DEVICE HELPS WOMAN CONTROL HER EPILEPSY

LaDawn Burleson can barely feel the electrical impulses being sent up a nerve in her neck, but she's hopeful they will make a big impact in her life by helping control her epilepsy.

Burleson of Malden, a 22-year-old mother of two, is the first patient at a Cape Girardeau hospital to receive a vagus nerve stimulator, a device that sends precisely timed and measured electrical pulses through the vagus nerve to the brain, with the goal of preventing epileptic seizures before they begin, said Dr. Mohammad Shakil, a neurologist with Neurology Clinics.

Last Thursday Shakil turned on the device that was implanted under the skin of Burleson's chest by neurosurgeon Dr. Scott R. Gibbs on Jan. 17.

About 24 hours after the device was turned on Burleson, who usually has 20 to 25 seizures a day, had not had an epileptic episode, but she said it was too early to tell if the stimulator was responsible. The device is set on its lowest setting and it could take several months to a year to get it adjusted to the right levels for Burleson, Shakil said.

Still, Burleson was excited even with the possibility that the device could control the seizures that the four different drugs she takes a day have been unable to stop.

More than 2 million people in the United States have some form of epilepsy, a neurological condition that produces disturbances in the electrical functions of the brain that cause seizures that affect a person's consciousness, bodily movements or sensations.

Burleson is one of the 15 percent of those whose seizures cannot be controlled with drugs.

"In the 20 years I have been in practice, they have come out with many good drugs that control seizures," Shakil said, "but they don't work for everyone."

Shakil said the vagus nerve stimulator is a new alternative for those whose seizures cannot be controlled even when they are taking three or more types of medications.

The stimulator, which is about the size of a watch, is implanted under the skin of the patient's chest. The device is connected to a wire tunneled under the skin to the neck where it is placed around the vagus nerve. The vagus nerve, one of 12 cranial nerves, is the main route for information to the brain from the heart, lungs, blood vessels and gastrointestinal tract.

Even Cyberonics, the company that makes the device, is not sure exactly how or why the device has been successful at controlling epileptic seizures, said registered nurse Cheryl Ault, a clinical specialist for the company.

"The leading theories are that it changes the blood flow to certain areas of the brain and that it may change the levels of neurotransmitters that excite seizures or inhibit them," Ault said.

But to patients like Burleson why the device works is less important than the fact that in study after study the stimulator has been shown to stop seizures, Ault said.

In fact, testing was so successful that the FDA, in 1997, approved the device for treatment of epilepsy in 16 days, she said.

The company keeps a registry of 1,800 patients who have been implanted with the stimulator, some for as long as three years. Of those, 83 percent have had at least a 50 percent reduction in seizures, with 34 percent having a 75 percent reduction and 20 percent have greater than 90 percent reduction in seizures, Ault said.

Shakil said when he first heard about the vagus nerve stimulator, he laughed it off.

"I could see no logical reason for it to work," he said, but as the number of studies on the device grew and he saw patients who had benefited from the stimulator, he began looking at it more seriously.

"It's definitely something that can help a lot of patients," Shakil said.

He is glad he can add it to the options he uses to treat patients with epilepsy. Until the stimulator came out, the only alternative to drug therapy, he said, was brain surgery. The surgery was very invasive and carried substantial risks.

Drug therapy also carries risks, in that many drugs have side effects, Shakil said. These drugs often affect liver function and patients must be monitored closely.

Side effects from the vagus nerve stimulator are a hoarseness to the voice when the device is delivering an impulse, coughing, an occasional feeling of shortness of breath and a 2 percent chance of infection, Ault said.

Features of the stimulator Shakil likes are the magnets patients are given to allow them to adjust the device.

The stimulator generally sends out an electric impulse every five minutes, Shakil said, but if the patient feels a seizure coming on, a small magnet can be used to deliver an extra impulse to try to thwart the seizure.

"This allows the patient to have a sense of control that most of these patients have never felt before," he said. "It not only helps them physically, but psychologically."

Even before the device was turned on, Burleson said she was in better spirits than she'd been in years.

"It's helped knowing there is another option for me," she said, "and even if it doesn't help me, it could help someone else."