New high-tech device offers hope for epilepsy patients

Epileptic seizures used to rule Cheryl Castle's life. They became so frequent that they could strike up to 42 times in three hours, leaving the once-active mother of three essentially housebound.

But after numerous treatments failed to control them, a new device implanted in her skull has reduced the frequency and severity of her seizures by half, she and her doctors say. Some physicians call it the first major advance in epilepsy treatment in more than a decade for the most severely afflicted patients.

"I'm much better," says Castle, 41, of Lowmansville, Ky. "I'm starting to cook again. I'm able to sit and write. I would love to find a job."

The device, created by California-based NeuroPace, includes a small, battery-powered neurostimulator that continuously monitors the brain's electrical activity, delivering brief pulses of stimulation when it detects a seizure might be coming. Wires connect the neurostimulator to the area of the brain where the patient's seizures start.

It's the latest advance to treat a brain disorder afflicting 2.3 million Americans, creating short changes in normal brain activity that can cause patients to fall, shake and lose awareness of their surroundings. Some patients suffer these seizures infrequently, but the most severely afflicted patients can experience dozens each day.

Doctors say the new device is the biggest advance in the field since the vagus nerve stimulation, or VNS, was approved in 1997. While VNS, a device placed under the skin on the upper chest, delivers stimulation at periodic intervals regardless of brain activity, the new device detects what the brain is doing and delivers electrical stimulation in response.

"The VNS delivers off and on, periodic stimulation. If it hits a seizure, great. But it doesn't always," says Meriem Bensalem-Owen, Castle's doctor and director of the Epilepsy Program at University of Kentucky HealthCare's Kentucky Neuroscience Institute. "NeuroPace is much more complicated."

After implantation, detection and recording of brain activity are turned on. A doctor reviews the recorded data, identifying patterns that typically precede a patient's seizures. Detection settings are then adjusted for those patterns, and the neurostimulator is programmed to respond to them.

Castle — diagnosed with epilepsy in 1996 after having a grand mal seizure while lying in bed — says she tried VNS, and many medications, to control her ever-worsening disease. But nothing worked. She lived with a constant fear that a seizure would strike, which would make her "shake inside just walking to the store."

Then in November, Craig van Horne implanted the NeuroPace in Castle during a five-hour surgery at the University of Kentucky. And after four weeks of recovery, Bensalem-Owen activated it.

Castle now collects information on her seizure activity each day, retrieving it using a special monitor and sending it to a database so her doctors can look at it between appointments and decide whether adjustments must be made.

"Metaphorically speaking, it's a defibrillator for the brain, much like a pacemaker for the heart or the paddles they use in the ER to shock a heart attack victim back to life," says van Horne.

The device doesn't completely eliminate seizures, doctors say, but it can halve their frequency, as it did in Castle's case. And it seems to work in the most difficult-to-treat patients, in whom drugs and other procedures have failed. Doctors say it also provides a springboard for other more "smart" medical devices in the future.

Gregory Kent Bergey, director of the Johns Hopkins Epilepsy Center in Baltimore, was involved with clinical trials of the device and says it's too early to know how it compares head-to-head with longtime treatments. But he says it's shaping up to be a real boon to patients with few other options.

"Now, we have something else we can use," van Horne says. "This gives you hope."