VOL. 132 | NO. 133 | Thursday, July 6, 2017
Area’s Only Epilepsy Monitoring Unit Progressing in First Year
By Michael Waddell
Dr. Pawan Rawal leads the Epilepsy Monitoring Unit established by the UT Health Science Center and Baptist Memorial Hospital-Memphis. (Daily News/Houston Cofield)
With more than 30,000 epileptics living in the Memphis area, the Epilepsy Monitoring Unit at Baptist Memorial Hospital-Memphis, which opened nearly one year ago, is providing much needed specialized care and treatment for patients that previously were forced to drive to Jackson or Nashville for similar care.
Baptist and the University of Tennessee Health Science Center launched the comprehensive, four-bed clinic for monitoring patients and their seizures last August.
“In 2014, we identified epilepsy as one of the key areas where we needed to prioritize for development of health services,” said Dr. Andrei V. Alexandrov, UTHSC chairman of the Department of Neurology and Semmes-Murphey professor. “Now we’re starting to see progress because a lot more patients who develop seizures now have access to fellowship-trained epilepsy specialists in town.”
Neurologist Dr. Pawan Rawal heads up the specialized unit and is a faculty member at UTHSC.
“Things have been going really well,” Rawal said. “I think we have bridged access to care, as it was difficult to get this kind of care in the surrounding region, and the time to get the appropriate diagnosis and appropriate therapy is steadily reducing.”
In general, one in 26 people will have a seizure during their lifetime. The unit sees predominantly two types of patients: those who have very bad seizures and medication is not helping and those who have been misdiagnosed as having epilepsy.
“It has been shown in our experience, and at other centers it has been similar, on average one out of three patients who have seizure-like episodes like shaking, confusion or staring, and medications are not working for them, don’t have the right diagnosis,” said Rawal. “The only way to make the right diagnosis is to do a seizure monitoring unit study where we capture the brain waves at the same time.”
He stresses there is no 100-percent way to know symptoms are a seizure or not without the study. Many patients are put on an epilepsy medication in an emergency room situation without the due diligence to make sure it is the right choice, and they could remain on that medication throughout their lives without a proper study.
“We figure out where exactly in the brain those seizures are coming from so that we can tailor their medical treatment to their seizure subtype and also provide them with options in addition to medication, such as devices and surgery,” Rawal said.
The unit’s hospital setting is important because it allows staff to adjust seizures quickly during the studies. An EEG tech staff watches over the brain waves of patients 24/7.
“Many times before a patient or their family knows they are having a seizure, we can detect it early on,” Rawal said. “Baptist has been making a lot of investment in that direction, and we have a really specialized staff with a nursing ratio of one nurse for every two patients.”
Studies show that half of people with epilepsy have a co-existing mood disorder, with the most common being anxiety and depression.
“There is actually a relationship between untreated mood disorders and epilepsy,” Rawal added. “In a seizure patient, all things being equal, if you recognize their symptoms early and get them on the right medication or counseling, then their seizures actually get better. There are so many options now that you can individualize the therapy.”
Surprisingly, there is often a five- to seven-year delay for patients to get to a seizure monitoring unit for the proper diagnosis and therapy, meaning many productive years of their life are handicapped in the process.
“I wish I could’ve been here sooner because so many patients could have been helped earlier, and I’m sure many of them are still out there who are not getting timely care,” said Rawal, who believes it is important to be aggressive with epilepsy treatment because in cases where it is identified early enough, some carefully selected patients could have an option of being cured through surgery.
He recommends that patients be monitored every two years because their epilepsy can change over time and there might be new options available to them.
A short-term goal for the unit within the next year is to hire a neurosurgeon with a special interest in epilepsy.
“As a university, we are trying improve care in Memphis by bringing in specialized neurologists, not general neurologists, and we still have several areas where we need to improve,” Alexandrov said.
UTHSC acts as a unifying force to provide academic medicine and cutting-edge ideas to local health care institutions. The goal is to develop a citywide epilepsy team with 24/7 access to board-certified physicians.
“The Epilepsy Monitoring Unit is strategically located next to the Neuro-Intensive Care Unit in that area of Baptist, so we are trying to create a new hub where different practitioners like vascular neurologists, neuro critical care doctors, epilepsy physicians, neurosurgeons, and general neurologists can all bring their patients and get everyone’s input,” Alexandrov said.