J. Michael Desaloms, M.D., of Dallas Neurosurgical & Spine explained the causes and treatment of epilepsy in his keynote speech at the Spring 2010 Texas Health Research & Education Leadership Council Dinner and Program.
While Dr. Desaloms’ expertise covers a broad range of cerebral and spinal neurosurgery, he is recognized as one of the leading neurosurgical experts on the subject. He strives for new ways to further educate himself so he might better help patients with epilepsy – from comprehensive case conferences to National Institutes of Health (NIH) research studies – a recent one with Yale University.
Epilepsy is a disorder that results from the generation of electrical signals inside the brain, causing recurring seizures. Seizure symptoms vary. Some people with epilepsy might exhibit nothing more than a blank stare for a few seconds during a seizure, while others can lapse into a wild, thrashing movement or full-fledged convulsions.
“Hippocrates was the one who came up with the word seizures, because it ‘seized’ the individual,” Dr. Desaloms told the audience at the Winspear Opera House in Dallas on April 29th. “Julius Caesar is one of the most famous people who had epilepsy. There are lots of references to epilepsy in religion.”
As a result of its outward symptoms, epilepsy has often been misunderstood. Long ago, it was not uncommon for people to believe epilepsy was the result of demonic possession.
While medical science and education have dispelled those beliefs, the disease still carries negative connotations and misunderstanding. People with very high IQs who have epilepsy may be labeled slow or mentally unstable. Children with epilepsy often underachieve because of the stigma attached to the disease. Many with epilepsy can have their emotional well-being shaken by the fear of an upcoming attack and the lasting effects of stares from others.
“Anyone can have a seizure,” Dr. Desaloms said. “Low blood sugar can cause a seizure. Sleep deprivation can cause a seizure. An infection in the brain can cause a seizure. Seizures are electrical shortages that happen in the brain. You can have a seizure without being epileptic.
“You can have one seizure and not have another one the rest of your life. However, there are people who may have 10 seizures a day. And that can be totally debilitating.”
Dr. Desaloms cited the fact that epilepsy typically occurs in people during adolescence and the early 20s. As a result, it prevents them from getting their driver’s license, which can have long-reaching, life-altering consequences.
“All seizure disorders should be evaluated by a neurologist,” Dr. Desaloms said. “An electroencephalogram, or EEG, is the standard diagnostic study for an initial evaluation of epilepsy.”
Temporal lobe seizures are often resistant to antiseizure medications. Fortunately, because knowledge of the brain has increased, so have treatment options for seizures and epilepsy – from sleep lab studies to EEGs and from magnetic resonance imaging (MRI) and nuclear medicine testing to brain surgery. Today, patients with seizures or epilepsy have more options than ever before.
Frequently, positron emission tomography (PET) scans and single photon emission computed tomography (SPECT) scans are performed to evaluate the seizure focus. PET scans can help visualize active areas of the brain and can often show a diminished metabolism in a portion of the brain that is plagued by recurrent seizures. SPECT scans are often performed during a seizure as well as in between seizures.
“Sometimes it’s hard to localize where the seizure is coming from. Now, we can open up the brain, lay as many as 90 electrodes on their brain and see where the seizure started,” explained Dr. Desaloms.
While surgery carries inherent risks, the ability to reduce the effects of epilepsy by up to 95 percent is worth it for most people suffering from seizures.
Dr. Desaloms’ passion for improving the quality of life for his patients was clear. “Seizures can dominate and ruin a person’s life. Helping a person become seizure-free is life-changing. It may not be sexy medicine, but one of the most satisfying things I get from my patients will be a picture of their driver’s license.
“It represents normal life and freedom,” Dr. Desaloms concluded. “People are so grateful, and it’s an honor to get to treat these patients.”