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Dr. Lysa Lomax

Kingston’s First Intracranial Electrode Case for Epilepsy Surgery

Joe Nashed, PhD Candidate, Translational Medicine

The January 16th Medical Grand Rounds, the Department of Medicine had the pleasure of hosting Dr. Lysa Lomax, an assistant professor here at Queen’s University that is appointed to both, the Divisions of Neurology and Respirology. Dr. Lomax has been instrumental in designating Kingston Health Science Center as a District Epilepsy Centre, which has allowed local access to patients in need of epilepsy assessment for epilepsy surgery.
 

Epilepsy is a brain disorder that causes people to have recurring seizures. Dr. Lomax highlighted the disorder affects approximately 1% of the population, which amounts to 55 million people worldwide. In Ontario, this epilepsy affects 75,000 adults, and 15,000 children, which has highlighted the need for an additional District Epilepsy Center in Kingston. Traditional therapy for epilepsy often includes anticonvulsive drugs. However, nearly 30% of all patients have refractory epilepsy, which is defined as inadequate seizure control following the use of two or more anticonvulsive drugs. Managing patients with refractory focal epilepsy can be difficult, as there are often diminishing returns when trying new or additional anticonvulsants.
 

In some cases, epilepsy surgery can represent a therapeutic alternative to anticonvulsive drugs, particularly in patients with refractory focal epilepsy. The surgery itself is a procedure that removes or alters brain regions where seizures originate. Dr. Lomax’s talk illustrated the utility of epileptic surgery in a patient with refractory focal epilepsy. Dr. Lomax made is clear that the surgical intervention could not be possible without a multidisplinary team of health practitioners. In fact, throughout the presentation, Dr. Lomax invited some of her colleagues up to discuss their roles and the temporal evolution of the surgical case. For example, Dr. Donatella Tampieri interpreted the subtle neuroradiological findings of the patient, which was subsequently used to locate the brain regions thought to give rise to the seizures. These MRI’s were then used by Dr. Ron Levy, who spoke about how he carefully placed intracranial electrodes along those areas designated by Dr. Tampieri, which would be used to monitor seizures. Dr. Lomax and Dr. Levy explained that the intracranial electrodes allowed them to precisely monitor these targeted brain areas. The intracranial electrodes provided insight into which brain regions could be removed in the hopes of attenuating seizure frequency. A subsequent surgery, performed by Dr. Levy, ultimately removed a small region in the parietal cortex, thought to be responsible for some of the symptoms the patient was experiencing. Finally, Dr. John Rossiter, a neuropathologist, observed “Balloon Cells” which were consistent with focal cortical dysplasia. Ultimately, the removal of the lesioned area resulted in a profoundly improved quality of life for the patient and served to show that epilepsy surgery is a viable option for some individuals with refractory focal epilepsy.
 

In our post rounds discussion, Dr. Lomax re-emphasized the collaborative nature of the epilepsy centre and the epilepsy surgery and made a special point to stress the importance of the nurses, physiotherapists and other health practitioners that she worked with. An important aspect of this collaborative environment is listening, not only to the patient and their needs, but other health care practitioners she collaborates with, and really valuing what they each bring to the table – a skill Dr. Lomax, said she learned during her fellowship and research career.
 

Despite the obvious clinical implications for patients, there remains a stigma about epilepsy surgery, which is perpetuated by both patients and the lay press. For example, a study from Prus and Grant (2010) illustrated that over half of epileptic patients would not consider brain surgery a viable treatment option for surgery. Dr. Lomax informed us that there really is a need to educate people and the media about the epilepsy surgery and its utility for many patients. Epilepsy really does remain poorly understood, even among those who have the disorder. Education can be used to destigmatize the disease and provide evidence and facts for patients so that they can make more informed decisions about their treatments.
 

It was a pleasure to have Dr. Lomax at our Medical Grand Rounds discussion. On behalf of the TMED graduate students, we thank her for her time and invaluable insight and advocacy.

 

References:

Prus, N., & Grant, A. C. (2010). Patient beliefs about epilepsy and brain surgery in a multicultural urban population. Epilepsy & Behavior17(1), 46-49.

Comments

Name
Jay Kataria

Mon, 01/27/2020 - 16:47

Thanks for the insightful post and thank you for the talk, Dr. Lomax! Do you think other neurological disorders, such as depression and schizophrenia, have altered electrical activity? If so, do you think it's possible use the intracranial electrodes to help diagnose these disorders?

