Brainstorming

Businessman drawing a brain on a giant wall

Epilepsy is one of the most widespread diseases of the nervous system. Due to its peculiarities, it represents a serious medical and social problem. It is believed that epilepsy is almost incurable. And people with such diagnosis are doomed to take medications permanently. Also there are a lot of limitations for such patients.

Professor Karl Schaller, chief doctor of neurosurgery department at Geneva University Hospital (Hopitaux Universitaires de Geneve, HUG), engaged in research in this field, is convinced that this disease can be defeated as well. Department headed by him offers the most uncommon surgeries which help get rid of the inferior person feeling once and for all.

– Professor Schaller, is epilepsy a congenital or evoked disease?

– Both options are possible. If we talk about children and teenagers, they have a special kind of epilepsy which can go away by itself without any treatment or surgery. But there are also the patients who suffer from epilepsy since childhood, even from birth, at the same time having such congenital diseases as deformities or anomalies of brain development. They can have thousands of epileptic seizures per day! Sometimes epilepsy occurs as a consequence of other diseases, for example, skull trauma or tumor. This is symptomatic epilepsy. There are also professions and hobbies with increased probability of craniocerebral traumas which can lead to epilepsy. These include football, diving, boxing…

– But what is the reason of seizures?

– Human’s brain has a certain quantity of neurons which oscillate in a normal rhythm. But this rhythm may be disturbed by some kind of exciter. Sudden excitation leads to the irritation of these cells and, when the irritation reaches critical point, the patient experiences convulsive seizure. This can happen both during sleep and while the patient is awake. It can also happen that the patient will not notice their condition, they do not realize that it is a seizure, but suddenly find themselves in an unexpected place, perhaps even lying on the ground.

Sometimes, the disease develops spontaneously, with no known cause. Alternatively, it can develop as a result of the fact that the patient often had fever in their childhood. This affects certain part of the brain and makes it highly perceptive. Over time, such deterioration can provoke epilepsy. It can also happen that seizure occurred unexpectedly, for example, if a man is under stress. Moreover, development of epilepsy is promoted by alcohol and other narcotic substances.

One person in a hundred or two hundred experiences epileptic seizure once in his lifetime.

– How can we characterize what a person feels during seizure?

– There is no single answer here, this disease has a lot of various forms. There is epilepsy with memory loss and there is one without it. There is epilepsy with image distortion. One person simply falls down, losing consciousness, another has some hallucinations related to the moon at this moment. Some patients experience sense organs disruptions. It often occurs before serious seizure. Such people lose sense of smell, have «already seen» the so-called deja vu symptoms. They have an unusual feeling in their stomach or something else. All this can also be considered as temporary epilepsy. However, headaches are usually not the symptom.

– So, what you are saying is that deja vu is a sign of epilepsy?

– Not necessarily. Deja vu is accompanied by other symptoms during epilepsy, for example, feeling of heat, mental disorders. But if the parents started noticing that their child experiences such conditions regularly, it is necessary to take him to a pediatric neurologist for examination.

– What if you noticed that you had the symptoms described by you? Do you need to visit a neurologist at your home place before going to neurosurgery department of Geneva University Hospital?

– Of course, we have our own doctor, and even during primary examination they will see if treatment is required. They will also explain to a patient when the pills can help and when a surgery is required.

Preparation to a surgery, specification of diagnosis, clarification of the fact whether a patient is a positive candidate for such kind of treatment, and certain manipulations is a very complicated and costly process. Such research is not done (or not done well enough) in other countries. Switzerland is a leading country in this field. That is why the people who suffer from epilepsy rarely come to our hospital on an emergency basis. Usually, they are here on preplanned visits, with the participation of their family or even with state support. And it is us who decide whether a surgery is required or not.

– And do other people live a normal life taking certain medications?

– The decisive thing here is an answer to the question: can the patient be treated using various medications? If yes, it is the best option. But when it is impossible (this happens approximately in 10–30% of chronic epilepsy cases), we launch the process of complicated diagnostic examination. Electrodes are fixed to the person’s head for several days and they must induce seizures conscientiously. It is done so that a doctor could see in which parts of the brain the excitement occurs. How it is spread in the brain.

And then the result is fixed in anatomic images with the help of computer or computerized tomography.

About two thirds of all the epileptic diseases, which can be treated well with the help of a surgery, are localized in the temporal lobe of the brain. If such patient undergoes a surgery, there is 80% chance that they will never again experience seizure in their life! In complicated cases (up to 500 seizures per day) they may not go away completely after a surgery, but will decrease to 50. And this is already a big win.

