A tool to improve lives
An innovative rating tool for surgery referral could improve the quality of life for people suffering from partial epilepsy.
Story by Laura Ly/Photo by Trudie Lee
When asked about her research and clinical work with epilepsy, Dr. Nathalie Jetté often recalls a particular patient. She tells the story of a man who suffered from seizures for several years before he was referred to her clinic. His seizures had initially been misdiagnosed as anxiety attacks. Within 12 hours of receiving treatment for epilepsy, the seizures had stopped. “I saw him about a week later, and he was radiant and energetic,” she remembers. “Since 70% of people respond to treatment, you can make such an impact in this area. It’s really fulfilling.”
Now Dr. Jetté’s research could help the other 30% of epilepsy patients: those who do not respond to medication. Many of these are people who suffer from partial or focal epilepsy, which is characterized by seizures originating from a particular part of the brain, most commonly from the temporal lobe. Surgery is a treatment option for those with this type of epilepsy who do not respond to medication. Yet some people suffer from incapacitating seizures for many years before being referred for surgery. Dr. Jetté is developing a rating tool to identify potential surgical candidates so that patients with partial epilepsy can be treated earlier and more effectively.
Since partial seizures originate from one specific part of the brain, removing that part has the potential to cure partial epilepsy. Although success rates can be as high as 60% to 90% for temporal lobe epilepsy and 40% to 60% for other partial epilepsies, surgery seems to be underused. Continued medication is the favoured treatment approach. Misconceptions about risks could explain the reluctance of patients and doctors to consider surgery. “People mistakenly see epilepsy surgery as a last-resort measure,” says Dr. Jetté.
In developing the rating tool, Dr. Jetté considered the benefits and risks of surgery, the frequency of partial epilepsy, and the long-term risks for patients who are treated with medication but continue to have seizures. She hopes the tool will better inform neurologists and other physicians about the risks and benefits of surgery so that patients can be referred earlier for treatment. “We don’t expect family physicians or general neurologists to decide whether patients should have surgery. The tool is to give them a little guidance, to show them that patients who fit certain profiles may be surgical candidates,” she says.
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| Dr. Nathalie Jetté (r) with one of her patients |
As an indication of whether or not patients should have surgery, the tool produces a rating calculated from a number of items of information: age, duration of epilepsy, seizure type, frequency of seizures, and the extent to which the seizures are disabling. Seizures are considered disabling if they cause injuries or other significant medical problems, or if they have serious psychosocial consequences. In children, seizures are also considered disabling if they interfere with development. The information also includes the number of drugs a patient has tried or is currently taking. For example, a patient may be seizure-free but suffering side effects from three different anti-epileptic drugs. The rating tool takes into consideration more than 3,000 possible patient scenarios.
The tool also considers the region of the brain where seizures occur. EEG and MRI scans of the brain help doctors determine where the seizures originate. Surgery is performed only if the relevant part of the brain is not essential for a critical task such as memory, language, or motor function.
The tool will soon be tested in clinics in Calgary and Saskatoon and will then be made available online for wider use. Dr. Jetté intends to summarize and simplify the rating tool information onto a single card for family doctors and other non-epilepsy specialists to use. The card could be available as early as 2010.
“By identifying those who may be candidates for surgery, not only can we reduce their seizure frequency, we can improve their quality of life and sense of independence,” says Dr. Jetté. “Studies show the sooner they have surgery, the better the success rate.”
As a clinician-scientist, Dr. Jetté applies her research in her practice to improve her treatment of patients. “I’ve completed some work with colleagues looking at the psychiatric conditions that can coexist with epilepsy. When I see patients in my clinic, I ask them about their mood and make sure they aren’t depressed or having anxiety attacks, because ultimately that is going to impact how I treat them. I can translate the knowledge from my research much faster and more efficiently in my clinic.”
Quick Facts
Surgery is a treatment option for patients with partial epilepsy who have not responded to medication. There are two main approaches:
- Surgeons remove or disconnect the area of the brain where the seizures originate (e.g., the temporal lobe)
- Surgeons place a device called a stimulator into a particular region of the brain, to stimulate the nerve pathways in an attempt to stop the seizures. This type of surgery is still experimental but preliminary results are promising.