’m taking college courses. I can drive and I can even swim and go to the gym and lift weights – all things I wasn’t able to do for the past seven years.”
“The goal of the Parkland Epilepsy Program is to stop seizures and give patients their life back,” said Barbara Voth, Department Manager of the Parkland Epilepsy Center/ Clinical Neurophysiology Laboratory. “More than 2 million people in the U.S. have epilepsy and approximately 30 percent do not respond to anti-seizure medications. Our physicians and staff are dedicated to finding help for our patients. Each epilepsy patient is unique and we don’t give up until we find the right treatment for them.”
The Parkland Epilepsy program has received accreditation as a level 4 epilepsy center for 2016 by the National Association of Epilepsy Centers (NAEC). Level 4 epilepsy centers have the expertise and facilities to provide the highest level of medical and surgical care for patients with the most challenging types of epilepsy. Parkland has been a certified level 4 center since the inception of NAEC in 2001.
Evaluation of an epilepsy disorder begins in Parkland’s outpatient epilepsy clinic where neurologists review a patient’s history, basic study results (brain MRI and EEG) and perform a neurologic exam. In FY2015, there were approximately 3,000 epilepsy seizure disorder visits. If patients are not responding to anti-seizure medications, they are referred to the Parkland Epilepsy Monitoring Unit, a 12-room inpatient facility with state-of-the-art EEG, video and computer capabilities where each patient is monitored by continuous video and EEG. Anti-seizure medications are withdrawn carefully in order to witness the patient’s actual seizures, with the hope of localizing the seizure focus and ultimately stopping the seizures forever.
“Registered nurses and EEG technologists are present 24 hours a day to ensure our patients’ safety,” Voth said. “All rooms are single with a private bathroom and a separate bed for one member of the patient’s family to stay with their loved one during their evaluation.”
Most of the approximately 450 patients admitted each year to Parkland’s epilepsy unit are new onset seizures and/or patients who need a diagnostic evaluation. Diagnostic tests include MRI, fMRI, SPECT, PET scan, neuropsychological tests and more. The multidisciplinary care team includes specially trained nurses and diagnostic technologists, neurosurgeons, neuroradiologists, neuropsychologists and social workers who specialize in epilepsy care. Support groups and educational events are also offered.
For more information about the Parkland Epilepsy Center, please call 469.419.9240. To make an outpatient appointment, call 214.590.5689.