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Implant Alleviates East Islip Man's Epilepsy (Newsday)

Source: Newsday 
By: Delthia Ricks

Featuring: Dr. Ashesh Mehta, Director, Epilepsy Surgery, North Shore-LIJ Cushing Neuroscience Institute.

The stormy electrical activity that once frequently seized Michael Sganga's mind has been squelched by a high-tech implant doctors call a pacemaker for the brain.

Sganga, 38, a resident of East Islip, has had epilepsy since his teens, but it took years for the condition to manifest, and years more, he said, to find a solution.

Doctors surmise Sganga's epilepsy was the result of a deep brain infection by a tropical parasite in South America where Sganga was adopted as a newborn from an orphanage. Although doctors say the infection fully resolved in infancy, it caused enough brain damage to produce persistent grand mal seizures by the time Sganga was 18.

Now, after 20 years of battling epilepsy, Sganga has received an implanted neurostimulator that prevents seizures by sending mild, continuous pulses of electrical energy to his brain.

While not a cure, the device provides assurances that seizures will cease.

"I am stabilized now," said Sganga who works in the human resources division of the New York State Office of Parks, Recreation and Historic Preservation.

"It affects my voice a little," he said, noting the implant sends electronic energy through nerves controlling his larynx, or voice box, giving his voice a slight Doppler effect. In mid-sentence the sound of his words recede before resuming full volume.

Sganga's implant surgery coincides with a range of recent developments that have trained a spotlight on epilepsy.

The Institute of Medicine, a division of the National Academy of Sciences, recently declared epilepsy is poorly understood in the general population. And epileptics, the experts said, have trouble with employment and disproportionately experience depression.

1 in 26 adults have seizures
Misconceptions, they added, persist despite 2.2 million people in the United States having been diagnosed and 1 in 26 adults experiencing a seizure at some point in their lives.

Epilepsy is characterized by a potent surge of electrical activity that flows through all or part of the brain, lasting seconds to minutes. Symptoms can range from full-blown convulsions and loss of consciousness to staring blankly or involuntary jerking motions of the limbs.

Causes include traumatic brain injury, stroke and infection. In some instances, the cause is never known.

Aside from the institute's research, federal studies have revealed that people with uncontrolled epilepsy are at greater risk of car crashes, drownings and other devastating accidents because of sudden seizure onset.

Sganga said he spent years with poorly managed epilepsy because the drugs doctors prescribed didn't work, leaving him vulnerable to frequent, unpredictable seizures.

Physicians at the University of California, Los Angeles, meanwhile, following a clinical trial reported in March, noted that surgery should be considered as soon as possible after medications fail—not as a last resort as is common practice.

It took 15 years before Sganga underwent his first neurostimulation operation in 2007. His most recent operation, earlier this month, involved the implantation of a state-of-the art device that functions round-the-clock using a battery guaranteed to last seven years.

"I have my good days and my bad days. I am able to drive," Sganga said. "So I am extremely lucky. Without it, I don't think I would be able to function at all."

Seizures often resist drugs
Dr. Jerome Engel, Jr., lead author of the UCLA analysis, estimates that anywhere from 20 percent and 40 percent of people with epilepsy are plagued by seizures that resist medications. Yet Engel found that patients referred for surgery generally have had epilepsy, on average, for 22 years.

Peter Van Haverbeke, spokesman for the American Epilepsy Society, said surgical options aren't new and have been available for a generation.

"The National Institutes of Health did a study on the effectiveness of surgery as early as the 1970s," Van Haverbeke said, noting that the kind of surgery Sganga underwent has been available since the mid-1990s. The difference now is the stimulator's stronger battery.

Dr. Ashesh Mehta of North Shore University Hospital in Manhasset, noted that surgery has to be well-tailored to the patient.

Mehta, director of epilepsy surgery, performed Sganga's implant operation, known as vagus nerve stimulation.

A neurostimulator—a disc about the size of a silver dollar—is implanted under the skin of the chest. The wire from the device is wound around a nerve in the neck.

Mehta said Sganga's implant will last 75 percent longer than earlier devices.

Sganga said he chose implant surgery because medications left him subject to seizures and side effects.

"I would get rashes, a bloody nose, dizziness and I would have auras," Sganga said, referring to physical changes epileptics experience minutes to hours preceding a seizure. An aura, doctors say, can manifest in the form of nausea, headache, depression or sleep disruption.

"I'd wake up with nightmares. That's why they kept switching them," he said of the medications. "There was never a normal day."