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Scott Webb: There are roughly 100,000 new diagnoses of epilepsy in the US each year and there are many surgical and non-surgical options for those suffering from seizures. And joining me today are doctors Emily Fan, Nicolas Jonas and Ryder Gwinn. They're members of the comprehensive epilepsy care team from the East Side Neuroscience Institute, and they're here today to talk about their team-based approach to epilepsy care.

So, I want to thank you all for joining me today. Dr. Fan, I'm going to start with you. How does the Eastside Neuroscience Institute bring in the whole team to treat epilepsy? It does really seem like a team approach. And, you know, as a part of your answer, please tell us what that approach looks like.

Dr. Emily Fan: Thank you for having us. It really is an honor to be here. And you're right, the Eastside Neuroscience Institute, we do very much aim to have a team-based approach in terms of taking care of our epilepsy population here, not only just on the east side, but in our neighboring communities. And so as a team, our providers are made up of epileptologists, our epilepsy surgeon as well as epilepsy nurses, technicians, and even neuropsychological providers as well. And altogether, we provide a multi-layered approach to the many needs of this epilepsy population from clinic evaluation to EEG monitoring and epilepsy monitoring unit in the hospital, as well as any surgical needs.

Currently, the Eastside Neuroscience Institute, we do have monitoring capabilities for our epilepsy patients in the outpatient as well as the inpatient setting. We have both routine and ambulatory EEGs available in our clinic setting for patients to get these studies done at the convenience of their own home, as well as an ability to have to be admitted to our hospitals, to be monitored in-house at the epilepsy monitoring unit for up to five days. And these are essential functions and studies that would allow us to better characterize the epilepsy conditions of these patients.

Scott Webb: Yeah. And Dr. Gwinn, you know, this amazing collaboration between your team and all the services, it's probably pretty amazing for epilepsy patients, families and so on. So maybe you can drill down a little bit here and tell us more about some of the services Dr. Fan mentioned, you know, people being able to stay home and do studies at home and things like that, but tell us more about the services.

Dr. Ryder Gwinn : As you know, epilepsy is a very difficult problem to have both for the patient and for the entire family as well. And so, having a broad set of services is very, very important. As Dr. Fan said, we take a multi-layered approach and oftentimes medication is enough to take care of the problem. But there are times when medication is not enough and people continue to have seizures despite the best efforts and even taking multiple medications at the same time. So, we also offer a number of surgical potential remedies as well.

And, you know, part of the team's approach is to sit down and have a conference and talk about each one of our patients and what particular problem they have, and particularly where their seizures might be coming from in the brain. And we put together EEG information, imaging information like MRI and CT. And then, we sit down and say, "Well, maybe there are other things we can do, such as what's called neuromodulation devices, where we can put in stimulators that will help suppress seizure activity. Those can be placed either outside the brain on something called a vagus nerve or inside the brain. There's something called a responsive neurostimulator that can listen to brain activity and then actually stimulate when it sees abnormal activity to try to shut down the seizures. Or we can take a more kind of conventional approach where we actually localize where the seizures are coming from by putting electrodes into the brain and then even going back and removing where the seizures are coming from. And so even, you know, patients with very severe epilepsy that are not well controlled with medications have really good options to become seizure-free at times. And, you know, we really work hard to try to provide the best possible outcome for every one of our patients.

Dr. Nicolas Jonas: If I could just add, you know, I think that with specialized epilepsy care, there is a bit of a gap in the knowledge that, you know, specialty providers can bring. We can bring a little bit more to the table. So, most of the time neurologists will treat patients with epilepsy with medications, but for our purposes, we're really trying to provide an extra level in care for people with epilepsy that's difficult to manage.

So, you know, to what Ryder is saying and to what Dr. Fan is saying, people that have difficult to treat epilepsy, people that, you know, it is difficult for their family to deal with these issues, we hope that we can get them some kind of better control, better treatment, and there is kind of an indication for providers to get people to an epilepsy center after medications just are not effective. By using a specialty practice, we apply medications in a more specific sense and deliberate sense. And then, we also can provide next level care to try and see if there's an identifiable area that we could treat even with surgical interventions with Dr. Gwinn. So, we really can kind of get people a better sense of security for their, illness.