Name
Jay Kataria

Hey Jay,

Good question! I know that a number of NeuroImaging studies have show considerable differences between individuals with depression and those without, and similarly for those with schizophrenia and those without. Particularly in the Default mode network between subjects. The utility of intracranial electrodes in epilepsy is that the disorder can have an abnormal focal node that can be measured precisely in from the electrodes, it makes sense to use them. In contrast, depression and schizophrenia don't have the same focal lesions that Dr. Lomax discussed. I may be wrong on this, but a quick literature search didn't yield many results. That being said it is a very interesting concept.

Name
Joseph Nashed

Name
Marty VandenBroek

Tue, 01/28/2020 - 13:58

Great summary Joe! I think educating the public and patients (and healthcare workers for that matter) on the feasibility and success of surgery is extremely important to combatting the stigma surrounding epilepsy. The challenge is experts like Dr. Lomax are simply too in demand in the clinic to have time for outreach and educating a wider audience (Dr. Lomax even mentioned how she isn't even able to conduct the research she would like to do as a result of this demand). I wondered what peoples thoughts might be on how this issue could be addressed, or what other education strategies could be explored?

Name
Marty VandenBroek

Name
Quentin Tsang

Tue, 01/28/2020 - 15:43

In reply to by Anonymous (not verified)

Hi Marty!
Reading your question caused me to think more in-depth about education, not only with patients, but with the general public. Dr. Lomax mentioned in her talk that there are epilepsy support groups where individuals will gather for peer support, but also to share their personal experiences with epilepsy and surgery. I was thinking that this model could also be applied to education of the wider audience. Perhaps patients with epilepsy, with and without having gone through surgery, may be able to educate the public via public speaking, advocacy and/or charity events. This would alleviate the workload of clinicians, like Dr. Lomax, while empowering patients themselves to combat the stigma, challenge stereotypes and allow their voices be heard. What does everyone think?

Name
Quentin Tsang

Great Point Quentin, and awesome idea! What better way to get education and information - straight from the source!

Name
Joseph Nashed

Hi Quentin,

You raise some excellent points and I agree that the media would be an excellent way to convey information and educate the public about epilepsy. Social media is such a powerful tool for the public and often reflects the ideologies of our current society. In 2012, 5000 tweets were analyzed over a week for the term “seizure”. Strikingly, approximately 41% of these tweets were derogatory, whereas only 2% of tweets were individuals looking for advice. Fortunately in more recent years, initiatives aiming to reduce stigma around mental health and neurological disorders are increasing and we are hopeful that this will positively reflect on the wellbeing of these individuals!

For those interested in the article: https://www.ncbi.nlm.nih.gov/pubmed/22134096

Name
Thalia Hua

Thanks for sharing the article Thalia, it was a good read. As the article discussed, unlike the traditional forms of media that have their content well regulatory this does not usually occur with social media. This situation facilitates the spread of misconceptions, stigma as well as fake news which has the potential to be destructive. The recent coronavirus infection, for example, has had its fair share of fake news on social media. Another thing I found worth noting in the article was how people spoke against derogatory tweets. As advocates, we should be prepared to speak out against such social media posts in a respectful manner and offer further education on the issue.

Name
Edwin Ocran

Name
Joseph Nashed

Tue, 01/28/2020 - 20:39

In reply to by Anonymous (not verified)

Thats such a good point Marty! I can only imagine how demanding it would be to balance clinical work, research, while trying to open an epilepsy centre too!! I wonder if a the department of medicine or district epilepsy centre has a outreach group that could be used to educate people and "advertise" so to speak.

Name
Joseph Nashed

Name
Katie Monteith

Wed, 01/29/2020 - 14:24

Great summary Joe! I found this article stating that biomedical companies are expecting there to be an 8% increase in the use of intracranial electrodes in the next 6 years. I found this to be in line with Dr. Lomax’s predictions about how she envisions an increasing number of patients choosing to have invasive treatment options due to their potential benefits in the following years. I am curious what other people think in terms of this proposed timeline?

Link to the article: https://www.globenewswire.com/news-release/2019/11/26/1952373/0/en/Subd…

Name
Katie Monteith

Name
Daniel Rivera

Wed, 01/29/2020 - 19:26

Hi Joe,

Thanks for the summary. I really enjoyed Dr. Lomax's MGR and particularly how she structured it to introduce her colleagues who helped guide us through what was an interesting case. It was intriguing to learn about the "village" of individuals, who are skilled specialists in their own right, collaborate to tackle complex cases together. I believe it was mentioned briefly in a post-rounds discussion as more of a general comment that with such a multidisciplinary team, while it can be extremely beneficial to have diverse expertise, it may also be challenging to have individuals from different aspects of healthcare coalesce. Upon reflecting upon this, I was further impressed by the success Dr. Lomax and her colleagues, from nurses to social works to surgeons, have achieved with their program. Thank you for your post, Joe!

Name
Daniel Rivera

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