Elaine Wyllie, MD, Neurologist and Epilepsy Specialist at Cleveland Clinic, talks about epilepsy and how new MRI technology is helping to locate problem spots in the brain, resulting in treatment of those who previously could not find relief.
Interview conducted by Ivanhoe Broadcast News in September 2017.
Tell us a little bit about epilepsy and how it affects the brain?
Dr. Wyllie: In persons experiencing epilepsy, the normal brain wave electrical activity is interrupted now and then by irregularities, which cause the signs and symptoms that we call seizures. The seizures can vary widely in their manifestations based on the type of irregularity and the part of the brain that is affected. In Ravi’s case, the manifestations were whole body stiffening and inability to speak lasting 30 seconds or so.
What does a seizure look like for these patients and how does this affect their quality of life?
Dr. Wyllie: When we met Ravi he was having frequent seizures, sometimes many in a single day, despite taking high doses of four antiepileptic medications and having already tried a total of eight. These seizures obvious take quite a toll on the activities that children want to be doing at that age and school was a real struggle during that time.
In Ravi’s case tell us a little bit about what he was going through when you first saw him?
Dr. Wyllie: Ravi was bravely trying to control the seizures, following the advice of his doctors and working closely with his parents, but no matter how hard everyone tried the seizures continued relentlessly.
Tell us a little bit about epilepsy surgery and how the advance testing helped Ravi reach the point of surgery?
Dr. Wyllie: In addition to the standard pre-surgical testing Ravi also participated in a research protocol that was developed and approved by Cleveland Clinic Institutional Review Board since 2012. This allowed him to have a very advance 7-Tesla MRI scan, which then could be compared with the standard 3-Telsa MRI that is used for clinical purposes, and when we looked at the 7-Telsa MRI we were able to detect and appreciate a clear but very subtle abnormality where the brain had formed improperly during early brain development before he was actually born. This discovery then guided his doctors to place some specialized recording devices directly on and in the brain to clarify the location of this abnormal area in relation to language function. The results from the testing then allowed the development of a surgical strategy to safely remove the troublesome region of the brain that was causing the seizures, without doing any harm to the nearby language area.
Perfect and tell us how well Ravi is doing today?
Dr. Wyllie: We are so proud of Ravi; he is an amazing young man. He not only completed high school, but now he is also working on completing the perquisites for nursing school, and his ultimate goal is to work with children with special needs. Ravi has a very kind and generous heart and it has been a privileged to be one of his doctors. Ravi has done very well since surgery. His language function was completely normal as soon as he woke up from the operation. He had a cluster of seizures four months after surgery, but we were able to get things back under control and since then he has only had a single mild breakthrough. It has been over a year now and we are very hopeful that Ravi will do well in the long run, and certainly his quality of life has vastly improved.
How important is it for patients to seek care with the best testing and the best options?
Dr. Wyllie: If you or a loved one have uncontrolled seizures, we strongly recommend that you seek out the help of a specialized epilepsy center where you will receive the most advanced testing and treatments to improve your quality of life. Advanced neuroimaging techniques, such as 7-Tesla MRI and the post processing techniques that were used in Ravi’s case, provide opportunities for better detection of very subtle brain abnormalities and this may allow more patients to benefit from epilepsy surgery than ever before.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Andrea Pacetti
Cleveland Clinic Epilepsy Center
866-588-2264
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here.