Scott Webb: I just love hearing that there's lots of options, right? So we as patients, of course, any patients, but especially epilepsy patients really seem to benefit from, "Well, let's try some medications first, and then maybe some different medications and then some specialized approach to medications." But ultimately, Dr. Gwinn, we may, patients may get to the surgical options, so maybe you can talk more about the surgical options for epilepsy patients.

Dr. Ryder Gwinn : You know, in the past, over the last 50 years or so, most of the surgical options that were available to patients with epilepsy were fairly invasive, where we actually have to take off a piece of bone and then go in and localize the seizures with electrodes, and then go back and remove the area of the brain that's causing the seizures. And while that's still employed at times today, we also have, you know, a whole litany of other interventions that we can do that are much less invasive. And so, we have very minimally invasive ways of placing electrodes to localize seizures now. And we have things like what's called laser interstitial thermal therapy, where we can place a laser catheter into the brain through a very small hole that's about the size of a pencil lead. And then, we can take the patient to the MRI suite. And in a very precise and monitored fashion, we can eliminate that area where the seizures are coming from. So, people can come through the entire surgical evaluation phase and treatment phase without ever having that traditional, what we call craniotomy, where we have to do something very invasive.

And so, you know, the option of being able to localize and eliminate people's seizures without ever having to do a big surgery is just a huge advance. We're taking care of patients that we might not have taken care of before because we would've thought it was too dangerous or too invasive, and getting patients seizure-free. And so, these options, you know, have a spectrum of efficacy or the ability to eliminate the seizures, but many of them are excellent in terms of potential outcome.

Scott Webb: Yeah, it's really amazing, Dr. Gwinn. We've spoken before and, when you go through the surgical options and things you can do for folks, it sounds like science fiction, sounds like something I saw in Star Trek when I was a kid, you know? But it's really happening in real time, like right now, maybe, you know, even later today. It's all really fascinating and you guys always do such a great job explaining things. Wondering, Dr. Fan, can you tell listeners how they can learn more about the Eastside Neuroscience Institute and just everything your team has to offer?

Dr. Emily Fan: We have a website that will give us quite a comprehensive overview of the epilepsy care at Eastside Neuroscience Institute, and that will be www.eastsideneuroinstitute.org. It does highlight the team that we already spoke of that work together to take care of our patients. But more than anything, I think our message out to our community of patients is that epilepsy is becoming more and more in the forefront of the consciousness of the population. Almost a hundred thousand patients will be diagnosed with epilepsy this year and every year in the United States. And we wanted our population of patients to realize that there is comprehensive care available in their neighborhood. And this may range anywhere from diagnosis to all the way to surgical decision-making that we were talking about. But I think it's also very important to understand that this is an illness that most patients live with chronically for most of their lives, and so affect very much quality of life as well as quality of life of the family. And management, medications and surgical procedures aside, there is a lot of education and a lot of need for empowerment of patients to understand this condition, how to deal with it, and how to live with it to optimize their quality of life. And that's really the overall goal of our epilepsy care at the Eastside Neuroscience Institute, is to ensure that the level of care is comprehensive on these different topics that would be very pertinent to the patient.

Scott Webb: Yeah. Well, that's perfect. This is really fascinating. It sounds like science fiction, but it's real. And as Dr. Fan is saying, a hundred thousand people diagnosed every year, so we need you more than ever. Those patients, those families need you more than ever and Dr. Gwinn, with the surgery and everything. So, thank you all and you all stay well.

Dr. Emily Fan: Thank you very much.

Dr. Ryder Gwinn : Thank you very much.

Dr. Nicolas Jonas: Thank you.

Scott Webb: The Eastside Neuroscience Institute helps improve the quality of life for people in need of individualized care for epilepsy. To learn more, visit eastsideneuroinstitute.org.