An interview with Hussam Shaker, MD
In August 2020, Hussam Shaker, MD, left Cleveland Clinic to join Mercy Health Physician Partners (MHPP) Neuroscience Specialists. He is one of a team of Mercy Health epileptologists, epilepsy specialists, at the Mercy Health epilepsy clinic in Muskegon, part of the Hauenstein Neurosciences Epilepsy program first established in Grand Rapids.
After five months of seeing patients in Muskegon, Dr. Shaker was shocked about the number of patients who suffer from focal refractory epilepsy — epilepsy that does not respond to medications — and had not been referred for epilepsy surgery.
Epilepsy is a neurological disorder that affects people of all ages. More than 3.4 million children and adults in the United States (data from 2015) are living with it. Anyone can develop epilepsy, as epilepsy affects both males and females of all races, ethnic backgrounds and ages. There are two main types of epilepsy: focal epilepsy (most common) and generalized epilepsy. The most common spikes in incidents of epilepsy occur in early childhood and after 75 years old.”
Symptoms That May Surprise You
Epilepsy means that the patient has the tendency to have seizures. Seizures manifest themselves in the part of the body that is controlled by an area in the brain where the seizure originates. The location in the body where seizures occur vary from person to person. In fact, any neurological symptom could be the result of a seizure.
Shaker wants people to know that if they have questions about any of the following symptoms, they should not wait! Consult a physician.
- Convulsions or seizure-like activity
- Episodes of forgetfulness or memory loss, especially in young patients
- Staring or a “loss of time”
- Frequent déjà vu, dreamy state or a roller coaster sensation
- Tremors in hands, feet, limbs
- Numbness or tingling
Convenient access to expert care is at the heart of the epilepsy clinic in Muskegon. Patients can meet with a specialist face to face or via virtual visit. Many diagnostic tests for epilepsy can be performed on the Mercy Health Muskegon campus.
“This is especially crucial to my patients because by Michigan law, a person who has had a seizure may not drive for six months,” Shaker said.
Diagnosis and Medication Options
One key to making an accurate diagnosis, says Shaker, is a thorough review of the patient’s complete medical history. To record the seizures and discover their location in the brain, Shaker then orders a scalp electroencephalogram (EEG). With a confirmed diagnosis, a treatment plan is developed.
The good news is that more than 20 medications have been developed to treat epilepsy, and research continues to develop more with fewer side effects. Finding the right medication is key and can take time.
Two thirds of patients find relief from their symptoms by taking medication. “Data show that with the right medication, 47 percent of patients become seizure-free. Adding a right second medication can lead to a 13 to 14 percent additional relief from seizures,” said Shaker.
“I always tell my patients, ‘Untreated seizures are more dangerous than any medication we prescribe. We can always stop the medication, but seizures affect the brain.’”
For the one-third of patients who do not respond to medication, different therapies are needed. Additional diagnostic tests are performed and then a team meets to analyze the data for what is known as focal refractory epilepsy.
SEEG: A Breakthrough Procedure for Refractory Epilepsy
A new, minimally invasive surgical procedure at Mercy Health is called stereotactic electroencephalography (SEEG) using the ROSA robot. During the procedure, the robot places electrodes in targeted brain areas, which are then monitored to precisely locate the source of the seizures. A SEEG can find seizure sites deep in the brain that a regular scalp EEG test may not reach. SEEG also has the capability to cover both sides of the brain.
“Following SEEG electrodes implantation, the patient is continuously monitored for 7 to 10 days in the Epilepsy Monitoring Unit at Hauenstein Neuroscience Center. The big difference with SEEG is that seizures are recorded from inside the brain,” said Shaker. Removal of the electrodes is a simple procedure that only takes a few minutes under local anesthesia.
Surgical Treatment Options Following SEEG
A patient management conference takes a place immediately following the SEEG monitoring — which includes epileptologists, neurologists, neurosurgeons and neuropsychologists — to analyze the SEEG data.
If the area in the brain identified as the source of the epilepsy can be removed surgically without significant side effects — such as memory or language loss, or weakness — then the patient later undergoes surgery to remove the affected tissue. Data following this treatment option indicate that 50 to 80 percent of patients are seizure-free.
Another treatment option for patients with focal refractory epilepsy is neurostimulation.This treatment involves placing an electrode or chip inside the brain where SEEG identified as the origin of the seizures. Following the surgical implant of this chip, the patient goes home. Seizures are recorded for 3 to 6 months to track patterns, and eventually the chip contain seizures before they spread. Patients who have undergone neurostimulation experience about a 60 to 70 percent reduction of seizures over time.
Development of new anti-seizure medications with fewer side effects is ongoing. The biggest breakthrough researchers are working on will likely take a decade to reach patients. Scientists are trying to collect data on as many epilepsy patients as possible to search for common genetic factors and to find therapies to target those genes.
“The goal is to avoid developing epilepsy in the first place,” said Shaker, “and to give patients better health and an improved quality of life.”
Learn more about epilepsy or request an appointment at www.MercyHealthEpilepsyCare.com.