UPdate Summer 2011 : Page 1

Physician Referral Line To refer a patient for a clinic appointment (800) 877-7197 (573) 882-7000 Consults/Transfers/ Admissions Line To transfer, admit or request a phone consultation with a specialist (888) 884-MU-DOC UNIVERSITY PHYSICIANS / UNIVERSITY OF MISSOURI HEALTH CARE / SUMMER 2011 Epilepsy is caused when specifi c regions of the brain malfunction, such as shown with the parietal lobe in the illustration above. MU Health Care physicians can pinpoint the area causing epileptic seizures and treat the condition medically or surgically. Neurology and neurosurgery: Treating epilepsy pproximately 3 million people in the United States have epilepsy, and about three percent of the population will develop the disease by age 75. Approximately 300,000 people will experience their ﬁ rst seizure this year. For those with epilepsy, University of Missouri Health Care oﬀ ers central Missouri’s most comprehensive team of experts. Our multidisciplinary program includes fellowship-trained doctors who specialize in surgical and medical treatment options, as well as nurses, social workers and psychiatrists trained in caring for those with the neurological disease. Our doctors work with referring physicians to make a diagnosis, determine the cause of a patient’s seizures and recommend a treatment plan. Experts from a variety of disciplines meet A monthly to discuss speciﬁ c pediatric and adult patients and how best to treat them. To aid in diagnosis, University Hospital has a four-bed epilepsy monitoring area, where doctors can observe patients’ seizures and record brain activity during neurological events. rough monitoring, doctors can often determine the exact part of the brain that is seizing, which can help guide treatment options. David Lardizabal, MD, assistant professor of neurology, has been treating patients with epilepsy since 1996. He received fellowship training in epilepsy care at the Cleveland Clinic Foundation. Lardizabal said the medical therapies available to patients have improved signiﬁ cantly in the past two decades. “ ere is a new generation of anti-epileptic drugs that are more tolerable and have fewer side (continued on page 2) When to consider a referral Any epileptic patient who • has not responded to two or more drug therapies • has seizures of an unknown cause • is under age 18, especially infants and toddlers • has poorly controlled seizures • blacks out because of seizures • is looking for a second opinion • is interested in surgical options • wants to participate in a clinical trial

Neurology And Neurosurgery: Treating Epilepsy

Approximately 3 million people in the United States have epilepsy, and about three percent of the population will develop the disease by age 75. Approximately 300,000 people will experience their first seizure this year. For those with epilepsy, University of Missouri Health Care offers central Missouri’s most comprehensive team of experts. Our multidisciplinary program includes fellowship-trained doctors who specialize in surgical and medical treatment options, as well as nurses, social workers and psychiatrists trained in caring for those with the neurological disease. Our doctors work with referring physicians to make a diagnosis, determine the cause of a patient’s seizures and recommend a treatment plan. Experts from a variety of disciplines meet Monthly to discuss specific pediatric and adult patients and how best to treat them. To aid in diagnosis, University Hospital has a four-bed epilepsy monitoring area, where doctors can observe patients’ seizures and record brain activity during neurological events. rough monitoring, doctors can often determine the exact part of the brain that is seizing, which can help guide treatment options. David Lardizabal, MD, assistant professor of neurology, has been treating patients with epilepsy since 1996. He received fellowship training in epilepsy care at the Cleveland Clinic Foundation. Lardizabal said the medical therapies available to patients have improved significantly in the past two decades. “There is a new generation of anti-epileptic drugs that are more tolerable and have fewer side Effects,” said Lardizabal, who said there are more than 20 anti-epileptic drugs available today.“Patients have more options now.” Lardizabal said he is cognizant of a patient’s ability to pay when writing prescriptions.Because some medications have been around for decades, they are available at little cost. In addition to medical therapies, diet changes are recommended for some patients.Some epileptics respond to a modified diet that limits carbohydrates. Lardizabal said the multidisciplinary team is important because epilepsy touches so many aspects of a patient’s life. Also, about 75 percent of epileptics have other mental health issues, such as depression and anxiety. At MU Health Care, a team of specialists can diagnose and help treat comorbid conditions as well. About 10 percent of epileptic patients are candidates for surgery. Neurosurgeon N. Scott Litofsky, MD, professor of surgery and director of the Division of Neurological Surgery, and pediatric neurosurgeon Tomoko Tanaka, MD, assistant professor of surgery, perform such operations. Litofsky said surgical intervention can provide immediate, life-changing results for some types of patients. Those eligible for surgery include patients for whom various drug therapies have been ineffective and patients who have seizures in a defined area of the brain that is operable — typically in the temporal lobe. A combination of magnetic resonance imaging (MRI) scans, positron emission tomography (PET) and neuropsychological testing can help pinpoint the source of electrical abnormalities in the brain that cause a patient to have a seizure. If located in an operable part of the brain — that is, an area where memory, speech or movement would be not significantly affected— the patient could be a candidate for surgery. “We’re like investigators, trying to find where the problem is and what’s causing it,” Lardizabal said. During the procedure, the neurosurgeon removes the portion of the brain where seizures occur. Infants and toddlers can often benefit the most from surgery because their brains are still developing and can compensate for any functional brain loss. About 80 percent of patients stop having seizures after the surgery, and half can discontinue all epileptic drug therapies. Many patients experience debilitating effects from persistent seizures, and even as side effects from the medications they take to control their seizures. Some patients can return to a normal life in as little time as a week, Litofsky said. “One of my colleagues described an 8-yearold patient who had frequent, severe seizures and was struggling academically,” Litofsky said.“After surgery, the patient went onto become an honors student, ultimately becoming a Rhodes Scholar and attending Cambridge University. “Surgery to correct epilepsy can be a great operation if you are a good candidate,” he said. For adult candidates, the surgery can allow patients to resume activities such as driving and working. In some cases, the causes of epilepsy are event-driven, stemming from an illness or an accident such as a fall or gunshot wound. Some cases of epilepsy are related to small, slowgrowing brain tumors. However, the majority of cases are idiopathic, meaning there is no known cause for the disease. Lardizabal and Litofsky expressed the Importance of referring patients as soon as possible. Especially in children, early interventions can ensure the patient is on the most appropriate medication. e child can also be evaluated for surgery, preventing a lifetime of enduring epilepsy. To refer a patient or confer with one of our epilepsy experts, please call (573) 882-1515. When to consider a referral Any epileptic patient who • has not responded to two or more drug therapies • has seizures of an unknown cause • is under age 18, especially infants and toddlers • has poorly controlled seizures • blacks out because of seizures • is looking for a second opinion • is interested in surgical options • wants to participate in a clinical trial

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