Technology Innovation Helps Stop Seizures

For decades, Eli Mies dreaded sleep. When he closed his eyes, the seizures hit. He'd lived with uncontrolled epilepsy for most of his life, with the worst of the seizures occurring at night.

"It wasn't as bad when I was younger, but as I grew up, my seizures took a turn for the worse," Eli says. "Life got pretty dark. I was anxious and nervous about going to sleep, which left me exhausted and without energy. I lost interest in my job, family gatherings, going out with friends. It was like life was blank, and I didn't really care."

"It was terrible," Eli's father, Paul, adds. "Years ago, a doctor had told him he would always be on medications, and he kind of resigned himself and gave up. He was depressed and not engaged in life. Fortunately, one day, my sister, a doctor, told us, 'You don't have to live this way.'"

Advanced, specialty care

She introduced Eli to the fellowship-trained epileptologists, neuroradiologists and neurosurgeons at The University of Kansas Health System, including epileptologist Patrick Landazuri, MD.

"Dr. Landazuri was a blessing," Eli says. "He was the one who gave me hope to become seizure-free. The day I saw him was the first time I thought, 'You know, let's give this a shot.'"

The experts collaborated as an interdisciplinary team – a group of specialists with combined expertise – to evaluate Eli's condition and find an answer.

"Eli's seizures were very disruptive," Dr. Landazuri says. "He had never been seizure-free and thought this was something he would have to deal with his entire life. Our team was ready and eager to find him a personalized solution."

Dr. Landazuri began treating Eli with anti-seizure medications, the most common first step in the effort to control epilepsy.

"For most people, the best and easiest choice of treatment is medication," Dr. Landazuri says. "But for those patients whose epilepsy does not respond to medication – and they can be identified pretty quickly – we offer a range of surgical options. We felt Eli was a strong candidate for surgical treatment and met as a team to evaluate him."

The team performed advanced imaging studies. The high-resolution images and the expertise of a diagnostic neuroradiologist revealed the cause of the epilepsy – a focal cortical dysplasia that could be surgically removed to stop Eli's seizures.

Progress

In April 2017, neurosurgeon Paul Camarata, MD, removed the abnormal tissue from Eli's brain. For an unprecedented several months, Eli experienced no seizures. But they returned. He visited his care team and learned about a brand-new technology innovation that would refine his next procedure for a complete and lasting result.

With the November 2017 opening of its state-of-the-art Cambridge Tower A, The University of Kansas Health System had acquired an intraoperative MRI. The technology, installed within the operating room, allows surgeons to take images during the procedure to assess their progress and determine their next steps. It reduces risk to the patient, as there is no need to move the patient to the imaging area while under anesthesia, and helps surgeons confirm all of the abnormal tissue has been removed before completing procedures.

"In many cases, we can see the difference between healthy brain tissue and scar tissue or tumor tissue," Dr. Camarata says. "But where that is less visually distinct, the iMRI is very helpful. It helps us remove tissue in very fine detail to ensure completeness and saves patients from having to return for repeat surgeries."

During Eli's first procedure, the neurosurgical team had had to err on the side of caution, removing as much abnormal tissue as safely possible without risking the healthy adjacent brain tissue, some of which controlled Eli's movement abilities. A follow-up MRI later showed that a small amount of abnormal tissue remained, a possibility the team had anticipated given the difficult location of the problematic tissue.

"That's when the intraoperative MRI came into play," Dr. Camarata says. "It is the highest-resolution imaging available in the country, and we have the only one in the region that's right in the operating room. We use it to assess and confirm we've resected all of the abnormal tissue before closing the surgery site. Eli hasn't had a single seizure since. It's a life-changing event, especially for a young person just getting his start."

A positive outlook

The results are highly encouraging.

"Eli has been seizure-free since the surgery," Dr. Landazuri says. "I am very optimistic for him. The imaging shows no remaining abnormal tissue, and that is the most powerful prognostic information. Eli is very pleased, and we are so pleased for him."

Eli credits his care team for an outcome he calls "a night and day difference."

"It's been incredible," he says. "I enjoy going to work and spending time with people. I'm sleeping well. It's like I've seen the light. These people honestly care, especially Dr. Landazuri and Dr. Camarata. I'm forever indebted to this amazing team. I have a different life."

His father could not agree more.

"What comes to mind for me is just hearing him laugh again," Paul says. "He's back, and it's fantastic. We got our miracle."

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