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UT Physicians

Epilepsy surgery helps young woman get life back

By Darla Brown

Amanda Saenz

After eight years of suffering with epilepsy, Amanda Saenz, 24, is finally living a normal life, seizure-free. "I feel like my life is as normal as it can be," Saenz says. "I got married in June, I can drive now – I had to stop because I had a seizure driving and drove my car into a bayou. I'm going back to school, and I hope to graduate in 2008.

"Seizures were a big part of my life, and they are not there anymore." Seizures have been erased from Saenz's life thanks to epilepsy surgery and the comprehensive epilepsy team of UT Physicians, which offers a multidisciplinary approach to epilepsy management and diagnosis.

"We have all of the components here," says Nitin Tandon, M.D., assistant professor of neurosurgery. "We have neuroradiology, neuropathology, neuropsychiatry, in addition to neurologists and neurosurgeons."

Two percent of all Americans have seizures, and half of these have epilepsy.

"A seizure is a short-circuit within the brain, where an excessive number of brain cells are firing at the same time," explains Jeremy Slater, M.D., associate professor of neurology and director of the Texas Comprehensive Epilepsy Program at the UT Medical School. "If the brain has changed in such a way where seizures will happen, that is called epilepsy. It's the second most common neurological disease behind stroke."

Thirty percent of those with epilepsy have refractory seizures that cannot be managed with medications alone.

"About half of those may be candidates for surgery," Dr. Slater says. "There are a lot of patients out there who may benefit from this surgery that we have so far not been able to reach."

The field of epileptology has grown over the last 50 years and now offers a variety of treatments to patients, from new medications now on the market to epilepsy surgery and the implantation of vagus nerve stimulators.

"Medicine now has much to offer patients suffering from epilepsy – it has become much more sophisticated and successful over the last half a century," says James Ferrendelli, M.D., chair of the Department of Neurology and past president of the American Epilepsy Society who has published many articles on the diagnosis and treatment of epilepsy. "There are now hundreds of neurologists and neurosurgeons specializing in epileptology. The University of Texas Medical School at Houston and Memorial Hermann Hospital is recognized nationally and internationally as a leading center for the diagnosis and treatment of epilepsy."

Patients like Saenz undergo a three-phase process when they enter the UT Physicians' Epilepsy Program, which is one of the leading centers in the country and is in growth mode, adding specialists to meet the needs of the citizens of Texas and surrounding states.

Phase 1 is a stay in the 12-bed Epilepsy Monitory Unit (EMU) at Memorial Hermann Hospital, which is directed by Dr. Slater. Here patients are monitored on video, hooked up to electrodes, and encouraged to have a seizure so that it can be mapped in the brain.

"I stayed in the EMU about 5 days, where they monitored my brain waves and took me off my medications and made me stay up a whole night to try to get me to have a seizure. Finally, I had one," Saenz recalls.

"After a patient has a seizure in the EMU, we go back and look at the video and the EEG (electroencephalogram) at the same time to see if it is a focal or generalized seizure," Dr. Tandon explains.

UT Physicians were able to determine if Saenz's seizures were focal or generalized and deduced that they were localized on her right temporal lobe.

"The next step was a series of tests to see where my memory and speech were located on my brain," Saenz says.

These battery of tests are known as Phase II and may include an MRI (Magnetic resonance imaging), MEG (magnetoencephalogram), PET (positron emission tomography), and SPECT (single photon computer tomography).

"These imaging tests help us map the important speech, language, and memory functions of the patient's brain. Everyone's language area is in a slightly different place in the brain, and there are several areas and connective fibers between them. The areas of the brain that control motor skills are more predictable," Dr. Tandon explains.

"We create a map of these functions by implanting electrodes on these specific locations before the surgery – and we stay away from them," Dr. Tandon adds.

Even though these areas of memory are mapped prior to surgery, memory loss can be a side effect of epilepsy surgery because a diseased hippocampus is often removed during the surgery. Because of this possibility, Joshua Breier, Ph.D., associate professor of neurosurgery, does testing of patients before and after surgery for memory.

"We do two pre-surgical procedures with these patients in addition to a full neuropsychological evaluation," Dr. Breier explains. "With the Wada test, we look at language and memory function by putting one side of the brain asleep for eight minutes and test the other side, then vice versa.

"We can also map their brain extraoperatively or intraoperatively if language is on the same side of the brain that will be operated on. We stimulate one of the grids sitting on top of the brain and ask them to perform language tests to gauge where the language resides," Dr. Breier says.

Patients undergo a full neuropsychological evaluation post-operatively as well.

"Following surgery, patients are often completely free of daily or weekly seizures, so it can be a large change in people's lives, and we help them prepare for it psychologically – usually things get better," Dr. Breier adds.

Saenz says memory loss has not been a problem for her since the surgery.

"I used to have memory problems before the surgery, but I think epilepsy surgery has served to prevent future memory problems for me because of where the seizures were on my brain," she says.

Saenz says her faculties were functioning fine when her boyfriend, Rudy, proposed to her just days after surgery while she was still in the hospital.

"I was hoping surgery would open up new doors to me, and it has," Saenz says.

For more information, or to refer a patient, call 1.877.4UT.DOCS (1.877.488.3627).

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