Surgery For Medication Resistant Epilepsy

    Published: 06-16-2009
    Views: 11,842
    Drs. Chris Kalhorn and Ghotam Motamedi of Georgetown University Hospital describe surgical procedures that can greatly decrease seizures for cases of epilepsy that resist medication.

    Christopher Kalhorn: Hi! I am Christopher Kalhorn, A Neurosurgeon from Georgetown University Hospital. I am the Director of the Epilepsy Surgery Program at Georgetown. Along with my colleague Dr. Gholam Motamedi in neurology, I would be speaking to you today about surgical treatment options for epilepsy. Gholam Motamedi: In general, two out of three patients with epilepsy will respond to medications. But one out of three patients despite taking medications will continue having seizures and those patients are potentially surgical candidates.

    Christopher Kalhorn: In brief, epilepsy surgery involves trying to target the precise area of the brain where seizures are coming from. And then, doing a targeted surgical procedure to try and remove those seizure areas to minimize seizure activity. Jeff Shriner: I was having other neurologists telling me they weren't seizures. So, I was been told one thing and I have been told another. I didn't feel really until I came here, and Dr. Motamedi said, it's a seizure. I lost jobs because of the seizures, because I would be unable to perform certain duties. I didn't want to go out in the public; I didn't want to go to engagements of any sort.

    Gholam Motamedi: Seizures can start anywhere in the brain, and that's why we call them focal or partial seizures. So the next step would be to bring them in for brain mapping by putting electrodes on the brain, which is non-surgically. We can record the seizures and pinpoint the seizure focus. If someone's seizure focus happens to be in those critical parts of the brain, unfortunately they won't be surgical candidates. Jeff Shriner: I did the sleep clinic and during that sleep clinic I produced, I believe a couple of seizures. We coded on some and from there we went forward. Going to the surgery is where they actually went in and resected part of my brain, they took it out. And I have been seizure-free ever since. And then slowly I had to do things, I got to go driving again. I got up walking again, all these little things were just happening. Christopher Kalhorn: Patience will typically take about four weeks to recover from surgery. Now during this period they may have some incisional pain that takes time to resolve. It's usually manageable with oral pain medication. They may also feel just slightly more fatigue than normal. We will often see a median improvement in the seizure activity. Some patients will have a seizure too after surgery. It does not mean that they motivationally become seizure-free. It's our practice though we will continue the medication for up to a year after surgery. If our patients are clinically stable at that point of time, and begin to gradually wean them off with the goal of trying to get them to be seizure-free and off of medication at the same time.

    A number of our patients after surgery have been able to go on and do the things that they haven't been able to do for years. For this reason it's really the most gratifying surgery that I perform.

    Jeff Shriner: So I am driving again. I had lost my license for a while. I am back at work which was huge with me. Little by little I am just reintroduced to society. I am just; I am not scared as much as I used to be. I am able to do things that I couldn't do before. I can walk down the street and not feel bad, overwhelming fear. It's a miracle, really is!

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