Changing Lives for Patients with Epilepsy
It was a long and winding path that brought Andrea Millares from Monterrey, Mexico, to Cleveland Clinic’s Epilepsy Center. Once she was here, she received an innovative, minimally invasive “brain mapping” procedure and highly targeted neurosurgery to treat her intractable epileptic seizures. Now, nearly 1.5 years later, that surgery has left her seizure free—and changed her life for the better.
Ms. Millares, now 29 years old, had her first grand mal seizure when she was 16, and that’s when doctors in Mexico first diagnosed her with temporal lobe epilepsy. “However, as long as I can remember, I had been experiencing another type of seizure known as a partial—or focal—seizure,” she says. “I had no idea these episodes were some kind of seizure, so I learned to live with them.”
Before looking into surgical options, Ms. Millares had tried six different types of anti-seizure medications—with no success. “I wasn’t getting any better and the partial seizures became stronger,” she says. “I was having from five to six focal seizures a month. Finally, after 11 years, it was my fourth neurologist who suggested I should try the brain mapping treatment.”
Ultimately, that recommendation led her to Cleveland Clinic neurosurgeon Jorge Alvaro Gonzalez-Martinez, MD, PhD, who first learned the brain mapping procedure in Europe. He has served as a pioneer in refining and developing the technique in the United States to make it as minimally invasive and precise as possible. “Several neurosurgeons from other institutions have come to Cleveland Clinic to learn the technique and spread the technique,” he says.
Dr. Gonzalez-Martinez explains that in patients whose seizures can’t be controlled by medication and who have seizures stemming from focal areas, removing the affected areas surgically through a minimal resection can often help make the patient seizure free. However, it can be difficult to pinpoint where the seizures are coming from, especially if imaging tests such as MRIs don’t indicate brain lesions.
“I tell patients that trying to localize where the seizures are coming is like watching a football game from the back row of the stadium,” Dr. Gonzalez-Martinez says. “You have an idea where the players are and what they’re doing, but you don’t have the details.”
That’s where Cleveland Clinic’s minimally invasive stereoelectroencephalography (SEEG) program comes in. “SEEG allows us to sit in the front row and watch the game very closely,” Dr. Gonzalez-Martinez says. The technique uses very small and flexible electrodes that “look like spaghetti” that are inserted through 2-mm holes in the patient’s brain.
“We use a robotic arm to implant the electrodes,” he says. “The robotic arm acts as a GPS, which makes the electrode placement safer and more precise.”
The electrodes stay in place for about a week to record patients’ brain waves during seizures, allowing clinicians to map with a high degree of accuracy the areas of the brain where seizures are occurring.
“The tiny probes that we insert allow us to be very specific about which areas of the brain we should remove,” Dr. Gonzalez-Martinez says. “We record functional areas of the brain and then we know where to resect and which areas we should not touch.”
Less invasive, fewer complications
This minimally invasive approach is a major improvement over traditional diagnostic procedures, which involve opening the skull, exposing the brain, and placing electrodes on top of the exposed brain.
“With the standard method, the chance of complications is 10 percent, and with the minimally invasive method, the complication rate is only 1 percent,” Dr. Gonzalez-Martinez says.
Once the brain mapping is done, the subsequent surgery to remove the areas of the brain that are causing the patient’s seizures also has become less and less invasive. Ms. Millares had a “small craniotomy” rather than the traditional protocol of a full craniotomy, and now the standard surgical treatment at Cleveland Clinic has evolved further and involves burning the affected areas with a laser probe.
“This is all evolving into minimally invasive epilepsy surgery,” Dr. Gonzalez-Martinez says. “The field is evolving very quickly, and we’re very happy with the results.”
We caught up with Ms. Millares to ask her a few questions about how she is doing and her experience at Cleveland Clinic’s Epilepsy Center, which has more than 5,000 patient visits annually—including 10 to 15 percent from international patients.
Did you use the Global Patient Services (GPS) concierge services while you were at Cleveland Clinic?
