Implant stimulates epileptics' hopes For some, new device reduces frequency, severity of seizures

January 05, 1998|By Jonathan Bor | Jonathan Bor,SUN STAFF

In the 15 years she has battled epilepsy, Erinn Farver has tried countless medications and even explored the possibility of a brain operation. But the drugs have done little but make her sleepy, and her seizures are not the type that disappear with surgery.

Now, she enters the new year hoping that the latest innovation in epilepsy therapy -- an electronic brain stimulater -- will make the difference. On Dec. 15, surgeons at the University of Maryland Medical Center made her the first patient in the state to receive the device, which looks like a hockey puck and is inserted in the chest just beneath the collarbone.

The computerized implant "turns on" every five minutes to deliver a 30-second burst of electricity to the vagus nerve, a pathway that carries the low-voltage current to the brain. For some patients, this has the mysterious effect of reducing the frequency and even the severity of seizures.

Years of struggle against this unpredictable disease have taught Farver not to hope for a cure. She'd be happy with fewer seizures -- episodes of jumbled speech, partial paralysis and even fall-to-the-floor blackouts that have turned her life into a frustrating and even dangerous adventure.

"Right now, all I can tell you is that it looks promising," Farver, 27, said a few days ago.

Epilepsy, which afflicts 2.5 million Americans, is a disease marked by bursts of abnormal electrical activity in the brain. Patients may lose consciousness or remain awake but lapse into states of fuzzy, disorganized thinking.

Farver, who lives in Westminster, said she has not had a full-blown seizure since getting the implant. And twice, when she felt the strange "auras" that typically mean trouble, she successfully headed off seizures by holding a magnet to the pocket of skin that hides the implant.

This automatically triggers the device, advancing its cycle so it launches a pulse right away.

Like most patients, Farver says the main side effect is a mild tingling in her throat that occurs whenever the device is supplying current. This makes her hoarse and raises the pitch of her voice -- side effects she is willing to tolerate if the stimulater calms her epilepsy.

It will be months before Farver and her doctors can say whether the implant has made a difference. This is because her seizures do not come with regularity -- several weeks of peace can give way to stretches in which the attacks are frequent. Doctors also warn of a placebo effect, a feeling of well-being that can happen when patients want something to work.

Farver has suffered from epilepsy since, at 12, she fell off a rope bridge at summer camp and struck her head on the ground. The head injury apparently triggered the disease, and the condition grew worse eight years later when she suffered a severe case of chickenpox.

Despite her positive attitude, Farver says the condition has profoundly limited what she has been able to do.

"My pediatrician took me off of roller skates and tree climbing, all the sorts of things you're supposed to do when you're a kid. I haven't ridden a bike in years; then, of course, when my seizures got this severe, I couldn't walk alone or do things on my own."

She cannot drive, and she quit a job at Kmart after she had a few convulsive "grand mal" seizures in the store. Now, she attends Carroll Community College and hopes eventually to teach art in an elementary school.

FDA approval in July

The vagus nerve stimulater received government approval in July after years of testing on animals and humans. All told, 1,500 implants have been installed in clinical trials or on the open market. It is made by Cyberonics Inc., a firm in Houston.

The implant costs $9,000, not including hospital expenses, and is covered by many insurers.

Clinical trials showed that after three months of stimulation, about 28 percent of patients reported at least a 50 percent reduction in the frequency of their seizures. After 18 months, the results improved -- 45 percent of the patients reported similar gains.

That still means about half of the patients did not improve. But treating epilepsy has long been a hit-or-miss affair, so doctors have begun to regard the device as a potentially useful treatment for patients who cannot benefit from standard remedies.

Eighty percent of all patients respond to medications, and another 10 percent are candidates for brain surgery, a procedure in which the offending piece of brain tissue is removed. It is an option for patients whose seizures originate in only one place.

That leaves a small percentage -- up to 10 percent -- who might be candidates for electrical stimulation. For Cyberonics, the number of potential clients is actually quite large -- up to 250,000 people in this country alone.

No guarantees

Doctors cannot guarantee that the device will work for a %J particular patient but welcome a therapy for people who are still seeking relief. At the same time, they emphasize that the stimulater is not a complete fix even when it succeeds.

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