St. Luke’s Comprehensive Epilepsy Center
New facility expands the treatment for those with intractable seizures

by Alan Minskoff

When someone with epilepsy does not respond to anti-seizure medication, a challenging situation-having a seizure condition- becomes complicated and frustrating. Usually the patient has tried more than one course of drug therapy and has not responded. Since the opening of the St. Luke's Comprehensive Epilepsy Center of Idaho patients for whom medication has not offered a solution now have the same diagnostic care available in Boise as in larger cities or in major university hospitals.

Opened this past fall, the mission of the four-bed Epilepsy Center is to treat patients, approximately one third of those who suffer from epilepsy, whose seizure conditions are not controlled by drugs. Asked why the hospital decided to invest in an epilepsy center, Chairman of St. Luke's Regional Medical Center board of directors Skip Oppenheimer replied that "we saw an unmet need in the community and worked to bring the latest technology and found a world-class epileptologist in Dr. Robert Wechsler so patients can now be treated in the Boise Valley instead of out of state." Nearly three million Americans and about 20,000 Idahoans suffer some form of epilepsy. The St. Luke's Comprehensive Epilepsy Center has arrived at a most fortuitous time for the thousands of Idahoans whose seizure disorders make them candidates for alternative treatment options.

Recently we caught up with Dr. Robert Wechsler, the medical director of the new Epilepsy Center, to see how the new facility and epileptologist were fairing. Wechsler quickly credited the hospital for its foresight and complimented its experienced staff members, Linda Monroe, supervisor of the Neurodiagnostic lab, and Marsha Cantrell, the department director for 5 East where the Center is located (both have long experience working with patients with seizure conditions) for the Epilepsy Center's smooth start. A fellowship-trained physician, Wechsler holds both an MD and PhD; he remarked that he was especially grateful that the hospital "puts the needs of the community first and has been 100 percent supportive," adding "it's a treat to work within an institution that's so committed to epilepsy care."

Asked why he chose Boise, he said he was looking to direct an Epilepsy Center in a medium-sized city-having a population-base of about a half million-with a hospital that could free up four beds for patient monitoring, with an experienced nursing support and strong neurologists and neurosurgeons. Boise and St. Luke's fit on all counts; besides his wife, Casey, grew up here.

The Center concentrates on those patients identified as unresponsive to antiepileptic drugs. For these patients Dr. Wechsler starts by confirming the diagnosis. He states, "there are at least a dozen things with which epilepsy can be confused." It's important to distinguish between a seizure condition-about forty types of seizure conditions have been defined-and imitators. Once the epilepsy diagnosis has been confirmed and it's determined that "the seizures are refractory to medication," then the next goal is to decide if the patient is a candidate for surgery. Studies show that patients with seizure conditions centered in the temporal lobes have very good success with epilepsy surgery.

Wechsler's indicates that 70 to 80 percent of these patients remain seizure free for a year. After five years, 50 percent are still seizure free. Of course not all patients who are monitored at the Center are candidates for surgery. For those for whom it is not an option, varied treatments are tried: continued medication; the Vagal Nerve Stimulator, a stopwatchsized chest implant that works by regulating the vagal nerve to control brain activity; the ketogenic diet helps others; also strict avoidance of triggers (things that set off unusual brain activity); experimental protocols as well as new medications under development. Wechsler adds, "At the Epilepsy Center we select the best strategy for every case."

Some cases present difficulties determining whether the problem is truly epilepsy or a behavioral issue. Wechsler maintains that many of these patients can benefit from monitoring as well. "At a fundamental level there are folks who don't know that they're having seizures; they understand that a seizure condition is a possibility." The path to the St. Luke's Comprehensive Epilepsy Center of Idaho follows a simple course. A primary care physician or neurologist recognizes that the patient's seizures do not respond to drug treatment-usually two different drug trials are tried for as long as a year each-then the doctor refers the patient to the Center. For those whose epilepsy may have seemed a hopeless burden, the new Center provides local services that will help identify the most appropriate treatment and allow the patient a minimum disruption at work, school or to home life.

Dr. Wechsler came to Boise after a two-year fellowship at Stanford University Medical Center in Palo Alto, California. He and his wife Casey have three children-ages six, four and two. He states that he chose Boise because of the hospital, his wife's family connection and it housed the Epilepsy Foundation of Idaho (EFI). The Epilepsy Foundation of Idaho offers educational programs such as Kids on the Block, presents conferences, helps clients who cannot afford medication with emergency funding and has offices in Boise, Idaho Falls and Coeur d'Alene. Wechsler sees EFI playing two essential roles: first, support and education for those with known epilepsy and second, educating the public about seizures. Wechsler is currently vice-chairman of the EFI's Professional Advisory Board.

Alan Minskoff
teaches journalism at
Albertson College of Idaho.
He is the current chair of the Epilepsy Foundation of Idaho.