After its first year of operation, the Nebraska Epilepsy Program at
the University of Nebraska Medical Center and its hospital partner, The
Nebraska Medical Center, has been a huge success with more than 300 epilepsy
patients presently being treated.
The program is under the direction of Sanjay Singh, M.D., who joined
UNMCs neurological sciences department in July 2002 as assistant professor.
A native of India, Dr. Singh is Nebraskas first trained epileptologist.
He did his neurology residency at George Washington University in Washington,
D.C., where he was chief resident, and his fellowship in epilepsy and clinical
neurophysiology at Yale University in New Haven, Conn.
Epilepsy is a very difficult disease, Dr. Singh said. People with
epilepsy never know when they are going to have their next seizure. They
must depend on other people to drive them places, and frequently they lose
their jobs, because people dont understand the disease. Sometimes called
a seizure disorder, epilepsy is a chronic medical condition produced by
temporary changes in the electrical function of the brain, causing seizures
that affect awareness, movement or sensation.
Approximately 20,000 Nebraskans have epilepsy, and of that total about
6,000 have intractable epilepsy and require specialized care. Because of
the high demand, Dr. Singh said they are currently scheduling patients
six months in advance. Exceptions are made for more complex cases.
About 181,000 new cases of epilepsy are diagnosed each year in the U.S.
with 42,000 deaths occurring annually as a result of prolonged seizures.
Its estimated epilepsy costs the country more than $12.5 billion per year.
Of the 2.3 million people with epilepsy, 86.4 percent are more than 15
years of age.
The Nebraska Epilepsy Program is based on a comprehensive four-phase
monitoring and treatment program. The cornerstone of the program is the
video EEG monitoring system contained in Phase I. During the initial phase
the patients are monitored as inpatients. The average length of stay is
about five days with about four seizures being recorded. The state-of-the-art
video monitoring system records seizures around the clock. By monitoring
a patient, the team first identifies if the patient has epilepsy then determines
which type of epilepsy the patient has.
Phase I is the real critical part of the program, Dr. Singh says.
Our monitoring equipment is state-of-the-art and allows us to make the
best evaluation possible. Dr. Singh says very few centers around the country
currently use this advanced monitoring system.
The system calls for patients to have 28 EEG electrodes placed on their
heads. Most epilepsy centers only use 20 electrodes, Dr. Singh said,
but the additional electrodes allow us to be more accurate in our diagnosis.
After the testing is complete, the entire treatment team meets to review
data. From the findings, a treatment plan is developed and medications
are prescribed. If the medication therapy fails, the patient moves on to
Phase II. Patients that go beyond Phase I are potential surgical candidates.
Approximately 20 to 25 percent of epilepsy patients nationally are surgical
candidates.
We have learned so much about the brain in the last three or four years,
Dr. Singh says. Therefore, you really need to keep abreast of the advances.
If you studied epilepsy 10 years ago, almost everything has changed since
then.
Nebraska is the only state in the United States that doesnt have its
own chapter of the Epilepsy Foundation of America, the primary patient
advocacy organization for families with epilepsy. Dr. Singh said several
Nebraska patients are now working to start a chapter in Nebraska.
In addition, UNMC is hosting a regional epilepsy conference on Sept.
19 at the DoubleTree Hotel at 1616 Dodge St. Nearly 80 health professionals
have signed up for the conference, which is believed to be the first epilepsy
conference ever held in Nebraska.
Two of the leading epilepsy experts in the country Drs. Dennis and
Susan Spencer will present at the conference, which will run from noon
to 5 p.m. Dr. Dennis Spencer is interim dean of Yale University School
of Medicine and chairman of Yales department of neurosurgery, while Dr.
Susan Spencer is professor of neurology at Yale and the former president
of the American Epilepsy Society. Dr. Singh also will present at the conference
along with John DeToledo, M.D., co-director of the International Center
for Epilepsy at the University of Miami School of Medicine.
Prior to the conference, the Medical Center will hold a celebration
event in the Durham Outpatient Center atrium to recognize the accomplishments
of the first year of the Nebraska Epilepsy Program.
The celebration event will begin at 10 a.m. and is open to Medical Center
employees. Brief presentations will be made by: Harold M. Maurer, M.D.,
UNMC chancellor; Glenn Fosdick, president and CEO of The Nebraska Medical
Center; Pierre Fayad, M.D., professor and chairman of the UNMC department
of neurological sciences; the Spencers; Dr. Singh; and an epilepsy patient
from the Omaha area who has been successfully treated at the Nebraska Epilepsy
Program.
Epilepsy programs are led by a trained epileptologist, who has had
two years of specialized training in epilepsy. They also include a neurosurgeon
who specializes in epilepsy surgery, Advanced Brain Imaging techniques
(such as PET, SPECT and special MRI techniques) and a neuropsychologist.
The Nebraska Epilepsy Program is the only one in Nebraska, western Iowa and South Dakota.