“When I learned about the brain mapping treatment, we contacted Cleveland Clinic through GPS, and they responded right away. We were very impressed with the excellent service and dedication to the international patient. GPS helped us a lot; they gave us a schedule with every appointment and test and assigned us a translator who helped us with everything that we needed. She was great!”
What differences has this treatment made in your life now that you are seizure free?
“I have no words to express everything Cleveland Clinic has done for me. My life has changed completely and I owe it to Cleveland Clinic staff—and to my family, who supported me and stood by me at all times. I remember walking in one of the hallways of the hospital and reading a quote painted on the wall that said ‘Patients First’—and I have to say this is absolutely true. I was overwhelmed with the excellent healthcare system and the outstanding attention that everyone at Cleveland Clinic gave to me and my family.”
What are you doing now?
“I completed my master’s degree in international law last May. Right now, I’m looking for a job, and I hope that I find one soon!”
What advice would you like to share with other international patients or potential patients?
“I hope that I can serve as an example for anyone who is thinking of having the brain mapping treatment at Cleveland Clinic. I promise it is a life-changing experience—not only for those who suffer from epilepsy, but also for your family and friends who care about you.”
Patient-Centered Pediatric Care
When it comes to pediatric care, the idea of a family-centered “medical home” is an increasingly popular concept. The general pediatrician is at the center of this approach, providing comprehensive primary care while also serving as an expert guide to refer the family to specialists and coordinate the patient’s care.
When you travel to the United States, we would like you to think of Cleveland Clinic Children's as your child’s “medical home away from home.”
We’re here to help if:
- you are already planning to visit Cleveland Clinic for an adult family member;
- you are traveling to the United States with your family for business or pleasure and are in need of world-class pediatric care while you are here;
- you are looking for state-of-the-art pediatric care at a center of excellence with a culture of innovation that puts “Patients First.”
“Cleveland Clinic Children’s offers a full line of pediatric services for children, including primary preventive care, acute care, and specialty care,” says Elaine E. Schulte, MD, MPH, chair of the Department of General Pediatrics. “We see patients from all over the world on a daily basis. Whether they see us for preventive care, a problem we are very familiar with, or a diagnostic dilemma, we provide them with the care they need from some of the best physicians in the country.”
It’s with good reason that the families of children with complex medical issues travel from near and far to see the physicians at Cleveland Clinic: In 2012-13, our children’s hospital was named a national leader in 10 out of 10 pediatric specialties in U.S. News & World Report’s “Best Children’s Hospital Rankings.” Our pediatric Neurology & Neurosurgery program, for example, ranked No. 3 in the country and No. 1 in the state of Ohio for the fifth year in a row.
The U.S. News rankings were developed to help patients, families and physicians determine the hospitals that provide the best care for serious or complicated medical conditions or procedures.
Prevention and collaboration
Cleveland Clinic Children’s offers a comprehensive pediatric preventive care program. “We provide some of the best medical care in the world, and we understand that primary preventive care begins in childhood,” Dr. Schulte says.
That care, she says, includes a focus on typical growth and development, and addresses common childhood diseases and conditions such as asthma, attention-deficit hyperactivity disorder (ADHD) and obesity. The Department of General Pediatrics also provides pre-operational screening for patients who come to Cleveland Clinic for surgery.
The children’s hospital also offers skilled treatment of acute issues, availability of high-tech equipment for imaging studies and other diagnostic testing, and ready access to pediatric specialists and subspecialists.
“We offer a multidisciplinary approach to care,” Dr. Schulte says. “If an international patient needs specialty care, our physicians in General Pediatrics will determine whom the right specialists are, and we will make sure that the family is seen in a very short period of time—usually the same day or the next day.”
Global Patient Services support
International pediatric patients are seen based on physician referrals or self-referrals. Global Patient Services (GPS) Coordinators provide all of the same logistical support services for pediatric patients and their families as for adult patients, including scheduling, translation and escort services, real-time assistance with direct admits, appointment rescheduling and transportation arrangements due to flight delays.
Cleveland Clinic Children’s provides access to high-quality pediatric care while striving to make the experience as seamless as possible for families visiting from other countries. After all, when you receive world-class, patient-centered care—you’re never really far from home.
