SURGICAL APPROACHES TO EPILEPSY: WENDY’S CASE HISTORY
Tuesday, June 14th, 2011
Wendy had her first complex partial seizure when she was 13. Her initial evaluation, including a CT scan and EEG, revealed no cause, and medication was prescribed. Phenobarbital made her sleepy, and phenytoin (Dilantin) only slightly reduced the frequency of her seizures, now occurring three to four times a week. Carbamazepine (Tegretol) was added, and the seizures became less frequent. However, Wendy’s school work began to suffer while she was taking several medications, and she became depressed. At sixteen she couldn’t drive and because of embarrassment she became less social and more isolated. When she was eighteen, valproic acid (Depakene) became available, but despite attempts to adjust medication, her physicians were unable to completely control her seizures. By this time, Wendy’s school work had suffered and she had been turned down by the colleges of her choice. She was about to enter the local junior college.
When we first saw Wendy, she was a highly motivated young lady, depressed about the seizures and about her future. She had received psychological counseling, which had helped some, but the seizures—suddenly stopping what she was doing, staring, then wandering about the room, picking at her clothes, and remaining in a confused state for ten to fifteen minutes—were still occurring several times each week despite good levels of medication.
Our evaluation suggested that the seizures came from the right temporal lobe. Surgery was discussed, but Wendy, now twenty-two, was afraid. We worked with her, long distance, to adjust the medications, but she either had problems with drug toxicity or with seizure control. Nevertheless, she finished college and began a masters program in psychology. Finally she decided she was willing to have the surgery. Repeat evaluation suggested that the focus was in the anterior right temporal lobe. This was removed surgically and revealed “mesial temporal sclerosis,” an old scar that had not been visible on the scans.
Wendy has had no seizures in the past five years, has finished her Ph.D. in psychology, and says that life and her work are both much easier now without seizures and without any medication. “I only wish that we had done the surgery much earlier,” she says. “It would have made growing up so much easier.”
*149\208\8*
