Life, interrupted

By the time she sought treatment for epilepsy from UC Irvine Medical Center, the 41-year-old woman had suffered seizures for more than two decades. The frequency of the attacks – five a day – prevented her from working, shopping, driving, socializing and other ordinary activities. She seldom ventured outside her home.

Today, she has a new life thanks to an advanced brain surgery technique performed by Dr. Devin K. Binder, surgical director of the center’s Comprehensive Epilepsy Program. For the first time since she was a teenager, she’s seizure-free.

“She can go out socially. She’s thrilled,” says Binder. “That’s what it’s all about. It’s one thing to look at the statistics, but it’s the patients who bring the greatest satisfaction from this work.”

Binder is one of only a few neurosurgeons in the country trained to perform a state-of-the-art microsurgical procedure for epilepsy, which involves delicate dissection between the brain’s frontal and temporal lobes to selectively remove areas of the amygdala and hippocampus that trigger the attacks.

“Before this technique, the standard operation for epilepsy was a temporal lobectomy, which involves taking out all the overlying brain tissue. This is a real advance,” Binder says.

Of those who have the surgery, about 70 percent are seizure-free. (Without the surgery, this population of patients who don’t respond to anti-epileptic drugs have virtually no chance of being becoming seizure-free.) The other 15 percent of patients see a major reduction in seizures, and the rest show no change.

“We don’t pat ourselves on the back if we simply lower the number of seizures,” Binder says. “Quality of life is only helped if the patient becomes seizure-free. Being able to drive, to go back to work or to school – it’s all so important to who they are. It’s like they’re a new person.”

Those who have seizures are often shunned by society. One of Binder’s patients, a banker, was fired from his job after suffering an attack in front of a customer. His own son was afraid to be alone with him because of the seizures.

“After he had surgery, he came back to our office and cried tears of happiness because he could go out and be alone with his son. That’s real fulfillment.”

Binder’s first encounter with epilepsy began in fifth grade, when a friend began having seizures.

“To this day, I recall her seizing on the playground. No one knew what to do,” he says. “That’s when I began to wonder, ‘How can we prevent this?’”

He has dedicated his career to finding the answer, graduating from Harvard University and getting a doctorate and medical degree from Duke University in 1999. After his residency at UC San Francisco, he went to the University of Bonn on a fellowship and learned the surgical technique from Dr. Johannes Schramm – “the best epilepsy surgeon in the world.”

Since coming to UCI in August 2006, Binder has focused primarily on epilepsy and Parkinson’s disease, performing a deep brain stimulation surgery that reduces symptoms and restores movement. In the future, he’d like to see more patients who could benefit from epilepsy surgery visit the UCI Epilepsy Center to see if they could be helped by the procedure. The need is great.

“One percent of the U.S. population has epilepsy. That’s 3 million people, and about one-third don’t respond to medication,” he says. “There are a lot of patients who could be helped by this who aren’t getting through the system.

“The goal is for these patients and their physicians to become aware that modern surgical options are available to help them become seizure-free. With proper education and outreach, I’m confident the surgery will become more widespread,” he says. “What we do in the UCI Epilepsy Center directly impacts people’s lives in a positive way.”