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.
Prus, N., & Grant, A. C. (2010). Patient beliefs about epilepsy and brain surgery in a multicultural urban population. Epilepsy & Behavior, 17(1), 46-49.