Epilepsy-NervesStimulated

A Place for Epilepsy

Mary Greeley Named an Epilepsy Center

By Stephanie Marsau

Those seizures remain a vivid memory for Tricia Venzke.

They struck her as a child and a teenager. It wasn’t until she was 19 that Venzke learned their cause: epilepsy. Partial epilepsy with seizures originating from the right temporal lobe, to be exact.

What is Epilepsy?

According to the Centers for Disease Control, epilepsy, which is sometimes called a seizure disorder, is a disorder of the brain. It can be caused by different conditions that affect a person’s brain, such as stroke, but for 2 in 3 people, the cause is unknown.

When we hear the word seizure, many of us think of the type of seizure that results in convulsions, but one of the biggest misnomers regarding epilepsy is that those types of seizures have to be present in order to be diagnosed with epilepsy.

“Epilepsy and migraines are actually the same thing,” explains Dr. David Moore, McFarland Clinic neurologist and epileptologist. “With epilepsy you lose consciousness, although not in the way some might think. It’s a disorder that depending on which type you have, may or may not be associated with motor activity. So not all epileptics will go into convulsions, some may just enter an altered state of awareness, like a staring spell.”

A seizure occurs when the brain’s normal electrical pattern is interrupted by sudden intense bursts of electrical energy and can last anywhere from a few seconds to a few minutes and sometimes it can be hard to tell when a person is having a seizure.

If you suspect someone is having a seizure though, stay calm and time it if you can. Although a seizure seems to last awhile, most will not last beyond 60 to 90 seconds If the seizure approaches the three minute mark, or if the person seizing is pregnant, call 911.

Now a registered nurse at Mary Greeley, Venzke has lived with her condition for 18 years.
“I tried different kinds of drugs and they couldn’t control my seizures,” says Venzke. “I don’t know when I’m going to have an episode and I’ve never been able to tell in advance. All through college I stuck to a strict drug regimen, but it did not make a difference.”

At least it didn’t until Venzke met Dr. David Moore, a McFarland Clinic neurologist and epileptologist. Moore himself has epilepsy, enabling him to bring both personal insight and professional expertise to treating the condition.

Thanks in large part to the work he and his McFarland Clinic colleague Dr. Anu Baweja are doing, Mary Greeley Medical Center recently has been designated as an Epilepsy Center.

“The development of Mary Greeley as an Epilepsy Center gives individuals with uncontrolled epilepsy an opportunity to seek out alternative treatment options that may not have been available to them otherwise,” says Venzke. “Hopefully, this type of advancement will make as much of a difference in the lives of those people as it did for me.”

Becoming an Epilepsy Center

Moore has worked with drug studies related to epilepsy since 1992. In 2000, he started doing vagus nerve simulation surgery at Mary Greeley. He aspired to do something more for his patients. He wanted Mary Greeley to be recognized as an Epilepsy Center by the National Association of Epilepsy Centers.

What is Vagus Nerve Stimulation?

The vagus nerve is part of the autonomic nervous system, which controls functions of the body that are not under voluntary control, such as the heart rate.

It passes through the neck as it travels between the chest and abdomen and lower part of the brain.

Vagus nerve stimulation involves sending electrical energy to the brain via the vagus nerve. So how does it work?

A device very much like a pacemaker for the brain is implanted under the skin on the left side of the chest. A wire runs from it to the vagus nerve in the neck. The device then sends signals to the brain’s thalamus, which acts as a relay station of sorts, and sends a message to both sides of the brain telling it to suppress seizure activity.

“The key word here is suppress,” says Dr. David Moore, McFarland Clinic neurologist and epilepitologist. “Vagus nerve stimulation may not necessarily stop seizures altogether, but in patients whose seizures are limited to one part of the brain, it can be effective in suppressing those seizures.”

The surgery is done at Mary Greeley and is typically an outpatient procedure which takes anywhere from 60-90 minutes. Moore estimates that he has between 80-100 patients who have vagus nerve stimulation devices implanted.

For more information,contact McFarland Clinic Neurology at 515-239-4435.