– Very few hospitals can perform surgeries offered by you.. Is this connected with uniqueness of equipment or is it a question of specialists?

– Complicated surgeries in this field are a new thing that is why they are very expensive. A person can become a candidate for such an intervention only when they passed a long series of diagnostics. Sometimes, it is necessary to open the skull and implant electrodes for days or even weeks in order to find out the details about epilepsy of a particular patient. Only then, at a second or third stage electrodes are taken out and resection in the corresponding area of the brain is done simultaneously. Such surgery can cost about one hundred thousand francs. Highly qualified specialists and their assistants are required to perform it. Such assistants are not surgeons, but they also take part in a surgery and know how to analyze the received signals.

Brain Research Challenges

– Do you provide surgical services to both adults and children?

– Yes, we work with children starting from when they are just two or three months old. The earlier you start, the better treatment will be for the child. Epilepsy develops from a very small area of the brain, and, if we are late, it can damage its other areas. Thus, it will restrain psychomotor development of a person in general. Our youngest patient is only two months old.

– How long does a surgery last and how much time is required for the patient to recover?

– It depends. There are simplest surgeries and there are some very complicated ones which can last 5–6 hours. But even if it all went well, a person is not ready for contacts within 2–3 days after the surgery. In particular, if the temporal lobe of the brain was subject to the intervention, emotions suffer. At first, such patients seem apathetic and ill-tempered, but after a few weeks, their condition is normalized. If there are no complications, they can be discharged from the hospital and get back to their habitual surroundings.

– It’s not easy to make a decision in favor of such surgery. People are usually afraid of the intervention into their brain.

– That is why we discuss all probabilities and forecast in details with the patient and their family. It happens that it is necessary to cut significant amount of tissue, but after that everything will look normal in appearance. On the one hand, our goal is to redeem the patient from epilepsy seizures and on the other hand not to harm them.

But there are some conservative families which believe that it is better not to undergo a surgery, as it will only make things worse. Small town doctors are not, perhaps, aware about the newest methods and they can’t convince them… It is necessary to get rid of outdated notions about treatment and the fear that surgery can do some harm, because the disease itself harms the brain.

– How many of such surgeries do you perform annually?

– We have hundreds of epileptics, but only 30–50 patients go as far as having a surgery.

– Do you observe your small patients when they grow up? Do they really recover?

– Yes, the majority of them experience no seizures in the future. If a child has fully recovered from epilepsy, they will develop normally. But there are those who still have these seizures even though they occur less often. In certain cases epilepsy is only a part of a big problem. Such children remain disabled, but they will suffer less from seizures. After all, the child is in grave danger, losing consciousness 10–20 times per day. If they fall in the wrong way, they could die. There are no such problems after a surgery, and it is a big progress already.

– Are there any documents required to undergo treatment at your hospital?

– The more information, the better. The perfect scenario is to send us your medical card with images and MRT (magnetic resonance tomography). We can say at least if there is any point in being admitted to the hospital on this basis. If some positive result is observed after a patient has been treated by other doctors, then it is better to wait and to observe them some more. But if there are no results, we will certainly help them.

Besides, linguistic neuropsychological examination is required to diagnose epilepsy. And it is necessary to known how to work with languages to do this. There are no problems with Russian patients and patients from Europe, but is gets more difficult with those who come from Middle East countries.

– Are there any recommendations on how to protect your brain in order to prevent the disease?

– I think that it is necessary to look after yourself and to be active, curious. You should constantly look for new targets and achieve them. All of us are different. But if each of us does something at their own level rather than just looking for comfortable conditions of existence and enjoying them passively, is already good. An elderly person should stop sitting at home and watching TV endlessly, but rather start expressing their interest in something new. Like reading more, solving crossword puzzles. Inner activity is required, only in this way we can prevent degradation. For example, I like cycling and listening to music.

Karl Schaller

Professor, Chief Doctor of neurosurgery department at Geneva University Hospital, professor of the Medical Center of Geneva University. Graduated from Tubingen University, received post-graduate medical education majoring in neurosurgery at Duisburg and Bonn, Germany.

Main expertise: surgery and research activity in neurovascular surgery, treatment of epilepsy and brain tumors. A member of editorial boards in such magazines as Acta Neurochirurgica, Neurosurgical Focus, Neurosurgery, and World Neurosurgery. Elected president of the Scientific Council of the European Association of Neurosurgical Societies (EANS) and co-founder of Geneva Institute, Research and Training Center in the field of new surgery technologies.