Lifewatch: Epilepsy

PITTSBURGH -- Three million Americans have epilepsy, and for at least 30% of those people, no medicines control their seizures.

But now, new imaging techniques have sharply increased the number of people who are candidates for epilepsy surgery.

Frequent epileptic seizures would stop Savannah Taylor in her tracks.

"She would have blank stares sometimes. Sometimes she would have what they call grand mal seizures where she would drool on herself," said Inger Tyree, Savannah's mother.

Seizures are like short circuits in brain cells, causing confusion, loss of control, or tremors.  Surgery is the only way to cure epilepsy completely, but pin point accuracy is crucial.

"We don't want any weakness, any memory problems, any language problems, any vision problems. We don't want to lose anything. So you want to make sure you take out only the area of the brain making the seizures, not any of the brain surrounding it," said Dr. Deborah Holder of Pittsburgh.

Researchers have developed new techniques to more accurately map the brain.  Sensors on a child's head allow a digital brain wave machine to create a high-tech image of what's happening inside.

Surgeons then place dozens of tiny electrodes directly on the brain surface.

"What we're doing is putting 64 electrodes within an eight by eight centimeter square. It's much more concentrated. There's only a centimeter spread between electrodes," said Dr. David Adelson of Pittsburgh.

That means doctors can pinpoint the source of the seizure, down to the centimeter.  Better screening means more potential patients, and better outcomes, especially for children.

"The brain is still flexible in children. You can take out an area that normally would be memory, and if it's not there, another area takes over. Unlike adults where the brain is set," said Dr. Holden.

Since her surgery, Savannah's seizures have stopped and her grades have improved.

"It's so wonderful to see her happy and playing and being normal," said Tyree.

According to doctors, recent studies show the risk of injury from repeated seizures is higher than the risk of complications from epilepsy surgery.


Children's Hospital of Pittsburgh

Neurology department

(412) 692-5520


BACKGROUND: Epilepsy is a neurological condition affecting the central nervous system. It is most commonly characterized by the recurrent, unprovoked seizures patients endure. Epilepsy is usually diagnosed after an individual as two seizures not caused by a known medical condition like extremely low blood pressure or alcohol withdrawal. More than three million Americans have epilepsy, 30 percent of whom are under the age of 18. About 200,000 new cases are diagnosed each year, yet the cause of the disease remains mostly unknown. Thirty percent of cases do in fact have a contributing factor to the disease's development. Brain tumor and/or stroke, head trauma, poisoning (including lead poisoning and substance abuse), infection (including meningitis, viral encephalitis and lupus) or fetal injury or infection are known causes of epilepsy. The remaining70 percent of cases, however, have no known cause. An Epilepsy Foundation report from 2000 reveals the disease costs the United States more than $16.6 billion every year in health care and unemployment.

SEIZURES: Seizures are the most tell-tale and dangerous symptom of epilepsy. During a seizure, a sudden surge of electrical activity in the brain -- usually in the cortex -- will suddenly alter a person's behavior. Seizure victims may black out, convulse, drool and their eyes may roll up. Teeth grinding, tongue biting and shaking are other physical signs of seizure. Not all seizures, however, will be as severe or tell-tale as others and the symptoms can vary. Seizures lasting more than 30 minutes can cause permanent neurological damage or death. Seizure patients can also die from vomit inhalation during or after a seizure. Generally, however, seizures are not fatal and the life expectancy of someone with epilepsy is the same as that of a normal, healthy individual.

CURING EPILEPSY: The only way to cure epilepsy is with surgical removal of the seizure-causing areas of the brain. For more than 50 years, this has been an accepted practice when medicines fail is an incredibly delicate procedure requiring exact incisions and movements. Modern technology has reduced the amount of brain tissue lost during surgery by 50 percent in the last several years. New tools are also making mapping the brain before surgery even easier. Electroencephalography (EEG) and video EEG record electrical impulses from the nerves in the head. Detectors are placed on the scalp and see what the electrical impulses look like when the patient is awake, asleep, in a room with flashing lights or when they breathe deeply.  It determines if a patient's level of alertness is normal, if abnormalities exist in a particular part of the brain or if patients have a tendency to have seizures.

Reported by Kristy Ondo