Episode 6 features Dr. Tyson Burghardt, Neurologist at Michigan State University, talking about the treatments for epilepsy and the role of the Epilepsy Monitoring Unit (EMU) is in managing it.
Transcription:
Deborah Howell (Host): Welcome to Sparrow speaks the podcast with the latest health news and information from Sparrow mid Michigan's premier community health care leader.
I'm your host, Deborah Howell. And today we'll be talking about epilepsy and the Sparrow epilepsy monitoring unit.
our guest is Dr. Tyson Burkhart, epileptologist, and associate professor at Michigan state university.
Host: Welcome Dr. Burghardt. What is epilepsy? And can it be treated with medicine?
Dr. Burghardt: Epilepsy is the name for a number of different disorders or diseases in which people have epileptic seizures, which sounds like a little bit of a circular argument. But epileptic seizures themselves, can happen even when people don't have epilepsy. So, it is a distinction that we tend to make. But it's the name for a group of disorders in which people will continue to have seizures basically out of the blue, with no necessary provocation, unless they are treated. And so medication treatment in fact, is the backbone of the way that we treat epilepsy.
Host: Very interesting. I did not know that you could have epileptic seizures without having the disease, you learn something every day. What's an EMU? And how does it run?
Dr. Burghardt: An EMU is an Epilepsy Monitoring Unit. And there are units like this all over the country, hundreds of them. So, they sometimes have different names of video EEG monitoring units, or video monitoring units or something that. And these are places where we admit patients into the hospital with the express goal of watching them have seizures, which sounds very counterintuitive. Usually people go to the hospital because they've had seizures and we don't want people to have seizures. And we're doing all of our very best to stop people from having seizures, but in an Epilepsy Monitoring Unit, our goals are often to precisely define just where in a person's brain, the seizures are coming from, or to see if the kind of weird tic or odd behavior that a person has, really is an epileptic seizure, or if it's due to another medical condition, since there are lots of imitators out there.
Host: Sure. And what's the EMU's role in managing patients with epilepsy?
Dr. Burghardt: One of the main roles is, that we can define the area of onset for epileptic seizures. Although, most people who have epilepsy can be successfully controlled with medications alone. And that's about two out of every three people with the disease. That still leaves one third of all folks with epilepsy, continuing to have at least some seizures, even despite being on two, three or more anti-seizure medications at a time. For these folks, the best possible outcome, at least for seizure control comes from figuring out whether they would qualify for surgical treatment and surgical treatment scares a lot of people. A lot of my patients are very, very trepidatious at first. They don't want anyone cutting on their brains, but surgical treatment has cure rates in some folks, certain types of epilepsy, cure rates of up to 75%. So, it can be an extraordinarily effective way to gain control of seizures, precisely in that population of people who we can't otherwise get control of their seizures at all. And so as one of the preliminary steps towards getting people, to the operating suite, if that's what's going to end up benefiting them the best, we need to define where the seizures are coming from. And so by watching people have their seizures. And of course, I don't mean just standing there at the bedside, watching them and pointing, we're recording continuously, both audio and video, as well as recording their brainwaves, what we call, the electroencephalogram or EEG, but most people will understand it as brainwave recording. And when people have epileptic seizures, their brainwaves are going to give off particular patterns and the location of those brainwave changes over the entire head as we measure them, are very strong clues as to where the seizures are erupting.
Host: So, that's your map. That's your guide?
Dr. Burghardt: It very much is. Among folks who do epilepsy surgery, quite a lot, they talk about something called the anatmoelectro clinical hypothesis. And it won't even fit on one line of a page of text. But one third of that, right? So, you've got your MRI and your CT, you've got the scans and you got your history and physical and history is still bedrock just like it is with medicine in general, but fully one-third of that is electrically figuring out how the seizures begin and how they propagate across the brain. And so it absolutely is a map.
Host: Yeah, well, you're absolutely right. That epilepsy surgery does sound a little scary. So, what are the steps for a patient before deciding on surgery?
