Anyone who has lived through a southeastern spring has probably seen hook echoes on Doppler radar and knows what satellite images of heavy weather coming up from the Gulf portend.
In much the same way that weather forecasters use multiple imaging to pinpoint dangerous weather and sound the all clear when calm has returned, the new director of UAB’s Epilepsy Center and Division of Epilepsy Jerzy Szaflarski, MD, PhD, has a particular interest in using multiple technologies to target the source of seizures and protect brain tissue governing essential capabilities.
“Using an fMRI while monitoring brain waves with an EEG helps us pinpoint the areas of irritability that are triggering seizures. It also allows us to map nearby tissue responsible for memory, language and other key functions with greater precision so we have a clearer picture of what our treatment options are,” Szaflarski said.
Mapping is of particular importance in the surgical treatment of epilepsy, which in some cases can completely eliminate symptoms if areas triggering seizures aren’t located too near those controlling critical abilities.
“Although general areas of function are usually predictable, there are tremendous differences between individuals,” Szaflarski said. “With lateralization of brain function, you’d expect to find the language centers of right-handed patients on the left side of the brain. However, there are multiple aspects to consider. Where is spoken language? Where is verbal memory? In temporal lobe epilepsy, you need to know the exact location of memory centers. There can be significant variations from one person to the next.”
UAB’s Epilepsy Center is one of the largest and most active in the country. As a Level Four facility, the highest level recognized by the National Association of Epilepsy Centers, it offers the most current medical techniques available anywhere in the world to diagnose and treat epilepsy. In addition to specialized epilepsy clinics for children and adults, the center includes a neurophysiology lab, an EEG/video monitoring unit, a robust research program and one of the most active epilepsy surgery programs in the U.S. Treatments range from new antiepileptic drugs to cortical resections for intractable epilepsy to vagal nerve implantation.
Recruiting a director as highly regarded in the field as Szaflarski is considered a major achievement that should position the center for more advances in the future.
“The Division of Epilepsy and the Center are a great group of people, and I’m honored to be associated with them,” Szaflarski said. “We hope to grow the program and improve lives through research, medication, surgery and support services. For example, stress seems to increase the frequency of seizures. I’d like to look at how it affects brain chemistry and how we can use psychological and social support and stress management training to help patients.”
Almost three million people in the United States have epilepsy. Although there are genetic factors in some cases, the risk of developing the disorder depends to a great extent on other aspects of a person’s individual history.
“Seizures are symptoms. The reasons for the seizures differ. People in urban areas have a higher risk than those in the suburbs. There are more new cases in children under ten, then again in the elderly where trauma, infection, brain tumors, MS, Alzheimer’s and other brain disorder may be a factor. Soldiers with head injuries are another group at higher risk. The risk for one individual may be ten to twenty times higher than another, depending on personal history,” Szaflarski said.
An area where Szaflarski says he’d like to see growth is in more and earlier surgical treatment for epilepsy.
“Although 60 percent of patients can be seizure free following surgery, the average waiting time between diagnosis and surgery is 15 to 20 years,” Szaflarski said. “It’s understandable that physicians would want to try other options first. There are many medications to try. If those options fail, there comes a point when the choice of surgery has to be balanced against the dangers of continually living with the risk of accidents and sudden death.
“We need to do more to educate other physicians about the surgical option. The advanced mapping techniques go a long way toward identifying the exact location of problem areas and centers of function. It is brain surgery, and if seizure triggers are located too near areas of essential function, not everyone may be a candidate for surgery. For those who are, it can be an opportunity to live free of seizures. That could change their lives.”
