After a Lifetime of Seizures, Patient Finds Relief

Growing up, while most kids were playing high school sports and getting their driver’s licenses, Michael’s epilepsy kept him sidelined. Since he was 12, seizures robbed him of a typical adolescence.

As an adult, he experienced as many as 14 seizures a month, even while on different antiseizure medications. He couldn’t work a full-time job and feared holding his infant grandchildren because of the risk of an ill-timed seizure.

“I just accepted that I was going to have seizures for the rest of my life,” says Michael.

At age 55, the seizures had become so bad that he sought help from the Epilepsy Foundation of Missouri and Kansas, a not-for-profit that provides programs, services, and resources for people living with epilepsy.

Michael was paired with an Epilepsy Foundation independent living coordinator, and they developed an action plan that included getting a second opinion about his diagnosis. It was recommended he seek care at Barnes-Jewish Hospital, where he met Brian Keith Day, MD, PhD, a WashU Medicine neurologist who specializes in epilepsy—and where Michael’s life began to transform.

A new chapter

Barnes-Jewish Hospital is a Level 4 Adult Epilepsy Center designated by the National Association of Epilepsy Centers (NAEC) for its commitment to providing patients with the most advanced and comprehensive treatment and care. This includes intensive neurodiagnostic monitoring, advanced imaging, neuropsychological testing, and comprehensive surgical evaluations. About 4% of hospitals in the United States are accredited as Level 4 centers by NAEC.

After reviewing Michael’s medical history and past testing, it was determined that he had left temporal lobe epilepsy, one of the most common forms of the condition. This meant his seizures originated from the left side of his brain above his ear, in a region responsible for memory and emotional processing.

Dr. Day recommended further testing in the Barnes-Jewish epilepsy monitoring unit (EMU), which uses the latest technology, such as a video EEG, which simultaneously records brain wave activity and physical actions.

The results confirmed Michael’s seizures were originating from the left temporal lobe near the middle of the brain. Dr. Day worked closely with his WashU Medicine colleagues across specialties to determine the best treatment option. Together, they recommended targeted brain surgery called left selective amygdalohippocampectomy.

“We know that one-third of patients with epilepsy do not fully respond to antiseizure medications,” Dr. Day says. “With these patients we always consider what more we can do.” 

Barnes-Jewish Hospital, with WashU Medicine physicians, was one of the first hospitals in the U.S. to regularly use brain surgery to treat patients with seizure disorders who were unresponsive to medications. The operation Dr. Day’s team offered would involve removing a small section of the skull to extract brain tissue in Michael's temporal lobe. Though this type of surgery is considered to be extremely safe, Michael was apprehensive. The thought of brain surgery made him uncomfortable. 

“He was concerned that brain surgery could make life more difficult for him,” Dr. Day says. “We went back to adjusting antiseizure medications for a few more years, but the seizures continued.”

The turning point

Several years later, during a routine clinic visit with Dr. Day, Michael began having a seizure that left him physically exhausted.

“When I came out of it, the first thing I thought was, ‘this has got to stop. I can’t keep doing this.’ That’s when I asked Dr. Day if I could still have surgery,” says Michael. 

Dr. Day explained to Michael that he was now a candidate for a different type of procedure called laser interstitial thermal therapy (LITT). In this minimally invasive surgery, a neurosurgeon makes a tiny hole in the skull and inserts a laser probe. The laser heats and destroys the seizure-causing tissue. 

While LITT is increasingly available at hospitals throughout the United States, Barnes-Jewish Hospital and WashU Medicine were among the first to combine LITT with interoperative magnetic resonance imaging (iMRI). This combination provides additional safety and precision and ensures the surgeon conserves healthy brain tissue. The approach is less invasive and offers a more comfortable patient experience.

Ready for the next step, Michael met with WashU Medicine neurosurgeon Eric Leuthardt, MD.

“Dr. Leuthardt went over the procedure and showed me a video of it,” says Michael. “He explained everything so that I understood it. After that, I told him, ‘Let’s go for it.’”

On the day of surgery, Michael's wife and daughter came with him to Barnes-Jewish Hospital.

“That was just an extra boost for me because I decided to have this operation for my family,” says Michael. “I wanted to be here for them.”

The operation went smoothly. Because LITT is minimally invasive, there is a shorter hospital stay for patients than for those who have traditional open brain surgery.  In Michael’s case, he was able to go home one day after surgery. After two weeks of rest, he was cleared to return to work part-time. 

A life transformed

It has been nearly seven years since Michael’s epilepsy surgery, and he has experienced only one seizure during that time. He’s also achieved multiple life goals: He became a full-time assistant manager at a grocery store, began riding a bike, proudly obtained a driver’s license, and feels very comfortable holding his great grandchild. 

“I just couldn’t give up,” says Michael. “I refused to let epilepsy defeat me. So much came into my life after that operation, and I’m just overjoyed.”

Michael continues to take antiseizure medication and follows up once a year with Dr. Day.

“Dr. Day is so supportive,” says Michael. “He makes sure his patients come first and that touches me deeply. He tells me if I need anything that he’s just a phone call away.” 

While surgery can have remarkable benefits, it is not always an absolute cure for seizures. 

“In most cases, there is a large epilepsy network in the brain that we can never fully address with surgery,” Dr. Day says. “We can only target important parts of that network with surgery and try to transform a seizure problem that does not respond to antiseizure medications into one that does.”

Dr. Day encourages people with drug-resistant epilepsy to make an appointment with an epileptologist and see their options.

“Like Michael, you may very well discover that you don’t have to live with seizures anymore,” Dr. Day says.

To make an appointment with a WashU Medicine epileptologist at Barnes-Jewish Hospital, call 866-867-3627.