Terry Rodgers-Neame, MD, Medical Director for Florida Comprehensive Epilepsy and Seizure Disorder Center talks about epilepsy and how the dense array EEG focuses on specific parts of the brain.
Interview conducted by Ivanhoe Broadcast News in April 2018.
Tell us about this machine.
Dr. Neame: Okay, so the background to this is that epilepsy and seizure disorders are very common. One in ten people will have a seizure at some time in their lifetime and one in twenty six people will have a diagnosis of epilepsy or seizure disorder at some time in their lifetime. So it’s very common. It does not respect any boundaries of age, sex, race, belief system or nationality. It affects everyone. I have patients who are professionals, patients who are small children so almost anybody can get epilepsy at any time in their life.
There’s all different kinds of seizures?
Dr. Neame: There are many different kinds of seizures. I like to tell my patients that their seizures belong to them. Every patient is unique from every other patient and every patient brings their own condition to the table. So every patient here gets treated as an individual, they get treated for their epilepsy. And so, and what their situation is like. There are a number of patients, about seventy percent of patients will respond to the first medication that they get put on and they may stay on that medication for years and never have another seizure. But other people will get seizure disorders and take a number of medications and not be controlled. What we say is at the point that the patient doesn’t respond to two medications then they need an evaluation for further treatments. So those further treatments can include diet, lifestyle changes, it can include surgical intervention, device placements and things like this. Our new equipment the EGI Phillips dens array EEG is one of the tools that we use to determine exactly where the seizures are coming from because one thing that patients want to know is why and where and how. And so they feel that if they know where the seizures are coming from that they have partway control over those seizures. And it helps physicians as well get control over their seizures sometimes by doing respective surgery. About one in a hundred people get respective surgery and those are only the patients that are poorly controlled with medications or other non- invasive interventions.
Is it used as a first line defense or is it after medication hasn’t worked and then you would do this?
Dr. Neame: We consider patients candidates for epilepsy surgery evaluation if after an honest try of two medications does not work. And that is to make the patient seizure free and without significant side effects from new medication. After two honest tries then we suggest epilepsy surgery. Now this sounds like a very drastic approach but when you consider the fact that we can significantly change your quality of life, they can drive, they can hold down a job if they would like, they can have a normal social life. All of those things those come in to play at that point because if someone is living with the idea that they can have a seizure today or tomorrow, next week, next month, they don’t know it seriously curtails their ability to have a good quality of life.
So the EGI machine helps the doctors to figure out where to do the surgery?
Dr. Neame: The EGI tells us, gives us one tool to focus in on exactly where in the brain the seizures are coming from and helps us to make a decision based on not just this piece of information but a whole milieu of information from different inputs. We get good pictures of the brain, we talk to the patient, we observe their seizures to see what their seizures actually look like. We get neuropsychological testing to see what they’re likely to lose with the surgery. And then we hone down on the exact area. The great thing about the dense array EEG is it allows us to focus the EEG appearance on to a certain part of the brain so it shows us on the patient’s brain where the seizure focus is. If we use standard EEG it is essentially the same as it was in the mid-fifties. If we use long term video EEG is no different than it was in the mid-eighties. This truly brings us in to the twenty first century in terms of being able to localize exactly where the seizures are coming from.
Before this you were using those outdated methods?
Dr. Neame: Older, older methods. That doesn’t give the doctor’s a level of confidence and it doesn’t give the patients a level of confidence. So we want to increase the patient’s level of confidence and the doctors and the surgeon’s level of confidence by pinpointing the exact area. If we pinpoint the abnormal area we can take out a smaller portion of the brain and therefore decrease the risk of having serious complications from the surgery.
This is a big breakthrough?
Dr. Neame: This is a very big breakthrough.
Is there a big cost involved for the patient or is this something insurance has recognized?
Dr. Neame: This is something that is covered by the insurance companies as well as Medicare and Medicate.
When you started utilizing this and you’ve been in this field for a long time are you like, wow?
Dr. Neame: Amazing, it’s amazing. That was my reaction, this is truly amazing. It’s been an amazing thing for my patients as well. And that’s the important thing that it makes a difference in their lives.
Alena we’re going to interview, she obviously had the EIG.
Dr. Neame: The EGI.
The EGI and you were able to pinpoint the area?
Dr. Neame: Yes, exactly where her seizures were coming from and even though she had epilepsy surgery before, she had areas in her skull that would render the normal EEG less effective and less localizing. The EGI helped us to pinpoint the area exactly where we were going to do the surgery. She went in to the surgery and came out exactly the same person and she had no loss of any memories, no loss of any function.
Is that always a risk with this kind of surgery?
Dr. Neame: It is a risk, it is a risk with doing surgery. Especially looking at scalp EEG rather than EEG that is localized on the patient’s brain.
Anything else you think is important?
Dr. Neame: I think it’s important to know that this is not a painful procedure, it is not an invasive procedure. There are other methods that we can use to localize seizures by putting electrodes actually on the brain but this allows us to localize the seizure focus without putting those electrodes on or it can guide us better in the placement of those electrodes so that we’re more likely to come upon the exact seizure focus.
When you say it’s not invasive these don’t go in and take the problem area out?
Dr. Neame: Yes. If it’s localized well and the seizure focus is unlikely to affect major functions such as speech, learning or movement. Vision, hearing, those kind of things then we will go in and take out that particular area. At that point it becomes more complex if we’re deciding on things like whether or not we sacrifice some movement, fine movement in the hand for seizure freedom then that is obviously a more complex decision.
I guess you said anybody can be affected.
Dr. Neame: Anyone can develop epilepsy at any time.
There’s not one common thing you notice in patients, or hereditary?
Dr. Neame: So hereditary factors play in to whether or not people have seizures. It’s just like hair color or eye color, those kind of things affect the color of the hair the color of the eyes, a propensity to have epilepsy. But we have patients who are identical twins where one has epilepsy and the other does not.
Does it come on at a certain age?
Dr. Neame: It can come on at any age. The most common ages are the very young and the very old. But many people develop epilepsy in between those times.
END OF INTERVIEW
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