Dr. Burghardt: Number one, of course, surgery is offered almost entirely to folks who have forms of epilepsy that are not completely treatable with medication. So, two out of every three people with epilepsy, this won't even come up. For those, for whom it does come up, they need to speak with their doctor, their neurologist in particular, about what exactly can and can't be done. They need to know the risks in and out. And they need to know all the steps that preceed the surgery. I tell my patients, for instance, when I first broach the subject, like I'm not wheeling you to the or tomorrow, there are steps ahead of this and some of these diagnostic steps, some of these tests that we're going to do might in fact, rule you out as a person who would benefit from surgery.
So, there's a little bit of a road to go to, and that's what patients need to know first and foremost. They should also be asking about the experience of the neurologist who's helping to guide them through this process. Although seizures are very common and epilepsy is comparatively a common disease, it affects approximately one half of 1% of the entire world. There are relatively few physicians who really specialize in it and most neurologists can treat seizures and epilepsy pretty good. But even among neurologists, there's a sub-specialty, Epileptology, in which people understand the disease better than anyone else. And people understand what you can expect as positive results from surgical procedures, what to look out for as possible negatives, who might benefit and in what kinds of procedures might be most salutary.
So, if a patient is still seeing a general neurologist and I have all the love in the world for general neurologists, they're my colleagues. They're my friends. If they are still having seizures, despite using more than two different anti-seizure meds, even if it's been one after the other, they should probably be seeing a subspecialist, Epileptologist.
Host: Got it. It's a huge decision to make I'm sure. Now are there other surgical options available?
Dr. Burghardt: It's expanded quite a bit. The main thing that could be done for most folks, let's say in the 1980s, would have been removing one of the temporal lobes. The temporal lobes are pieces of the brain that are on either side, they're right by where your temple is. Hence the name and temporal lobe epilepsy, epilepsy whose seizures begin in the temporal lobes is a relatively common, subtype of epilepsy. And so this was pretty commonly done, all through the eighties and nineties. And it's still done today. It's a relatively simple procedure as far as brain surgery goes and it has really good outcomes, but not everyone has seizures coming from their temporal lobes.
And nowadays, neurosurgeons have perfected techniques that allow them to take out very focal parts of brain that are causing all the ruckus, so to speak, and Epileptologists and Neurophysiologists, sort of, an overlapping discipline in which we use electricity and brainwaves to help diagnose disease, we've developed techniques to be able to help find those very focal areas of brain that are to blame and also to figure out what parts of the brain around it might be vital for normal everyday function, the sorts of brain that you absolutely should not remove, because you can't just glue it back in when you're done.
Host: How can the EMU help a person in making that huge decision?
Dr. Burghardt: The EMU helps because although the majority people with epilepsy have seizures, which begin in one, or maybe just a small handful of spots in their brain, around one in seven people with epilepsy have what's called primary generalized epilepsy. And in that type of epilepsy, the seizures begin all over the brain all at once and the only real surgical treatment, at least before we had some of the newer neurostimulators that we have nowadays, the only real surgical treatment you could do was remove the entire brain, which would, would generally make you a poor conversationalist, among other things.
So, it's important number one, so that we can classify who has generalized and who has focal epilepsy. It can help us figure out does this person seem to have one area of the brain that's generating seizures and is therefore much more likely to achieve seizure freedom with a possible surgical procedure? Or do they have multiple areas that might make it a little dicier or might require more state-of-the-art techniques? And for some significant number of patients, it helps because it turns out that they don't have epilepsy at all. And this is really interesting because in monitoring units, like the one we have at Sparrow, like the hundreds of them that exist across the United States, fully 40%, four out of 10 cases that we admit turned out not to have epileptic seizures. They have all manner of different kinds of spells, that superficially, that is to say to the lay person, or even to a non-neurologist physician might be called a seizure.