For information, contact the Global Patient Services Office at +1.216.444.8184.
Spotlight on the Glickman Urological & Kidney Institute and State-of-the-Art Prostate Cancer Treatments
Cleveland Clinic’s Glickman Urological & Kidney Institute and its physicians and scientists are recognized worldwide for excellence in patient care, teaching and research. Last year alone, people from 34 countries and all of the states in the U.S. traveled to our institute for cures, treatment and long-term kidney care.
U.S. News & World Report ranked our urology and kidney disease programs No. 1 in the nation in its 2012-13 “America’s Best Hospitals” survey. In addition, Cleveland Clinic was named one of the nation's top 4 hospitals in that survey. The U.S. News rankings were developed to help patients, families and physicians determine the hospitals that provide the best care for serious or complicated medical conditions or procedures.
The Glickman Urological & Kidney Institute merges Cleveland Clinic’s urology and nephrology programs. This consolidation of disciplines allows us to better serve patients in the prevention, diagnosis and treatment of kidney disease while we continue to provide high-quality patient care and carry on innovative research in all aspects of urology.
Innovation in prostate cancer treatment
One of the areas in which the Institute has an ongoing commitment to innovation and exceptional care is in the treatment of prostate cancer. Surgical treatment of prostate cancer has expanded in the past decade from traditional open surgery to new minimally invasive approaches.
Laparoscopic surgery substantially reduces abdominal wall trauma compared to open surgery. This translates into less postoperative pain, faster recovery, fewer wound complications and improved cosmetic outcomes.
Our state-of-the-art, minimally invasive clinical capabilities include:
- Robotic radical prostatectomy. Cleveland Clinic was one of the nation's first medical centers to offer this minimally invasive surgical treatment for prostate cancer. Since 2001, Cleveland Clinic has been using the state-of-the-art robotic surgical system approved by the United States Food and Drug Administration for many surgical procedures. Now, robotic-assisted surgery is enabling surgeons to perform radical prostatectomy with more precision, offering patients improved outcomes. We have performed over 1,000 robotic and laparoscopic prostatectomy procedures to date and continue to be the leaders in the prostatectomy field.
- Single-port radical prostatectomy. Our experience with single-port robotic transumbilical surgery provided better ergonomics and precision during radical prostatectomy surgeries without complications. Because the procedure uses only one point of access to the body, single-port surgery can leave minimal to no scarring that can commonly occur after traditional open and laparoscopic abdominal surgery procedures. Some patients are reporting less discomfort and faster recovery times compared with those undergoing traditional laparoscopy. Distinctively, single port radical prostatectomy (SPRP) is a surgical procedure with potential benefits that are beyond just cosmetic.
Free prostate cancer treatment guide
Being diagnosed with prostate cancer raises many questions. As the first step in taking control of your health, it’s important to learn about all available treatment options and the benefits and risks of each.
Cleveland Clinic prostate cancer specialists tailor prostate cancer treatment plans to their patients’ needs, taking into account the type of cancer, the age of the individual, the degree to which the cancer has spread and the health of the patient.
To help you decide the best approach to take against prostate cancer, Cleveland Clinic has produced a comprehensive Prostate Cancer Treatment Guide, available for download at clevelandclinic.org/prostatecancerguide. This free download provides the facts you need to make informed decisions when considering prostate cancer treatment or surgery.
New Online Resource for Health Information
Earlier this year Cleveland Clinic launched a new online resource for health information. Health Hub from Cleveland Clinic is a central site containing medical, health and wellness news, information, insights and perspectives from clinical experts across the many specialties at Cleveland Clinic. The purpose of the site is to help readers make greater sense of the world of medicine, health and wellness; and support quality decisions about personal healthcare and overall well-being.
Recipe Corner: Red Fruit Frozen Yogurt Topping
To satisfy your family's sweet tooth, try pouring this warm, delicious fruit topping over frozen yogurt. Raspberries, cranberries and cherries are high in fiber, and contain vitamin C plus powerful antioxidants that help prevent disease.