New surgery brings hope to people suffering from Epilepsy

Dana Doyle used to ride her bicycle and drive a car. She led the typical active life of a teenager. But when she was 19, epilepsy came on suddenly, limiting her lifestyle and restricting her independence. No treatment in the subsequent eight years could c urb her temporal-lobe seizures.

When the 27-year-old student was offered a new procedure that held great promise for the control of her epilepsy, she didn't hesitate. Last week, Doyle became the first Seattle-area patient to receive an NCP System implan t, or vagus nerve stimulator (VNS) at the University of Washington Regional Epilepsy Center at Harborview.

The device, a disk the size of a silver dollar, was surgically placed under the skin of the patient's chest with an electrode connected to the v agus nerve in her neck. The VNS reduces epileptic seizures by sending low-level electric impulses to the brain through the vagus nerve.

Dr. Daniel Silbergeld, UW associate professor of neurological surgery, implanted the device during the two-hour proc edure at Harborview Medical Center. Mark Holmes, UW associate professor of neurology, is Doyle's epileptologist, and will follow up with her and make any needed adjustments to the device.

"I envision this being the future of treatment for certain types of epilepsy and am proud we can offer this to the people of the Seattle area," said Silbergeld.

Holmes and Silbergeld say the frequent and violent seizures characteristic of refractory epilepsy can often control a patient's life. "The vagus nerve stim ulator brings new hope to patients with uncontrollable epilepsy for a higher quality of life," said Holmes. "Dana was a perfect candidate for our first procedure of this type, and she is doing well."

Doyle is now recuperating at home in Redmond. The UW senior hopes to complete her schooling, hold a regular job, and gain her independence behind the wheel of a car again.

The University of Washington Regional Epilepsy Center at Harborview Medical Center has been a leader in researching, diagnosing, controlling and treating epilepsy for more than 20 years. An interdisciplinary team of University of Washington Physicians provides complete resources for seizure control for both inpatients and outpatients.

Services include: ultra-high-resolution MRI, SPECT brain imaging; advanced quantitative digital EEG analysis; 128-channel long-term video monitoring; diagnosis and treatment of psychogenic seizures; epilepsy surgery, including intracranial mapping; investigati onal drugs and vocational counseling.

Epilepsy is a neurological disorder characterized by brief disturbances in the normal electrical functions of the brain, often resulting in seizures. 2.5 million people in the United States have epi lepsy, making it the nation's second leading neurological disease. While an individual can develop epilepsy for a variety of reasons including genetic predisposition, head injury, or stroke, in more than 70 percent of cases there is no known cause.

The NCP System is intended for patients with refractory partial onset seizures, that is, those patients whose seizures cannot be controlled with antiepileptic drug treatment or surgery. Like a pacemaker, the pulse generator is implanted under the skin in the chest. The lead wire is then tunneled under the skin to the lower neck, where it is placed around the vagus nerve.

Using an external programmer, the neurologist can set or reset the stimulation parameters of the device. The NCP System del ivers preprogrammed, intermittent electrical pulses to the vagus nerve 24 hours a day. Additionally, when a patient senses a seizure coming on, he or she is able to activate the system to deliver an additional dose of stimulation by passing a magnet over the device. The device lasts 3-5 years before requiring a battery replacement.