Lancet Paper Shows Epilepsy Surgery Controls Seizures For Many Years, Recommends That Surgery Be Considered Earlier
Long Island Woman Benefits from Surgery Following Intensive Search for Answers About Her Uncontrolled Seizures
ROCKVILLE CENTRE, NY – October 26, 2011 – The largest and longest duration study to date on epilepsy surgery has shown that nearly half of those who undergo surgery remain seizure free for 10 years. Study authors demonstrated that more patients should be candidates for surgery earlier in the course of their disease, if medications don’t adequately control seizures. The study, which appears in the October 15 Lancet, tracked 615 adult patients for up to 19 years.
“Patients should not needlessly suffer for years, being switched from medication to medication, when surgery early on might be more effective,” says Alan B. Ettinger, M.D., a neurologist specializing in epilepsy and director of epilepsy for Neurological Surgery, P.C. (NSPC).
"This study confirms what those of us in the field know: that surgery for epilepsy is not just a ‘last resort’ and can help many patients unresponsive to medications live far more normal lives,” says Brian J. Snyder, M.D., attending neurosurgeon with Neurological Surgery, P.C., who specializes in surgery for adult epilepsy, movement disorders and chronic pain.
Charisse Lofton of Bay Shore, NY, is among those who have new reasons for optimism following successful epilepsy surgery with Dr. Snyder. Lofton, 33, started experiencing devastating seizures when she was 28, repeatedly losing consciousness and even suffering nonstop seizures for a prolonged time (status epilepticus), and was even placed in a drug-induced coma during one particularly severe episode. She went to numerous doctors, who put her on medications that did not solve the problem and had horrendous side effects. Rounds of tests did not reveal either the cause of her seizures or the location of abnormal brain activity. Doctors had given up on her, leaving her in a state of ill health and desperation.
Three years after the start of her seizures, she contacted Dr. Ettinger. She heard that he had a track record of solving the most baffling cases, and successfully treating these patients.
Dr. Ettinger, Dr. Snyder and their colleagues began a painstaking search for answers, lasting more than 16 months. “Her case was very complicated, as earlier tests did not indicate brain abnormalities or show the location in her brain of the seizure activity,” Dr. Ettinger says. “We knew we needed an intensive, multidisciplinary approach to find out how to treat Ms. Lofton safely and effectively.”
Dr. Ettinger first tried newer types of epilepsy medication, to determine whether they would make a difference. Not seeing any benefit from these drugs, the team, which included neurologist David Friedman, M.D. and neuropsychologist Gad E. Klein, Ph.D., began a series of tests to help determine the best and safest surgical approach.
Lofton participated in long term video-EEG monitoring, in which her brain waves were monitored and seizures recorded on camera. Functional MRIs provided a map of her brain, showing areas responsible for critical functions that must be avoided in surgery. She underwent a “Wada” test, which determines what side of the brain controls language function and how important each side of the brain is with regard to memory function.
Dr. Snyder was brought in early, as it was obvious that it would be difficult to locate the source of Lofton’s seizures and that she needed invasive diagnostic tests only available at major epilepsy centers, done by highly skilled neurosurgeons. He performed a three-part procedure at Winthrop University Hospital in which he surgically placed electrodes directly on the exterior and interior of Lofton’s brain to identify both the general and specific location of Lofton’s seizures, and to further improve both the efficacy and safety of planned surgery.
These exhaustive tests pinpointed the area of Lofton’s seizures – an area in the back of her temporal lobe - and helped Dr. Snyder avoid areas that were responsible for vital functions. Using a high level of skill, experience and judgment that comes from performing many epilepsy surgeries, Dr. Snyder conducted a multipart procedure that removed a small portion of Lofton’s brain’s from the outside and back of her temporal lobe - an area that is not typically resected in treating epilepsy. (Lobectomies, the most commonly used type of epilepsy surgery, are usually done in the inside and front of the temporal lobe, a part of the cerebral cortex where seizures typically originate.)
A month after Lofton’s final surgery, she appears to be seizure free, and she is beginning to go back to the normal life she had before seizures started five years ago. The mother of three reports she recently went pumpkin picking with her kids, and hopes to start working soon, maybe even entering a medical field. She is grateful for the care she’s received from Dr. Ettinger and Dr. Snyder, and she looks forward to marrying her fiancé and living without fear of losing consciousness due to epilepsy.
Alan B. Ettinger, M.D. is a nationally known epilepsy specialist who has dedicated his life to helping individuals with seizures and related disorders. One of only two neurologists selected this year for New York magazine’s 2011 “Best Doctors” list, he is a member of the national professional advisory board and executive board of directors of the Epilepsy Foundation of America, as well as president of the professional advisory board of the Long Island Epilepsy Foundation. On November 19 he will be honored by the Leslie Munzer Neurological Institute for his work on behalf of people with epilepsy.
Brian J. Snyder, M.D. is a neurosurgeon who specializes in treating seizure disorders and epilepsy, as well as movement disorders such as Parkinson’s disease, tremor and dystonia. He is a leading practitioner of deep brain stimulation (DBS), having trained under Dr. Andres Lozano, perhaps the world’s foremost DBS authority. He has extensive expertise in vagal nerve stimulation and procedures for mapping, recording and identifying seizure foci in the brain, and in the surgical resection of these foci. He is certified in both Gamma Knife® and CyberKnife® radiosurgery.