Controlling Seizures, Improving Lives

Forty-two year-old Jeffrey Shriner of Fairfax, Virginia began experiencing seizures as the result of epilepsy when he was around 20 years of age. The seizures he suffered came on mostly as he slept, sometimes as many as five a night, waking him, his wife and family.

November 22, 2011

MedStar Georgetown’s Comprehensive Epilepsy Center Tackles Toughest Cases with Medication, Monitoring, Brain Mapping and Surgery

(Washington, D.C.) – Forty-two year-old Jeffrey Shriner of Fairfax, Virginia began experiencing seizures as the result of epilepsy when he was around 20 years of age. The seizures he suffered came on mostly as he slept, sometimes as many as five a night, waking him, his wife and family.

“In the beginning I was told I had so many different things, Tourette’s syndrome, panic attacks, sleep apnea. Finally I got the correct diagnosis of epilepsy,” said Jeffrey Shriner. “Medications did not work for me and it affected every part of my life. I couldn’t hold down a job for very long because it affected the duties I could perform and I’d be let go. I couldn’t drive; I couldn’t take my kids places. My seizures were so violent at times that my wife and I couldn’t sleep in the same bed. Socially, I never felt normal. I knew the seizures could pop up at any time.”

“From my perspective it was hard to watch someone I love go through the seizures all night,” said Shawna Shriner, Jeffrey’s wife. “As time went on, he started having some seizures in the daytime as well as at night.”

“A seizure is a strong surge of electrical activity in the brain that can result in a change in movement, sensation, experience or consciousness. Seizures can last from a few seconds to a few minutes and can be mild or may result in convulsions,” said William Bell, MD, a neurologist and director of the Comprehensive Epilepsy Center at Georgetown University Hospital. “Epilepsy is a chronic neurological condition that is diagnosed when a person experiences two or more unprovoked seizures and it can affect a person’s ability to function both physically and mentally.”

In 2010 Jeffrey sought out the opinion of the team of neurologists at Georgetown University Hospital’s Epilepsy Center, where doctors explored with him the possibility of a surgical treatment for epilepsy.

“About two thirds of patients with epilepsy respond to medications,” said Gholam Motamedi, MD, Jeffrey’s neurologist at Georgetown and epilepsy specialist. “But one third of patients will continue to have seizures even with the medication. For those people, surgery might be an option. To find out if they are a candidate for surgery we start with our epilepsy monitoring unit (EMU) where we watch them over a period of time and record when they’re having seizures. This will help us determine the area of the brain where the seizures come from. After this step many patients might be eligible for surgery, after a few other outpatient tests like MRI are also completed. However, in some patients when the seizure onset area remains unclear, the next step would be to place electrodes on the brain, a surgical procedure. Again, we record the seizures and pinpoint the seizure focus and then perform brain mapping to find the areas of the brain that control speech and motor. That way, the seizure focus can be taken out with surgery safely.”

“When they proposed the idea of the surgery to me, I was really ready for it,” said Jeffrey. I felt I had nothing to lose. I didn’t want to live the way I was living and I was ready for a change if I was an appropriate candidate.”

“Epilepsy surgery involves trying to target the precise area of the brain where seizures are coming from, and then performing a targeted surgical procedure to remove those areas of the brain to minimize the seizure activity,” said Christopher Kalhorn, MD, Jeffrey’s neurosurgeon at Georgetown.

Jeffrey was monitored in Georgetown’s EMU, where clinicians monitored his seizures. The information gained from the EMU was used to perform Jeffrey’s brain mapping and then, the final step, the surgery to remove the seizure focus in his brain, was performed in November 2010 by Dr. Kalhorn. Jeffrey has been seizure free since then.

“It’s a miracle,” said Jeffrey. “I never thought it was possible to be seizure free. Now I’m back to work, I’m driving and I can do things for my kids now.”

“Patients will generally take four weeks to recover from the surgery,” said Dr. Kalhorn. “They might have some pain at their incision which we can handle with oral pain medications, and patients might be slightly fatigued. We often see immediate improvement with seizure activity after the surgery. Some patients might have one or two seizures after surgery but that doesn’t mean they won’t become seizure free. We usually continue medications for one year after the surgery and if they’re stable, we’ll gradually wean them off the medications so they can be seizure-free and medication-free at the same time.”

“It’s like night and day now how different life is for us,” said Shawna Shriner. “Such simple things as we went to the beach this past summer and Jeff actually drove. He can help with the kids now and things that make life easier for all of us. It’s those little things I’m thankful for.”

“We’ve seen people resume normal activities of their life. For this reason it’s the most gratifying surgery I perform,” said Dr. Kalhorn.

“To anyone else facing this and pondering surgery, I want to say that it is possible to get better. I didn’t believe it, but here I am seizure free.”

The Centers for Disease Control and Prevention reports that about two million Americans have epilepsy, which accounts for $15.5 million in direct and indirect costs each year. The CDC estimates that ten percent of Americans will experience a seizure sometime in their lifetime.

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