An innovative surgical intervention creates a new pathway for managing seizures
Two years ago, when David Haughee was 24 years old, friends began telling him he was “spacing out.” David himself had not noticed anything different. Then, seemingly without warning, he experienced a “big, explosive seizure that made everyone take note,” he says, and David sought medical attention. As it turned out, those earlier episodes of fading in and out were indicative of complex partial seizures.
Though the word “seizure” typically conjures thoughts of uncontrollable jerking and loss of consciousness, partial seizures may not necessarily be associated with those outward signs. Nevertheless, they require attention.
David was referred to a general neurologist. But after being tried on several conventional antiseizure medications (AEDs) without much benefit, he was referred to an epilepsy specialist. That is when he met Jeffrey Politsky, MD, FRCP(C), medical director of the Atlantic Neuroscience Institute’s Comprehensive Epilepsy & Brain Mapping Program for Overlook Medical Center. Because seizures may arise from a single spot in the brain (which, if necessary, may be removed surgically), Dr. Politsky recommended a thorough evaluation, including continuous video-EEG, to record David’s seizures and to determine where in his brain they were coming from. David was also sent for an MRI, magnetoencephalogram (MEG), a PET scan, and ultimately surgical implantation of electrodes on the brain’s surface. Once testing confirmed that seizures were originating in multiple locations, Dr. Politsky recommended the responsive neurostimulation (RNS®) system by NeuroPace.
The RNS system consists of a small implantable neurostimulator connected to two small electrodes implanted in the brain. These electrodes record seizure activity and then deliver a pulse of stimulation back to the brain to interrupt the seizure, keeping it from spreading beyond its origin. Much like a pacemaker that monitors and responds to heart rhythms, RNS monitors and responds to brain activity. In other words, explains neurosurgeon Ronald Benitez, MD, chief of endovascular neurosurgery for Overlook Medical Center, RNS “short-circuits the short circuits that cause seizure activity. Surgical treatment of epilepsy, including the RNS system, is most effective early in the disease, before seizure patterns become hardwired,” he adds.
RNS is a multistep procedure. First up: implanting electrodes pinpointing the locations where seizures are originating.
In April, David had electrodes implanted by Dr. Benitez at Overlook. (He enjoys relating that the procedure was scheduled for Friday the 13th. “When I told that to people, they were like, ‘You’ve got to be kidding!’” he says. “I tend to be silly and sarcastic, so they thought I was kidding and said I shouldn’t make jokes like that. But it was no joke!”) He was bedridden for nearly two weeks as the electrodes captured his brain activity.
Though David describes this process as stressful and often uncomfortable, he credits the hospital’s nurses and volunteers for helping him through this time. “Everyone was fantastic and easy to work with,” he says. “My needs were instantaneously taken care of.” The sitters at David’s bedside who watched for external signs of seizure activity “weren’t just sitting in a chair, waiting for something bad to happen. They were all remarkably kind and open and nice, and it was comforting to know someone was there.”
He credits Drs. Benitez and Politsky also. “They take great interest in every patient. They try to figure out who each person is, how they are handling their situation, and what they understand. You know everything that is going to happen before it happens. They both spent a lot of time with me.”
In June, David underwent the next step of the RNS process. He was scheduled for a brief two-day admission during which time, under Dr. Benitez’s care, the RNS device was permanently implanted into his brain. “I get to be a cyborg now,” he says with his trademark humor. “That’s pretty cool!”
One month after the device was implanted, he returned to see Dr. Politsky and his epilepsy team along with the folks from NeuroPace to have the RNS system fine-tuned. All David has to do at home is wirelessly collect information from the neurostimulator and transfer it to the patient data management system. Since the device was implanted, David has reported no seizures – that’s even cooler.