“No epilepsy center existed in central Iowa,” states Moore. “At the time, the only other center in Iowa was in Iowa City and in order to be treated at an epilepsy center, patients either had to drive there, to Omaha or the Mayo Clinic.”

Many of the services needed to earn epilepsy center designation were already in place at Mary Greeley. Neurologists who practice at the hospital are able to do epilepsy monitoring to determine what kind of epilepsy someone has. They are doing research projects and numerous drug studies. Many of the clinical staff who would comprise the epilepsy team are in place. One last requirement was needed though: another epileptologist.

In March of 2014, McFarland Clinic neurologist and epileptologist Dr. Anu Baweja joined the team, allowing Mary Greeley to be recognized as a Level 3 Epilepsy Center. Baweja joined McFarland after a residency and fellowship at Washington University/ Barnes-Jewish Hospital in St. Louis. (A Level 4 center performs invasive surgery and requires at least one neurosurgeon.)

“We offer options in care that other places don’t offer,” says Moore. “We can offer the newest medications available by participating in drug studies, which are done here. Also, as an Epilepsy Center we have ties to other centers. If it should ever happen that a patient has to have surgery at a Level 4 center, their follow up care can still be done here because we have a direct relationship with them.”

Cannabis Oil: Legal or Not?

Mary Greeley and McFarland Clinic are currently taking part in a drug study with GW Pharmaceuticals regarding the use of cannabis oil. A drug trial is being done in special populations to test the oil’s effectiveness.

“If it does well in this study, the FDA would approve the oil and it would become available for use in all 50 states,” says Dr. Moore.

To learn more about the studies, contact the McFarland Clinic Clinical Research at 515-956-4037.

As for the legality of the oil in Iowa, the answer is yes and no. In 2014, the state of Iowa passed the Medical Cannabidiol Act, which allows possession and use of up to 32 ounces of cannabis oil for the sole purpose of treating chronic epilepsy and its side effects.

Here’s the catch. Production of cannabidiol, or cannabis oil, is not legal in Iowa. Patients can sometimes gain access in other states, but it is illegal to transport the oil across state lines.

“Essentially our legislature passed a law saying you can use it, but there’s no way to
legally obtain it,” says Moore. “You can only get it in Colorado or Oregon, but it’s against federal law to bring it back into Iowa.”

In fact, if caught moving the oil across state lines, federal laws, which carry harsher
penalties, could come into play. Outside of the legal factor, there are other hoops to jump through in order to obtain cannabidiol because it is a Schedule I controlled
substance.

A patient must find a neurologist willing to prescribe it. The patient must be diagnosed with epilepsy and the neurologist has to sign papers saying why the patient should be on cannabidiol. This neurologist also must have a registration number assigned to them by the U.S. Drug Enforcement Administration that allows them to write prescriptions for controlled substances.

Personal Experience

McFarland Clinic neurologists and
epileptologists, Dr. David Moore and
Dr. Anu Baweja review a patient’s
electroencephalogram (EEG) results.
Moore himself has epilepsy, which
provides him a unique perspective
when treating his patients.

Moore had his first seizure in June 1980, shortly after earning his undergraduate degree. He had his last seizure in May 1988 after graduating from medical school. He did a neurology residency at the University of Wisconsin.

“The University of Wisconsin is an Epilepsy Center and it wasn’t until I was there that I decided to go into epilepsy,” recalls Moore. “Strangely enough, I didn’t go into it because I had epilepsy. I decided to go into it because I wanted to be able to treat both adults and children.”

It was then on to Vanderbilt and then Elkhart, Ind. where he opened an epilepsy monitoring unit in 1994. In 2000, he arrived in Ames and opened up a monitoring unit at Mary Greeley.It was also around this time that Venzke became a patient of Moore.

In 2002, Venzke was referred to a specialty epilepsy clinic in Minnesota and in 2003 she had right temporal lobe surgery to better control her seizures. Since that surgery, she only has episodes while she is sleeping and only a few per year.

“The decision to have that surgery has made an incredible difference in my life,” says Venzke. “Although I continue to take medication, Dr. Moore helped reduce my condition into something much more manageable that doesn’t affect my life as drastically as it once did.”