Comprehensive Epilepsy Program
Article from USF Magazine, Spring 2001
Changing Lives: From left, epilepsy researchers Fernando Vale and Selim Benbadis are pioneering a surgery that removes abnormal brain tissue without impairing the patients. The treatment could help patients become seizure free.
Terri Mueller was constantly groggy from taking three different medications to help control her recurrent seizures. "I was swallowing 12 pills a day and still having seizures. I kept asking my neurologist to take out whatever part of my brain was making this happen," said Mueller, 40, a Tampa dental assistant who was diagnosed with epilepsy 14 years ago. "He said surgery is not for you, this is a chronic illness you have to live with." Finally, Mueller and her new husband sat down with the physician and convinced him to give them the name of neurologists specializing in epilepsy, including Selim R. Benbadis, MD, director of the USF/Tampa General Healthcare Epilepsy Program. Mueller went to TGH in November, where she found out she was a candidate for a highly successful type of epilepsy surgery called a temporal lobectomy. Since the operation was performed in February 2000 by USF neurosurgeon Fernando Vale, she has not had a single seizure and was recently weaned from all her medications. "Epilepsy surgery might not be for everyone, but it has changed my life," she said. "I can work. I can drive. I'm not tired. I don't live in fear of having a seizure in front of people." Unfortunately, Benbadis said, many patients like Mueller never explore surgery as an option for severe epilepsy because their physicians tend not to mention surgery, and may even discourage it. "Many neurologists, unless they've had training in epilepsy or work at an institution with an epilepsy center, still perceive epilepsy surgery as unsafe or ineffective," he said. "In fact, epilepsy surgery is no longer an experimental procedure. Since the 1950s, it has been perfected into a very safe standard of care." Benbadis wants neurologists and their patients with epilepsy to know two things. First, there are other treatment options, including several types of surgery, for the 20 to 30 percent of patients whose seizures are not controlled with anti-epileptic drugs. Second, contrary to what is generally recommended, non-drug alternatives should be examined early rather than as a last resort, Benbadis said. "If the first few attempts with drugs fail, don't wait. Send the patient to an epilepsy center for a comprehensive evaluation." More than 10 different drugs are now available to treat epilepsy. But, studies have shown that after two unsuccessful drug trials, very few patients subsequently become seizure-free by trying other drugs. Even those whose seizures are finally suppressed by drug treatment may experience "unacceptable side effects," such as extreme drowsiness that interferes with their ability to think or walk, or blurred vision, Dr. Benbadis said. "If you can only stop seizures at the expense of quality of life, that is a failed treatment." About half the patients whose seizures cannot be controlled by drugs -- some 20,000 to 40,000 Americans-- may benefit from epilepsy surgery," Benbadis said. Yet fewer than 10,000 epilepsy surgeries are performed each year in the United States. The goal of surgery is to eliminate seizures by removing the abnormal area of the brain where seizures originate, without damaging the patient's speech, memory or movement, Dr. Benbadis said. Epilepsy centers have multidisciplinary teams skilled in the care of patients resistant to drug therapy. The team relies on an extensive evaluation, including prolonged EEG video monitoring, advanced brain imaging and neuropsychological tests, to determine whether the patient is a candidate for epilepsy surgery and what surgical technique would be most appropriate. With electrodes attached to the patient's scalp, the EEG video monitor records normal brain activity as well as the abnormal electrical discharges that cause epileptic seizures. This is the only procedure that can definitively diagnose epilepsy -- an important distinction since nearly 20 percent of patients referred to epilepsy centers have another condition instead of epilepsy, Benbadis said. Furthermore, the test distinguishes between partial epilepsy, in which seizures are triggered in one small part of the brain, and generalized epilepsies, in which seizures are produced by the entire brain at once. If the seizures are partial, EEG video monitoring can usually pinpoint the area of the brain where the seizures start. In general, the more confined the source of the seizures, the better the chances that surgery can eliminate them, Benbadis said. Some patients may need to continue taking medication after surgery, he added, but their seizures are usually better controlled with less medication. If the comprehensive evaluation rules out a patient as a candidate for surgery, a high-fat, low-carbohydrate ketogenic diet or a new procedure known as vagal nerve stimulation (VNS) may be beneficial non-drug treatments. The TGH/USF Epilepsy Program exceeds guidelines established by the National Association of Epilepsy Centers for the highest-level medical and surgical epilepsy center. It is one of few in the country with a neurosurgeon (Dr. Vale) who has fellowship training in epilepsy surgery.
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