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Luis Morillo, Neurologist
Dr. Luis Morillo, Neurologist

Evolving Epilepsy Care

The Adult Epilepsy Program at Hamilton General Hospital helps patients become seizure-free.
“Curing someone of epilepsy is very rewarding. It truly is life-changing.”

“One of the most common misconceptions about epilepsy is that it affects only children,” says Dr. Michelle Shapiro, an Epileptologist at Hamilton General Hospital. “The truth is that epilepsy can develop at any age.”

Epilepsy is a brain disorder that causes recurring and spontaneous seizures. According to Dr. Shapiro, epilepsy can be caused by:

• Genetics

• Brain infections

• Autoimmune disorders

• Issues related to stroke, tumours or brain bleeds

There are also instances where the cause of a patient’s epilepsy cannot be identified. “Having a single, isolated seizure is not the same as epilepsy,” explains Dr. Shapiro. “You must experience more than one seizure 24 hours apart to be diagnosed as epileptic, or demonstrate a predisposition to having seizures, usually through MRI or an electroencephalogram (EEG) test.”

A common condition

Epilepsy is prevalent in 1 to 3 per cent of the population. Patients may be referred to the Adult Epilepsy Program at Hamilton General Hospital by a caregiver in the Emergency Department, a family physician or a neurologist.

“I see about nine new patients a week and approximately 1,400 patients total each year,” says Dr. Shapiro. “We see patients from communities like Niagara, Brantford, Guelph and Kitchener-Waterloo.”

Pediatric patients who receive care at McMaster Children’s Hospital may be referred to The General’s transition clinic to help ease them into the adult program.

Prepping for surgery

“Medication is always the first course of treatment,” explains Dr. Shapiro. “If medication proves unsuccessful in stopping the seizures, then the next option is surgery.”

While there are many types of seizures, they fall into two major categories:

• Focal seizures, which occur in one particular area of the brain

• Generalized seizures, which originate in both hemispheres of the brain

“Adults tend to have more focal seizures compared to pediatric patients,” says Dr. Shapiro. “Focal seizures are much easier to cure with surgery.”

The program is also home to a three-bed monitoring inpatient unit, where patients are taken off of their medication and assessed via EEG and video monitoring over an extended period to determine if surgery is a viable option.

If surgery is unsuccessful or not a viable option, patients at The General can undergo vagus nerve stimulation (VNS). Similar to a pacemaker, a device is implanted into a patient’s chest which sends regular pulses to the brain through the vagus nerve in an attempt to prevent seizures.

Other treatment options include a ketogenic diet – a high-fat, medium-protein, low-carbohydrate diet therapy. However, this diet is more commonly prescribed for children, as most adults can tolerate only a modified version.

Donor dollars in action

If patients continue to experience chronic series, they are typically followed for life by the clinic.

“EEG tests are important, as they monitor and record electrical activity in the brain. Thanks to donor support, we acquired a special monitor in our inpatient unit that clearly displays the EEG to ensure that seizures are detected with greater accuracy. If a nurse sees an abnormality on the monitor, they can check in with the patient immediately.”

An evolving program

Dr. Shapiro has been proud to watch the program evolve and expand over the past 10 years.

“Every patient used to be sent to another centre for assessment, but now we can perform all assessments at The General. We also used to do very few inpatient EEG tests, and now we conduct them all the time.”

Ultimately, making a difference in patients’ lives is Dr. Shapiro’s favourite part of her work.

“Curing someone of epilepsy is very rewarding. It truly is life-changing.”

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