Monitoring epilepsy

For epilepsy specialist Dr. Jack J. Lin, patient cases aren’t much more rewarding than Thomas Phelan’s. The Irvine teen’s mother had been seeking medical help since his staring spells prompted a preschool official to write him off as autistic, destined to live out his life in a group home.

Thomas was 16 when Renee Phelan – fed up with dueling diagnoses and medications that failed to control what had become grand mal seizures – turned to Lin at UC Irvine Healthcare’s nationally recognized epilepsy program. “He was the first doctor who really listened to me,” Renee Phelan says.

The neurologist did much more. He admitted the teenager to a state-of-the-art epilepsy monitoring unit at UC Irvine Medical Center in Orange for a week of highly sensitive imaging and scanning tests. He tracked the seizures into the very folds of Thomas’ brain where electrical storms raged through his neurons.

Epilepsy treatment has come a long way since potassium bromide, phenobarbital and high-fat, low-carb diets were used to try to control seizures. Yet today’s most advanced anti-convulsion drugs fail to help one-third of the estimated 2.7 million Americans who suffer from epilepsy, Lin says. Surgery and deep brain stimulation represent the next best hope.

That process begins with pinpointing the exact origin of the seizure using the array of non-invasive tests. Lin and colleagues offer sophisticated video-EEG monitoring, functional imaging and MRI scans through UCI’s Comprehensive Epilepsy Program, one of only 60 U.S. facilities designated as a fourth-level comprehensive epilepsy center by the National Association of Epilepsy Centers. Neurologists, neuroradiologists and neurosurgeons use the tests to analyze a patient’s seizures.

Thomas’ seizures were traced to a portion of both the parietal and temporal lobes, which process sensory information and memory. At that point, neurosurgeon Dr. Devin K. Binder inserted an array of electrodes into Thomas’ brain to map the misfires.

Some patients’ seizures involve brain tissue that cannot be removed without disabling them. For Thomas, Lin says, “That region of the brain did not have any motor or sensory function, so Dr. Binder was able to remove it without affecting Thomas’ ability to move or feel. Now Thomas is completely seizure-free. He is so happy.”

Thomas, 18, recently passed the math portion of California’s high school exam and is on target to graduate in June. “I feel really confident,” he says. “My goal is to graduate, get my driver’s license, and start college this fall. None of this would have been possible without Dr. Lin and all the doctors, nurses and ‘neurotechs’ who took care of me during my journey with epilepsy.”

Lin is pleased, not only because of Thomas’ improved quality of life, but because the epilepsy program soon will accommodate more than the 160 or so patients evaluated annually. When it opens in March, University Hospital will have six epilepsy monitoring beds – up from the current four – all equipped with the most sophisticated monitoring technology. Plans to add another two beds in about a year should make a considerable dent in a long waiting list of patients with uncontrollable epilepsy, Lin says.

Research underway at Orange County’s only university medical center is expected to lead to new therapies. Lin, for example, is studying the network of neurons that link the lobes of the brain.

“Our mission,” Lin says, “is to offer hope to people who have not had the chance to be seizure-free with standard medical treatment. Very few places do that.”