Patients and staff of the Comprehensive Epilepsy Center at Dartmouth-Hitchcock Medical Center are celebrating the second anniversary of the highly successful unit this fall.
Over the past two years, the epilepsy program at the DHMC has grown into one of the top epilepsy centers in the country, treating nearly 250 patients, some of whom have been referred by other renowned epilepsy centers.
Originally set up to serve the northern New England region, the Epilepsy Center has attracted patients from across the nation and abroad because of the remarkable success of the center's team of surgeons.
Sixteen-year-old Michael Stephenson from LaPaz, Bolivia, is one of the program's recent success stories. His parents brought him to the DHMC after years of unsuccessful treatment at another American epilepsy center.
Stephenson, an intercranial patient, underwent extensive evaluation before the diseased part of his brain could be completely mapped.
On January 4, 1993 Roberts removed the diseased section of Michael's brain.
Two weeks after surgery, Stephenson had a brief seizure. In the nine months since then, he has had no other seizures.
"Our lives have changed completely," said Stephenson's mother. "We go out as a family now. Before, we isolated ourselves. Michael's negative attitude has improved dramatically and he is not as irritable as he used to be."
The epilepsy staff at the DHMC has developed a comprehensive program to evaluate and treat patients with epilepsy, said Dr. Peter Williamson '58, director of the center.
"We were able to hit the ground running when we started up the program here because we have a very experienced staff of professionals who work cohesively as a team," Williamson said.
Although the epilepsy staff at the DHMC has achieved successful results in treating epilepsy through the use of medicines, the basis of their program is its strong surgical intervention component, Williamson said.
In 1971, treatment of epilepsy began at the DHMC with the late Dartmouth neurosurgeon Dr. Donald Wilson, who pioneered the process of severing the connection between the two halves of the brain to help treat epilepsy.
This procedure, called palliative or split-brain surgery, eases the severity of epileptic seizures but is usually not a cure.
Over the past 23 years, Williamson has worked to improve upon these results through resective surgery, which involves the removal of the diseased brain tissue causing the epileptic seizures. The goal of resective surgery is to cure the patient of the condition.
In the first year of the DHMC's epilepsy program, neurosurgeons performed 26 epileptic surgeries -- about two surgeries per month compared to less than one per year in the previous decade.
"Many physicians, including practicing neurologists, do not appreciate the potential enormous benefits of epilepsy surgery," Williamson said. "Furthermore, the risks, which are minimal, are often exaggerated."
Williamson, a neurologist who developed the Yale Epilepsy Surgery Program, specializes in the pre-surgical evaluation and medical management of patients. DHMC recruited him from Yale two years ago.
His colleagues in the epilepsy program include Dr. Vijay Thandani, also from Yale; Dr. Richard Nordgren, a pediatric neurologist who has been with the DHMC since 1972; Dr. Alexander Reeves, a neurologist with the DHMC since 1971; and Dr. David Roberts, a neurosurgeon who has worked there since 1982.
The Epilepsy Center is also staffed by Karen Gilvert, the program clinical coordinator and Mark Natola, the program computer technologist.
In addition to the experienced medical and surgical staff, the center is equipped with two state-of-the-art computerized monitoring systems that record brain waves while simultaneously videotaping the patient during seizures.
The computer evaluation involves the placement of electrodes inside the skull over the surface of the brain. The electrodes localize the region of the brain in which the seizures originate, and the computer records this data.
Physicians can then play back the seizure and find the part of the brain it originated from.
The program treats two intercranial patients a month, Williamson said. The center treats eight to 10 patients per month.
Since the beginning of the program, the machines have been running 24 hours each day. They are at the heart of the entire operation and are a vital bridge to successful treatment, Williamson said.
The key to the success of this type of surgery is the selection of patients for the procedure and correct diagnosis, Williamson said.
"Of the over 200 patients that we have seen in the past two years, we have found 20 percent to be misdiagnosed," Williamson said.
In addition to correct diagnosis, it is important to locate the region of the brain responsible for seizure origin as precisely as possible, Williamson said.
"We are working to get the evil part of the brain out," he said.
Of the 17 resective surgeries that Williamson and his staff have completed to date, 16 patients have remained seizure-free as a result of the procedure.
These facts have made Williamson optimistic for the future of these patients and the procedure.
"As I speak we are working toward a second operation that we predict will convert the 17th patient and insure complete success," Williamson said.
However, Williamson emphasized that the duration of follow-up to the procedure is still short for many of these patients, as the program has only existed for two years.
