What is now considered an option of last resort for addressing epilepsy may one day become the go-to option that benefits not only patients and their families but the whole healthcare system.
Dr. Mark Lee, chair of Neurosurgery at the WVU School of Medicine, is a pediatric neurosurgeon who specializes in epilepsy surgery at WVU Medicine. He’s made it his goal to expand and enhance the ways by which this condition can be treated surgically.
“Epilepsy affects about one percent of the population,” he said. “So, in this country that means about 3.5 million people, and 40 percent of people with epilepsy have what we call drug resistant or intractable epilepsy. This means medication is not stopping their seizures. We can frequently do a surgery to stop the seizures for these people, basically curing their epilepsy.”
Dr. Lee said that when two medications have failed to stop a patient’s seizures, the chances of finding a drug that can do the job fall to about two percent. However, tackling the problem through surgery increases the chances of success to 85 percent.
He said epilepsy surgery has actually been an option in the medical community since the 1940s but has historically taken a back seat to seizure treatment in favor of medication because surgery was seen as a very last resort.
In the intervening time, years of observations could mean the patient sees an upswing in the number of seizures while trying different medication.
However, for the sake of the patient, Lee said the focus now is on exploring surgical options sooner rather than later. This is especially important for younger patients considering the long term effects of uncontrolled seizures.
“If a kid stops going to school because he’s having four or five seizures a day, that child is placed at a disadvantage because of missed learning opportunities. He is not going to be able to be fully functional,” Lee said, adding that caring for a child with uncontrolled seizures also makes things harder on families, so addressing it early is beneficial for everyone involved. “It’s all about the quality of life.”
Epilepsy surgery has come a long way since the 1940s, and WVU Medicine has invested in the latest technology to offer a variety of options.
Examples include surgical robots and minimally invasive laser ablation. For 2020, WVU Medicine hopes to add an amagnetoencephalography (MEG) machine, which is able to detect magnetic changes in the brain in order to see epilepsy activity and brain mapping.
Lee said removing the tissue causing epilepsy is similar to removing a tumor. The tumor is not supposed to be there, and neither is the epilepsy. Doctors must pinpoint the location of the seizure-causing tissue, and then excise it with surgery.
Laser ablation is one of the newer options in which a tiny incision is made, and a specialized beam is used to zap the affected tissue. This minimally invasive procedure means the patient is kept over night for observation but is otherwise good to go the following day.
Now that the proper tools are in place, Lee said the focus is now on expanding the program. There are three epilepsy specialists who work with the surgeon to diagnosis and plan the surgeries, but he wants to grow that to 10 by 2021, which also means recruiting the necessary support staff, such as specialists in psychology and neuropsychology.
Right now, only about 10-12 epilepsy surgeries are performed at WVU Medicine per year, but Lee says he was conducting about 150 per year at his previous program in Texas.
He wants to see the program in Morgantown grow to meet the needs of not only the state but be a national player so patients in the surrounding states will also seek out treatment at WVU Medicine.
Lee said this is well within reach seeing as the hospital system’s epilepsy monitoring unit will have 12 beds — six beds for children and six for adult patients — available once WVU Medicine Children’s new tower is complete.
Lee said no one he’s seen that’s needed this surgery has been turned down by insurance companies for epilepsy surgery. In fact, he said insurance companies are starting to see the value in paying for surgery to address the seizures sooner.
While the operations are expensive upfront, the costs of repeat hospitalizations and trying different medications add up over time, and the surgical options are now seen as the better option in the long run since there are fewer claims.
In fact, Lee estimates epilepsy surgeries could save the healthcare system in central Texas $180 million over a five-year period with the expanded program he was planning there before coming to WVU Medicine.
With WVU Medicine merging with The Health Plan to form a vertically integrated healthcare system in which the interests of the hospital and insurers are aligned, he anticipates it only getting easier for patients to address the condition via surgery rather than medication.
Like many of WVU Medicine’s physicians, Lee is relatively new to the Mountain State, having joined 10 months ago.
Having worked in academia at the Medical College of Georgia in Augusta, Georgia, he later practiced in Austin, Texas, and even set up a few medical start-ups.
While initially hesitant to re-enter academic medicine following an invitation by WVU Rockefeller NeuroscienceInstitute Director Dr. Ali Rezai, Lee didn’t look back after meeting with WVU Health Sciences Dean Dr. Clay Marsh.
“I didn’t want to go back into traditional academic medicine,” Lee said. “He [Marsh] showed me there was nothing traditional about WVU Medicine. There’s just this huge upward trajectory.”