But that when you look at their brainwaves, there's no electrical storm going on at all. And when you see the manifestations of the seizure, what the patient does, what their body does without them wanting their body to do that, they also don't look like what seizures usually look like at least to someone who's seen literally thousands of them. So, for these folks, it's obvious why multiple anti-seizure medications would not have worked because they're trying to treat something they don't even have. And the response that I get from patients, when I tell them, listen, you don't have epilepsy, it can be quite variable, and incredibly emotional, in many cases, quite liberating. It's like, this is a thing that I thought I had, and epilepsy, let's not kid ourselves, still carries quite a bit of stigma in 2021. It's defined them as a disabled person and there's nothing wrong with being a disabled person, but it has meant for them that there are restrictions, it has meant for them that they feel like they don't have a normal life.
And the things that we discover as the actual cause of their spells, oftentimes they're treatable. Sometimes they're not curable per se, but we have ways of increasing the quality of their life, quite a bit, that using antiseizure medications one after the other, just wasn't doing. It's really interesting to see the variety of epileptic disease that exists, to see the kinds of seizures that people have and the patterns that they produce on their brainwave scans. But it's also really satisfying to quote unquote, "cure" people of their epilepsy by finding out that they never had it.
Host: Fascinating work, Dr. Burghardt. Is there anything else you'd like to add? Perhaps some words of hope and encouragement to anyone listening.
Dr. Burghardt: Oh, absolutely. Lansing is smack dab right here in the middle of the state. And it's not the largest city, but we have a huge number of people living within 60 miles or so. And by definition, around one in a hundred of them have epilepsy and there are ways that we can help those of you who are struggling with it. And some of those ways are going to involve medication. Some of those ways are going to involve advanced testing, referral to more advanced centers, maybe a stint in the EMU, but we have ways of making life high quality for anyone who wants to come seek it out and work with us.
Host: I love it. And the compassion just shows in your voice. Dr. Burghardt, we so appreciate your time with us. Thanks so much for being with us today.
Dr. Burghardt: It was my pleasure. Thank you.
Host: And to learn more about the Epilepsy Monitoring Unit at Sparrow, visit sparrow.org/epilepsy, and be sure to subscribe to Sparrow Speaks in Apple podcasts, Google podcasts, or wherever you listen to your podcast for our additional healthcare topics. I'm your host, Deborah Howell. Thanks for listening and have yourself a great day.
Deborah Howell (Host): Welcome to Sparrow speaks the podcast with the latest health news and information from Sparrow mid Michigan's premier community health care leader.
I'm your host, Deborah Howell. And today we'll be talking about epilepsy and the Sparrow epilepsy monitoring unit.
our guest is Dr. Tyson Burkhart, epileptologist, and associate professor at Michigan state university.
Host: Welcome Dr. Burghardt. What is epilepsy? And can it be treated with medicine?
Dr. Burghardt: Epilepsy is the name for a number of different disorders or diseases in which people have epileptic seizures, which sounds like a little bit of a circular argument. But epileptic seizures themselves, can happen even when people don't have epilepsy. So, it is a distinction that we tend to make. But it's the name for a group of disorders in which people will continue to have seizures basically out of the blue, with no necessary provocation, unless they are treated. And so medication treatment in fact, is the backbone of the way that we treat epilepsy.
Host: Very interesting. I did not know that you could have epileptic seizures without having the disease, you learn something every day. What's an EMU? And how does it run?
Dr. Burghardt: An EMU is an Epilepsy Monitoring Unit. And there are units like this all over the country, hundreds of them. So, they sometimes have different names of video EEG monitoring units, or video monitoring units or something that. And these are places where we admit patients into the hospital with the express goal of watching them have seizures, which sounds very counterintuitive. Usually people go to the hospital because they've had seizures and we don't want people to have seizures. And we're doing all of our very best to stop people from having seizures, but in an Epilepsy Monitoring Unit, our goals are often to precisely define just where in a person's brain, the seizures are coming from, or to see if the kind of weird tic or odd behavior that a person has, really is an epileptic seizure, or if it's due to another medical condition, since there are lots of imitators out there.
Host: Sure. And what's the EMU's role in managing patients with epilepsy?
