Brain Surgery Overcomes Epilepsy

Plagued by seizures since childhood, Carol Salinas’ life had been a roller coaster.

During her teens, Salinas often zoned out, hearing what was happening around her but not seeing. Doctors said she was hypoglycemic but never prescribed medication. Her condition worsened. By age 21, Salinas suffered her first grand mal seizure, blacking out and ending up in the hospital. Still, there was no official diagnosis.

Then, oddly, the seizures stopped for 20 years. But they returned with a vengeance: Salinas once suffered six back-to-back grand mal seizures in a day.

“I always knew when one was coming because it felt like my brain was swollen too big for my skull and it was going to blow—like a tea kettle releasing steam,” she said.

Finally, at age 41, Salinas got an official diagnosis: epilepsy, a brain disorder that causes repetitive, unprovoked seizures. But despite medication, Salinas’ seizures kept getting worse and occurred more often during the next decade. A neurologist said her only chance of relief was removing the seizure-causing brain matter. But the thought of someone cutting into her brain scared Salinas so much, she decided to just live with the seizures.

That was until a seizure in 2008 caused the 51-year-old to miss her mother’s funeral. Salinas was ready for surgery—and Saint Luke’s was ready to help.

The head of the matter

For eight days at Saint Luke’s Comprehensive Epilepsy Center, John Croom, M.D., Ph.D., put Salinas through a series of tests. He and Ron Fields, M.D., are the two epileptologists, or neurologists specializing in treating epilepsy, who practice at Saint Luke’s.

One of the tests, video electroencephalogram monitoring (vEEG), can show where seizures originate. Combined with information from a high-resolution MRI scan and other tests, the location of the seizures can be more precisely pinpointed. This allows the neurosurgeon to make precise cuts and avoid damaging healthy tissue. Unfortunately, these initial tests did not locate the origin of Salinas’ seizures.

Therefore, one final test was needed. A neurosurgeon placed a credit card-sized grid directly onto Salinas’ brain. The grid featured several tiny electrodes—each the size of a pencil tip—that recorded her brain activity. Meanwhile, an overhead camera captured her body movement. Based on this data, Dr. Croom created a map pinpointing which areas controlled Salinas’ speech and which caused seizures.

“We captured five seizures coming from her right temporal lobe,” recalled Dr. Croom. “This is a relatively safe area that isn’t near her language center.” On July 29, 2008, a neurosurgeon removed the right temporal lobe from Salinas’ brain. Two days later, she went home.

‘A new lease on life’

Since her brain surgery two years ago, Salinas hasn’t experienced a seizure. Although time will tell whether she’s completely seizure free, Salinas is learning to live normally once again.

“Epilepsy makes you feel purposeless and is very depressing,” she said. “I had lost all my energy.” Today, Salinas volunteers at a local school and lends a hand at a friend’s candy store in Independence. “I feel like everything has fallen into place,” said Salinas. “I have a new lease on life thanks to Saint Luke’s.”

Suffer no more

Kansas Citians who suffer from life-limiting seizures can find help locally and get back to living life faster

One out of every 100 people suffers from epilepsy. While 60 percent of patients can be treated with antiepileptic medications, others may require surgery for relief. But research shows that most patients suffer from seizures an average of 22 years before considering surgical options.

“We have the tools to help patients with seizures that are difficult to control, so they shouldn’t put off seeking help,” said Ron Fields, M.D., a neurologist specializing in treating epilepsy. “For those who suffer from epileptic seizures, we can provide a path to treatment that may transform their lives.”

Comprehensive care

Saint Luke’s offers patients a range of treatment options, including resective surgery, through the Kansas City area’s only adult Level 4 Comprehensive Epilepsy Center

For example, some patients may receive a vagal nerve stimulator. Similar to a pacemaker, doctors implant this small, flat disc — about the size of a half dollar — in the chest. Its wires travel up the neck to the vagus nerve, a major nerve leading to the brain, where it controls seizures with small electrical pulses.

Others may be candidates for resective surgery, which removes the brain matter causing seizures which can result in a cure. (See “Head Strong.”) Patients usually go home within a couple days and return to work a few weeks later. Many remain on medications for a couple of years, if not longer, as a precaution.

“I tell patients it’s not always an instant cure,” said Dr. Croom. “It’s like finishing one chapter of your life and beginning the next.”

The whole process—from testing to confirm a surgical candidate to postsurgical care—can take a year. Patients also receive evaluations from a neuropsychologist, social worker and psychologist.

Helping the masses

For many patients, the words “brain surgery” are terrifying. Yet, surgery can drastically change lives.

“I’ve seen patients who haven’t worked in years because their seizures were so severe,” said Dr. Fields. “But surgery can allow them to live a normal life again.”

Because up to 90 percent of patients are seizure-free after surgery, the Comprehensive Epilepsy Center staff is on a mission to educate the masses: Seek specialized help sooner. The National Association of Epilepsy Centers recommends patients seek advanced care if medication can’t control their seizures within three months (under a primary care physician’s care) and 12 months (under a general neurologist’s care). “State-of-the-art treatment is available right here in Kansas City” said Dr. Croom. “There are many patients with epilepsy who can benefit from the services we offer.”