CLEVELAND, Ohio (Ivanhoe Newswire) – Two hundred thousand people will be diagnosed with epilepsy this year. Neurons fire in the brain, creating a storm of electricity that can spark uncontrollable shaking. Now, advanced tracking and targeting approaches are helping stop the seizures.
It can happen anytime, anywhere. Every day, three million Americans fear this will happen. Jeff Martig was one of them.
"I was having about thirty a day," Jeff Martig, who suffers from epilepsy, told Ivanhoe.
They started when Jeff was twelve. The seizures continued for the next 21 years, striking the high school athletic director at home and work.
"I would feel a sensation in my nose, and then my left side of my face would twitch and then I would start gasping for air," Jeff said.
Doctors at the Cleveland clinic use SEEG to pinpoint exactly where in the brain the seizures start.
"It's a technique to access where the electricity is coming from," Imad Najm, M.D., a neurologist at Cleveland Clinic, explained.
SEEG electrodes are snaked into the brain through tiny holes to record those electrical storms. New imaging tools can help doctors pinpoint the exact cause.
"We can see that microscopic level some of these lesions," Dr. Najm said.
For the first time in patients with epilepsy, these lesions are being destroyed with lasers. In some cases the lasers go through the same holes created by the SEEG.
"We started using it to ablate small areas of the brain where the seizures may be coming from," Dr. Najm said.
And after two decades of seizures the problem area in Jeff's brain was removed.
"I haven't had a seizure since. It's like I'm a brand new person," Jeff said. "It's amazing."
New technology that helped Jeff clear the storms in his head for good. Surgery is only an option for the 30 to 40 percent of patients who do not respond to medications. The doctor said patients who have epilepsy are more prone to cognitive and memory declines later in life. He hopes the surgery will stop that as well.
BACKGROUND: Epilepsy is when a person experiences repeated seizures, which are episodes of disturbed brain activity that causes changes in attention or behavior. There are various types of seizures that can range from simple staring spells to violent shaking and loss of alertness. The type of seizure depends on the part of the brain affected and the cause of the epilepsy. Epilepsy can be the result of medical condition or injury that affects the brain, although sometimes the cause is not known (idiopathic). A brain tumor, abnormal blood vessels in the brain, certain infections, dementia, and stroke are some things that can cause a person to develop epilepsy. The strange sensations that some people with epilepsy have before a seizure, such as tingling or smelling strange odors, are called auras. (Source: www.ncbi.nlm.nih.gov).
TREATMENT: When epileptic seizures are the result of a brain tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these issues can possibly make the seizures stop. Other possible treatments include medications called anticonvulsants which can help limit the number of future seizures, but if a person misses the medication, it can cause a seizure and many of the drugs cannot be used by pregnant women because of the risk of birth defects. Surgery is another option, especially when the anticonvulsants are not working. The surgery options include removing the abnormal brain cells that cause the seizures, and placing a vagus nerve stimulator, similar to a heart pacermaker, in the brain. (Source: www.ncbi.nlm.nih.gov).
NEW TECHNOLOGY: The Cleveland Clinic Epilepsy Center was the first in North America to introduce SEEG, a more precise and less invasive approach to localizing seizures. The SEEG allows doctors to explore larger areas in the brain with little tissue damage, although the main risk of the procedure is bleeding during electrode insertion. Other risks include stroke and infection, though only 2% of the patients will have a complication. The electrodes extend into the folds of the brain where the subdural grids cannot reach and the area where the seizures occur must be known before the doctors are willing to perform the surgery to eliminate those cells. So far, 60% of patients who have completed the SEEG procedures are now seizure free or their seizures have significantly improved. However, doctors recommend that patients continue to take medication for a year after the surgery. (Source: www.clevelandclinic.org)
Dr. Ankit Desai, an investigator for the the East Coast Institute For Research, talks about how a remote control is making breast reconstruction less painful.
What is the need for breast reconstruction?
Dr. Desai: Women that are diagnosed with breast cancer have a multitude of options, but one of the options is that they get a mastectomy. Some undergo prophylactic mastectomy and some do it because of the size of the cancer. We strive to provide women with reconstructed breasts than are better than they once had before. I think that reconstruction has evolved over time. Twenty to thirty years ago it was about finding something that looked good to fill a bra and looked good in clothes. Now the demands and the techniques have improved in that It's not just about filling a shirt or a bra but it's actually looking esthetically pleasing to the naked eyes.
What is the chief complaint that comes along with the traditional way of doing things with saline injection?
Dr. Desai: Before we would do an implant base reconstruction, that's one of the most common ways to do breast reconstruction. We put in a tissue expander and they have a port that we can inject saline into. Patients come to the office, usually about once a week, and we inject a needle through the skin into the port of the saline tissue expander and then inject a bolus of saline. That's how we stretch that skin envelope to recreate that pocket for what eventually will be the permanent implant.
The saline expander limitations are the frequent doctor visits. The patients have to come once a week to the office for these injections. They have to have a needle that's stick through the skin which sometimes can cause some discomfort for the patients.They get a bolus injection, meaning they get at least about sixty cc's at a given point in time. The reason for that is, you can't have them come to the office every day for expansion. If you look at anything the most natural way of expansion is little by little, multiple times a day, every day. You see women over nine months undergo gently gradual tissue expansion and that's nature's most natural tissue expansion. As plastic surgeons we're always trying to recreate tissue. When we recreate tissue or expand tissue for bones and jaws for younger kids, they actually undergo daily expansion of the bone. They get a little half turn of a screw twice a day. We haven't been able to simulate something like that with saline breast reconstruction. That's what's wonderful about the Aeroform technology. It will allow us to more gradually expand the patient and I think that the satisfaction and comfort for patients are going to be higher.
You are gradually expanding but in essence, you're able to get the reconstruction going much faster, correct?
Dr. Desai: The advantages of the aeroform expander are less pain because you're gradually expanding multiple times every day. In addition, the overall expansion takes less time. If you look at our growing data and research that's out there traditionally, saline tissue expansion is on the average of about three to four months and Aeroform expansion is really within weeks to a month. The patients are completed with their expansion in a month and that's primarily because they can do it every day, it's more comfortable and they're getting a more gradual expansion. Gradual expansion also means a better aesthetic result in my opinion because we're not putting a lot of pressure on the skin so the skin and the muscle thins out less and you get a better coverage of your permanent implant.
How does this compare to something like Bravo?
Dr. Desai: Bravo is external tissue expansion and it uses suction to actually expand the skin and the soft tissue envelope from the outside. It is temporary, it doesn't create an internal pocket for a permanent implant. If you use the Bravo for external tissue expansion and then stopped using the Bravo then your breast, if you had a mastectomy, go completely flat again. If you did it and you went to go put an implant in there's really not a space to put an implant like there is with a traditional saline tissue expander or the air expander. Typically the Bravo technology is used for external tissue expansion and then to inject fat in to that area.
What's been the response so far in the trial?
Dr. Desai: I think patients are really excited about it. They don't have to have a needle stick; they don't have to come in to the doctor's office as frequently. When I tell them about it they immediately jump on board. Patients not only are excited about it but they find that it's more convenient. They can do it at home.
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