Dr. Burghardt: One of the main roles is, that we can define the area of onset for epileptic seizures. Although, most people who have epilepsy can be successfully controlled with medications alone. And that's about two out of every three people with the disease. That still leaves one third of all folks with epilepsy, continuing to have at least some seizures, even despite being on two, three or more anti-seizure medications at a time. For these folks, the best possible outcome, at least for seizure control comes from figuring out whether they would qualify for surgical treatment and surgical treatment scares a lot of people. A lot of my patients are very, very trepidatious at first. They don't want anyone cutting on their brains, but surgical treatment has cure rates in some folks, certain types of epilepsy, cure rates of up to 75%. So, it can be an extraordinarily effective way to gain control of seizures, precisely in that population of people who we can't otherwise get control of their seizures at all. And so as one of the preliminary steps towards getting people, to the operating suite, if that's what's going to end up benefiting them the best, we need to define where the seizures are coming from. And so by watching people have their seizures. And of course, I don't mean just standing there at the bedside, watching them and pointing, we're recording continuously, both audio and video, as well as recording their brainwaves, what we call, the electroencephalogram or EEG, but most people will understand it as brainwave recording. And when people have epileptic seizures, their brainwaves are going to give off particular patterns and the location of those brainwave changes over the entire head as we measure them, are very strong clues as to where the seizures are erupting.
Host: So, that's your map. That's your guide?
Dr. Burghardt: It very much is. Among folks who do epilepsy surgery, quite a lot, they talk about something called the anatmoelectro clinical hypothesis. And it won't even fit on one line of a page of text. But one third of that, right? So, you've got your MRI and your CT, you've got the scans and you got your history and physical and history is still bedrock just like it is with medicine in general, but fully one-third of that is electrically figuring out how the seizures begin and how they propagate across the brain. And so it absolutely is a map.
Host: Yeah, well, you're absolutely right. That epilepsy surgery does sound a little scary. So, what are the steps for a patient before deciding on surgery?
Dr. Burghardt: Number one, of course, surgery is offered almost entirely to folks who have forms of epilepsy that are not completely treatable with medication. So, two out of every three people with epilepsy, this won't even come up. For those, for whom it does come up, they need to speak with their doctor, their neurologist in particular, about what exactly can and can't be done. They need to know the risks in and out. And they need to know all the steps that preceed the surgery. I tell my patients, for instance, when I first broach the subject, like I'm not wheeling you to the or tomorrow, there are steps ahead of this and some of these diagnostic steps, some of these tests that we're going to do might in fact, rule you out as a person who would benefit from surgery.
So, there's a little bit of a road to go to, and that's what patients need to know first and foremost. They should also be asking about the experience of the neurologist who's helping to guide them through this process. Although seizures are very common and epilepsy is comparatively a common disease, it affects approximately one half of 1% of the entire world. There are relatively few physicians who really specialize in it and most neurologists can treat seizures and epilepsy pretty good. But even among neurologists, there's a sub-specialty, Epileptology, in which people understand the disease better than anyone else. And people understand what you can expect as positive results from surgical procedures, what to look out for as possible negatives, who might benefit and in what kinds of procedures might be most salutary.
So, if a patient is still seeing a general neurologist and I have all the love in the world for general neurologists, they're my colleagues. They're my friends. If they are still having seizures, despite using more than two different anti-seizure meds, even if it's been one after the other, they should probably be seeing a subspecialist, Epileptologist.
Host: Got it. It's a huge decision to make I'm sure. Now are there other surgical options available?
Dr. Burghardt: It's expanded quite a bit. The main thing that could be done for most folks, let's say in the 1980s, would have been removing one of the temporal lobes. The temporal lobes are pieces of the brain that are on either side, they're right by where your temple is. Hence the name and temporal lobe epilepsy, epilepsy whose seizures begin in the temporal lobes is a relatively common, subtype of epilepsy. And so this was pretty commonly done, all through the eighties and nineties. And it's still done today. It's a relatively simple procedure as far as brain surgery goes and it has really good outcomes, but not everyone has seizures coming from their temporal lobes.
