Epilepsy: a collaborative cure

Epilepsy:
a collaborative cure
Epilepsy – a disorder that causes abnormal electrical brain activity leading
to recurring seizures – can affect anyone. Although daily medication
can treat the condition, doctors are increasingly recommending surgery
as a cure for patients who don’t respond to medical treatment. A multidisciplinary team of University of Cape Town (UCT) specialists is making
sure that more and more patients with drug-resistant epilepsy are cured.
Step 1: Diagnosis
Step 3: Treatment
Mikhulu* had her first seizure when she was nine months
old. She was referred to the UCT-affiliated Red Cross War
Memorial Children’s Hospital where she was assessed by the
head of paediatric neurology, UCT Professor Jo Wilmshurst,
and her team. They diagnosed Mikhulu with epilepsy,
identified the type of epilepsy affecting her and started her
on medical treatment.
Now five years old, Mikhulu has prolonged seizures
many times a day. Unfortunately, three kinds of antiseizure
medication haven’t been able to control them.
As part of her assessment in the neurophysiology
department, Mikhulu is monitored with a specialised tool that
records her seizures and helps doctors identify the part of
the brain where they most likely originate. After a thorough,
multi-part assessment, Wilmshurst and her team identify the
cause of Mikhulu’s epilepsy and recommend her for surgery.
Once the team has confirmed which part of Mikhulu’s brain is
causing her seizures, Enslin decides which surgical technique
to use.
“We decide whether we can do a surgical resection to
remove the part of the brain causing her seizures – the
preferred choice – or whether we can … disconnect it from
the rest of the brain.”
If neither of these techniques is appropriate, they will
consider inserting a battery-operated nerve stimulator.
But in Mikhulu’s case, the team decides to remove the
temporal lobe causing her seizures. After an operation that
lasts six hours and involves multiple neurological tests, Enslin
successfully removes the brain tissue.
Step 2: Evaluation
Before Mikhulu undergoes surgery, she is assessed by
neurologists and neurosurgeon Dr Nico Enslin, who will
operate on her to isolate the part of her brain causing the
seizures. She also undergoes a full neuropsychological
assessment.
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Step 4: Research
The piece of brain Enslin removes is about the size of a
matchbox. This would normally go for routine examination,
but Mikhulu and her parents have given their consent for it to
be used for research too.
So, Dr Joe Raimondo and his team receive the brain tissue
in the operating theatre and keep it ‘alive’ using artificial
cerebrospinal fluid, a clear liquid found in the brain and spinal
cord that helps to protect the brain.

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