Blog #145: Epilepsy Patient Passes Driving Test After Brain Surgery

  

Several of my previous 144 monthly blogs on LanceFogan.com dealt with brain surgery as a chance to improve, or even cure, epilepsy in those whose epilepsy is poorly controlled. (See Blog # 89 December 26, 2017: Surgical Removal of Seizure Foci in Your Brain to Cure Poorly Controlled Epilepsy is Safe!; Blog # 101 February 26, 2019: Epilepsy—Fit to Drive?; Blog # 114 January 26, 2020: Epilepsy Surgery in Childhood and Long-Term Employment Is Encouraging.; Blog # 121 August 25, 2020: If Your Seizures Aren’t Controlled Epilepsy Surgery Is Safe and Really Can Help).

 

The greatest chance to cure your uncontrolled epilepsy is by successfully removing the seizure focus surgically.

My clinical experience has shown that there is so much that can physically alter the brain anatomically by surgery and by unintended trauma that surprisingly results in undetectable, or barely detectable, changes in a patient’s mental and physical capabilities. I have examined people who have been shot in the head, the bullet entering one side traversing through parts of the brain and exiting the other side of the head sparing sensitive brain areas. When neurosurgeons and neurologists perform specialized types of EEGs and imaging scans anticipating epilepsy surgery, sensitive parts of the brain can be identified and avoided.

The BBC on-line service recently reported that a man with epilepsy says he finally has independence. A surgical procedure removed his epilepsy focus and he then was able to pass his driving test.¹ The 40-year-old man had the brain operation eight years ago. Government rules meant the computer programmer from Birmingham was unable to take his driving test unless he was seizure-free for two years. But twice since learning to drive he had a seizure, setting him back each time and then Coronavirus lockdowns led to further delays. But eventually he was able to take the test and since passing, plans to take his young family on regular camping trips.

The man said he never thought he would be able to drive after living with epilepsy since childhood. But he underwent lesion resection, which involved inserting electrodes into his brain to detect electrical activity and carefully removing abnormal tissue.

Discuss possible epilepsy surgery with your neurological caregivers.

 

1)    Epilepsy Patient Passes Driving Test After Complex Surgery. https://www.bbc.com/news/uk-england-birmingham-62568014. Aug 16, 2022.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

 

 

 

 

 

 

 

 

 

   

 

Blog #89: Surgical Removal of Seizure Foci in Your Brain to Cure Poorly Controlled Epilepsy is Safe!

            Only half of people with epilepsy are seizure-free even if they are taking the best anticonvulsant in the correct dosage for them. This “best” regimen is usually a trial and error exercise. Another 30 percent of patients find that anticonvulsant medications improve their seizure control but not completely. Another 20 percent do not respond at all to anticonvulsants and experience frequent seizures.

            Children and adults that undergo surgery to treat their poorly controlled epilepsy can find it to be life-changing. Anticonvulsant dosages and drug side-effects can diminish―the medications may even be stopped completely. Patients then feel confident to be alone at home and may even safely drive vehicles. What may surprise people is that brain surgery causes few or no observable side-effects and can lead to improved quality of life. IQ, too, is little, if at all, affected by surgery, and the surgery has been found to have less effect on IQ compared to those only treated with long-term medical therapy. Dan Hurley reviewed this topic in, “Surgery for Pediatric Epilepsy Found to Have Better Outcomes than Medication Management Alone” in Neurology Today, December 7, 2017, page 17-18.

            One patient told her personal story in Neurology Now, December 2017-January 2018, page 38. She developed convulsions at age 31. Anticonvulsant medications helped but she still averaged 3-4 seizures per month. Her job as a nursing assistant ended because of the danger her epilepsy posed working with her patients. MRI, EEG and neurological evaluations with further testing suggested her seizures originated in a part of her brain that epileptologists and epilepsy neurosurgeons felt confident that its removal could lessen her seizures or even make her seizure-free. Following her right temporal lobectomy she reported that she has been free of seizures for six years. She is still on medication but at a lower dose. She advocates for her treatment by speaking to patient groups considering surgery.

            If uncontrolled epilepsy is your experience you should definitely consider the surgical option. As scary as it sounds, this treatment has been time-tested over decades. The neurological community finds this life-changing option is under-utilized. Discuss this possible treatment with your neurologist. If testing shows that you would be a good candidate, you will probably wonder why it was not recommended before or why you hesitated for so long.

            Epilepsy centers that perform this surgery are available throughout the United States and the developed world. If your neurologist believes that you would be a candidate, ask for a referral.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft-cover editions.

Blog #74: New Studies Reveal High SUDEP Risk of Death in Poorly Controlled Epilepsy

 

     SUDEP (Sudden Unexplained Death in Epilepsy) is not rare. These individuals with epilepsy are found dead without evidence of having had an associated convulsion, i.e., there is no sign of incontinence or tongue biting or thrashing.

    New studies reveal sudden death is more common, dangerously more common, than previously thought. One-third of people with epilepsy continue to have some seizures despite adequate treatment with antiseizure medications. These individuals’ epilepsy is referred to as “poorly controlled” or “uncontrolled” epilepsy. Their risk each year of SUDEP is 1/150. The risk is particularly high in those whose uncontrolled seizures are the tonic-clonic type. Among epilepsy patients whose seizures are well-controlled, i.e., no seizures while on treatment have a risk of SUDEP incidence of 1/1000. ¹             

      What should you do to lessen your risk of SUDEP? Take your medications as prescribed to hopefully decrease the likelihood of having a seizure as it’s more common among those with poorly controlled tonic-clinicepilepsy. Discuss SUDEP with your doctor. You may have to bring up the subject as many physicians are hesitant to discuss possible “bad” news.

      For more information about SUDEP I invite you to read my blogs at LanceFogan.com, titled:  #13: Sudden Unexpected Death During Seizures; #30: Should Doctors Discuss SUDEP with Epilepsy Patients? #57: Sleeping on Your Stomach Increases Risk of SUDEP; and #68: Epilepsy, Risks to a Long Life and Mortality.

1) LJ Hirsch, EJ Donner, EL So, et. al. Abbreviated report of the NIH/NINDS workshop on sudden unexpected death in epilepsy. Neurology 2011: 76 1932-1938

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.