And nowadays, neurosurgeons have perfected techniques that allow them to take out very focal parts of brain that are causing all the ruckus, so to speak, and Epileptologists and Neurophysiologists, sort of, an overlapping discipline in which we use electricity and brainwaves to help diagnose disease, we've developed techniques to be able to help find those very focal areas of brain that are to blame and also to figure out what parts of the brain around it might be vital for normal everyday function, the sorts of brain that you absolutely should not remove, because you can't just glue it back in when you're done.
Host: How can the EMU help a person in making that huge decision?
Dr. Burghardt: The EMU helps because although the majority people with epilepsy have seizures, which begin in one, or maybe just a small handful of spots in their brain, around one in seven people with epilepsy have what's called primary generalized epilepsy. And in that type of epilepsy, the seizures begin all over the brain all at once and the only real surgical treatment, at least before we had some of the newer neurostimulators that we have nowadays, the only real surgical treatment you could do was remove the entire brain, which would, would generally make you a poor conversationalist, among other things.
So, it's important number one, so that we can classify who has generalized and who has focal epilepsy. It can help us figure out does this person seem to have one area of the brain that's generating seizures and is therefore much more likely to achieve seizure freedom with a possible surgical procedure? Or do they have multiple areas that might make it a little dicier or might require more state-of-the-art techniques? And for some significant number of patients, it helps because it turns out that they don't have epilepsy at all. And this is really interesting because in monitoring units, like the one we have at Sparrow, like the hundreds of them that exist across the United States, fully 40%, four out of 10 cases that we admit turned out not to have epileptic seizures. They have all manner of different kinds of spells, that superficially, that is to say to the lay person, or even to a non-neurologist physician might be called a seizure.
But that when you look at their brainwaves, there's no electrical storm going on at all. And when you see the manifestations of the seizure, what the patient does, what their body does without them wanting their body to do that, they also don't look like what seizures usually look like at least to someone who's seen literally thousands of them. So, for these folks, it's obvious why multiple anti-seizure medications would not have worked because they're trying to treat something they don't even have. And the response that I get from patients, when I tell them, listen, you don't have epilepsy, it can be quite variable, and incredibly emotional, in many cases, quite liberating. It's like, this is a thing that I thought I had, and epilepsy, let's not kid ourselves, still carries quite a bit of stigma in 2021. It's defined them as a disabled person and there's nothing wrong with being a disabled person, but it has meant for them that there are restrictions, it has meant for them that they feel like they don't have a normal life.
And the things that we discover as the actual cause of their spells, oftentimes they're treatable. Sometimes they're not curable per se, but we have ways of increasing the quality of their life, quite a bit, that using antiseizure medications one after the other, just wasn't doing. It's really interesting to see the variety of epileptic disease that exists, to see the kinds of seizures that people have and the patterns that they produce on their brainwave scans. But it's also really satisfying to quote unquote, "cure" people of their epilepsy by finding out that they never had it.
Host: Fascinating work, Dr. Burghardt. Is there anything else you'd like to add? Perhaps some words of hope and encouragement to anyone listening.
Dr. Burghardt: Oh, absolutely. Lansing is smack dab right here in the middle of the state. And it's not the largest city, but we have a huge number of people living within 60 miles or so. And by definition, around one in a hundred of them have epilepsy and there are ways that we can help those of you who are struggling with it. And some of those ways are going to involve medication. Some of those ways are going to involve advanced testing, referral to more advanced centers, maybe a stint in the EMU, but we have ways of making life high quality for anyone who wants to come seek it out and work with us.
Host: I love it. And the compassion just shows in your voice. Dr. Burghardt, we so appreciate your time with us. Thanks so much for being with us today.
Dr. Burghardt: It was my pleasure. Thank you.
Host: And to learn more about the Epilepsy Monitoring Unit at Sparrow, visit sparrow.org/epilepsy, and be sure to subscribe to Sparrow Speaks in Apple podcasts, Google podcasts, or wherever you listen to your podcast for our additional healthcare topics. I'm your host, Deborah Howell. Thanks for listening and have yourself a great day.
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