Principal back to school after tough fight against Epileptic seizures

Susan Ehlers is working again as a school administrator, free from the epileptic seizures that threatened to end her career.

But her return to health has not been quick or easy.

Ms. Ehlers, 51, of McCandless, had brain surgery in 2002 to relieve her complex partial seizures. She later resigned as principal of Perrysville Elementary School in the North Hills School District.
She believes she might still be employed there if her supervisors better understood the debilitating effects of the seizures, a common disorder that many people may not associate with epilepsy.

The popular image of epilepsy is a person with a grand mal seizure, "someone who is stiff or shaking," noted Dr. Kevin Kelly, Ms. Ehlers' neurologist and director of the Center for Neuroscience Research at Allegheny General Hospital.

But people with complex partial seizures often have more subtle symptoms, he noted. They may stare, smack their lips or fumble with their clothing, yet be unconscious of their actions.

Ms. Ehlers had lapses in awareness lasting less than a minute, often once or twice a day. During those spells, she might tap her fingers. Afterward, she might be disoriented or tired.

Complex partial seizures are different from petit mal seizures, also known as absence seizures, noted Dr. Mark Scheuer, a neurologist and director of the University of Pittsburgh Epilepsy Center. Petit mal seizures can cause brief lapses of consciousness but typically are not followed by confusion or disorientation.

Seizures are considered partial if they begin in one part of the brain and complex if consciousness is impaired, said Dr. Brien Smith, an epilepsy specialist at Henry Ford Hospital in Detroit. In some cases, partial seizures progress to grand mal seizures.

While many people may not associate complex partial seizures with epilepsy, they are quite common, accounting for about 36 percent of all seizures, Dr. Smith said.

Some patients experience auras that warn them of the seizures, such as a rising sensation in the pit of their stomach or a sense of deja vu.

Some, too, exhibit bizarre behavior during their seizures. Dr. Jack Wilberger, chairman of neurosurgery at Allegheny General, recalled one patient who would say curse words over and over. Others may laugh uncontrollably, he said.

Complex partial seizures can be precipitated by very specific stimuli. Dr. Smith noted that one patient's seizures apparently were triggered by eating sweet potatoes. Another patient had seizures after listening to phone messages from an automatic bank teller, looking at a wedding portrait or watching Bob Barker on "The Price Is Right."

But often, the seizures have no clear precipitating factor, Dr. Scheuer said. Many times, the cause of the seizures also is unknown, though they are sometimes linked to birth complications, high fever in infancy, penetrating head injury or brain infection.

Seizures are sudden changes in brain function caused by abnormal electrical discharges in the brain. Patients with recurrent seizures are considered to have epilepsy, a family of syndromes that affect 2.7 million Americans. It is the most common neurological disorder after Alzheimer's disease and stroke, according to the Epilepsy Foundation.

About two-thirds of patients with complex partial seizures respond well to medications, Dr. Smith said. For those who don't, a vagus nerve stimulator, an electrical device implanted in the neck and chest, may help.

But surgery may be the best option for many patients who have intractable seizures linked to a specific area of the brain.

Surgeons remove a small area of brain tissue after conducting tests to determine that vital functions like memory and speech will not be impaired. As many as 70 percent of patients with epilepsy localized to the temporal lobe, an area of the brain near the ears, may be cured by surgery, Dr. Smith said.

Ms. Ehlers began having seizures about six years ago. Family members noticed that at times, she seemed disoriented or unaware they were speaking to her.

Tests confirmed that she had complex partial seizures and she was placed on medication. But several medicines were ineffective in controlling her seizures and they often made her tired.
Often, she would have seizures in the evening or as she slept. But they also occurred at school.
She said she was able to perform her duties despite the seizures, but needed more time to complete tasks and sometimes had memory lapses. She also had to stop driving.

In August 2002, she had a portion of her right temporal lobe removed. The surgery was so successful in controlling her seizures that she soon had no need for medication.

But school officials kept her from returning to the Perrysville school in early 2003, saying they were investigating her job performance.

Dr. Kelly told school officials that her performance had been affected by her seizures and her medication.

Ms. Ehlers said officials seemed unwilling to consider that she had been struggling with a medical problem. "Had it been diabetes or some other medical condition, I don't believe I would have been treated that way."

She filed a complaint with the U.S. Equal Employment Opportunity Commission alleging that she was the victim of discrimination based on her disability. But in September 2003, investigators said they were unable to find evidence of a violation.

Ms. Ehlers said she reached a settlement three months later with the North Hills School District. Among other provisions, she said school officials agreed to cooperate in allowing her to regain her principal's certification, which had lapsed.

Tina Vojtko, a spokeswoman for the school district, declined to comment in detail about the case, noting it was a personnel matter.

Since 2004, Ms. Ehlers has been coordinator of student services for the Communities In Schools Academy in Pleasant Hills. The alternative school helps high school students who have left traditional schools complete their course requirements for graduation.

Feeling better than she has in years, she said she enjoys the opportunity to again work with students.

"I feel when one door closed, another opened," she said.

Her experience with epilepsy has taught her to "never lose your belief in yourself -- and to count on your family, your friends and your faith."