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Breaking free from epilepsy

A minimally invasive procedure helped Julie become seizure-free.

Smiling woman in winter coat and scarf sitting outside near an animal shelter.
Julie outside of the shelter where she adopted her beagle, Lily.

Julie Sullivan of Wantagh, NY, a dog lover and business analyst, had been under the care of a neurologist for migraines for most of her adult life. Managing the frequent episodes became second nature. But 10 years ago, Julie began to experience new symptoms that concerned her. “I really didn't know what it was,” said the 47-year-old, explaining that she would experience moments where she would stare or mumble, or her arms and hands would move strangely.

Her neurologist at the time wasn’t alarmed by her concerns, but eventually, even Julie’s co-workers started to notice the behavior.

She sought a second opinion from another neurologist who diagnosed her with epilepsy. He explained she was experiencing partial (focal) seizures, which are the result of abnormal electrical activity in a specific part of the brain. “I had only thought of seizures as something involving convulsions, which I never experienced,” said Julie. She was prescribed medications to help alleviate symptoms, and for the next decade, she saw many doctors who prescribed a variety of medicines to find a combination that worked.

At times, the medication regimen would control her seizures. But eventually, symptoms would return. Julie had to give up driving because her focal seizures made it unsafe. She relies on her boyfriend and friends at work when she needs to drive places, but Julie misses the freedom of running errands when she needs to.

Couple walking their beagle on a winter day.
Julie, her boyfriend and Lily enjoying a brisk walk in the park.

A few years ago, Julie’s search for symptom relief brought her to the care of Noah L. Rosen, MD, at the Northwell Health Physician Partners Neuroscience Institute for her migraines. When she mentioned that her seizure medications weren’t working once again, he referred her to Chetan Malpe, MD, a Northwell neurologist who specializes in epilepsy.

Dr. Malpe told Julie about a noninvasive surgical option available to some patients. “He said they would do a lot of different tests to see if I was a candidate,” explained Julie. “Before I even finished the appointment, I knew I wanted to try it.”

Dr. Malpe referred Julie to neurosurgeon Ashesh Dinesh Mehta, MD, PhD, and underwent a video electroencephalogram (EEG) at North Shore University Hospital, in which electrodes are placed on the head to monitor brain activity. The test gives doctors a general idea of which part of the brain is responsible for seizures. She also underwent a stereoelectroencephalography (SEEG), a surgical procedure in which doctors implant electrodes in the brain to further pinpoint the area causing seizures. Julie spent about 10 days in the hospital for testing.

Upon receiving the results, Dr. Mehta was confident that laser interstitial thermal therapy (LITT) was an option for Julie. The minimally invasive procedure, which targets and removes brain tissue causing focal seizures using heat, would allow her to avoid removing bone from the skull and a potentially larger portion of brain.

Julie agreed to the procedure and preparations began. During the WADA test, a standard part of the workup for LITT, the surgical team discovered an aneurysm—which otherwise might have remained undetected. Typically, if there is a family history of brain aneurysm, patients are advised to get screened. But since Julie was adopted, she was unaware if brain aneurysms ran in her family. Dr. Mehta quickly got her in to see one of the cerebrovascular neurosurgeons, who deemed that the aneurysm would need to be repaired. Luckily, it wasn’t emergent, so they could proceed with the LITT procedure.

In the summer of 2018, Julie underwent LITT. Dr. Mehta and his surgical team made a small hole in the back of her head through which a tiny laser wire was placed to remove brain tissue. The procedure took about three to four hours, and she was kept overnight for monitoring. “I went in one day and came home the next,” said Julie. “After all the testing, the laser surgery was the quickest part.”

Man and woman standing outside, holding a small dog.
A happy, seizure-free Julie is loving life with her boyfriend and pup.

Julie has been seizure-free for seven months. Under the care of Dr. Malpe, she still takes medications with the goal of reducing the dose over time. She still occasionally has migraines, and experiences a little bit of numbness and pain where Dr. Mehta created the small hole, which will subside.

Perhaps the best thing, Julie adds, is that she was relieved of her seizures. “The biggest thing I’m looking forward to is driving again,” she said. “I’m used to being independent.”

Julie will have a routine procedure to clip her aneurysm this summer at Northwell. “It’s so wonderful how connected all of the doctors are,” she added.