Epilepsy: Sandy's Story

Transformative Treatment for Epilepsy: Sandy's Story Sandy Sinclair
Following multiple brain surgeries, Sandy Sinclair gains independence

"I've had epilepsy since I was 13 years old," says Sandy Sinclair, now 36. "Medications had not worked for me, and over time the seizures had gotten worse and become more frequent."

Of the nearly 3 million Americans who have epilepsy, almost 1 in 3 experiences seizures that cannot be controlled by medications. Holy Cross Hospital has a full-service epilepsy program that offers long-term relief to those patients.

Sandy's severe epilepsy was treated with two separate, planned epilepsy surgeries under the direction of Gregory Mathews, MD, neurologist, Holy Cross Hospital. James Leiphart, MD, is the neurosurgeon who performed these surgeries.

Sandy was an ideal epilepsy patient for the surgery. Pavel Klein, MD, a Holy Cross Hospital neurologist with specialty training in epilepsy, also known as an epileptologist, explains, "Her seizures could not be controlled by medication, and they originated from one specific location of her brain-and that portion of her brain could be removed without impairing her ability to function."

Better control of debilitating seizures requires a two-step approach. First, a team of neurologists pinpoints the precise place, or places, in the brain where seizures originate. Second, a neurosurgeon removes that part of the brain under the direction of the neurologists.

"Every case is totally different," Dr. Mathews says. "Each epilepsy patient experiences a unique pattern of seizure activity. We have to find the exact places where the seizures originate and remove those areas without causing functional impairment."

Successful epilepsy surgery markedly reduces or even eliminates seizures and may allow patients to stop taking anti-epilepsy medications. In the past, Sandy had experienced up to 13 seizures a month. Since her surgery in December 2010, she has had only one.

"It will take up to two years before we know if her surgery has completely eliminated her seizures," Dr. Mathews says. Patients are considered seizure-free when they have gone a full year without a seizure.

Brain Mapping
When the areas responsible for seizures are located close to the surface of the brain the area can be identified by placing electrodes on the patient's head while an electroencephalogram (EEG) measures seizure activity and pinpoints the exact sites of origin.

But when the origin is located deep in the brain, it is much more difficult to pinpoint. This calls for two trips to the operating room. During the first surgery, the neurosurgeon opens the skull and the neurologist places electrodes on top of the brain. Alternatively, the neurosurgeon can drill holes in the skull so the neurologist can place strips of electrodes along each side of the brain.

Then the neurosurgeon closes the incision or holes, and the patient goes to Holy Cross Hospital's Neuro Critical Care Unit for monitoring. During the next five to seven days, an EEG records the patient's seizure activity.

"We map the brain to find out where seizures come from," Dr. Mathews explains. "We have to make sure we can remove those areas safely without compromising major functions."

Then the patient goes back to the operating room, and the neurosurgeon removes the parts of the brain that have been identified.

"More and more we are finding that patients with well-controlled or less severe epilepsy are opting for surgical treatment so they can avoid a lifetime of epilepsy medication," Dr. Mathews says.

To learn more about our epilepsy program, call 301-754-8266 or click here.

To find a physician, call 301-754-8800.

This article appeared in the Spring/Summer 2011 issue of Holy Cross Health.