Save the date! This year’s Epilepsy Walk is April 16. Form a team now and check back in March for walk details. Casper’s walk is scheduled to correspond with the National Epilepsy Walk in Washington, D.C.
Dr. David B. Wheeler, M.D., Ph.D., is director of the Wyoming Epilepsy Center in Casper.
Today is International Epilepsy Day, devoted to highlighting the problems faced by people with epilepsy, their families and caregivers. We sat down with neurologist and epileptologist Dr. David B. Wheeler of Wyoming Neurologic Associates to talk about a disease that affects 1 percent of the population.
After coming to Casper in 2005, you built the Wyoming Epilepsy Center, the region’s first Level III Epilepsy Center. Tell us about it.
I did an epilepsy fellowship in clinical neurophysiology, EEG and epilepsy at Brigham and Women’s Hospital in Massachusetts. I learned what it takes to build an epilepsy program, and how much difference an epileptologist can make in a life of somebody with seizures. General neurologists and other doctors do not know much about it, and they do not treat it very appropriately. There are a lot of people with epilepsy, and a lot of need.
The National Association of Epilepsy Centers has a map that shows where all the epilepsy centers are in the country. Idaho, Montana, Wyoming and the Dakotas had none. There was a big blank spot, so Casper was kind of right in the middle of that.
The point of an epilepsy center is to make an advanced diagnosis and treat patients based on real information rather than presumptions. That real diagnosis often relies on admitting the patient to the hospital for what we call long-term video EEG monitoring, which is at the heart of an epilepsy center. That involves having a geographic place in the hospital with specialized equipment, and nursing staff and technicians with special training in how to take care of these patients.
What is an EEG?
It is an electroencephalogram. We put electrodes all over the scalp and passively listen to the electrical activity of the brain. This turns out to be super interesting and has very specific patterns that are reproducible from one person to the next. In people with epilepsy, there are abnormal electrical discharges that tell us where their seizures might be coming from.
So you don’t have to wait for a seizure to learn something from an EEG?
Right. In between seizures, the brain will still misbehave from time to time. That is not to say that it happens every time you do an EEG. Sometimes the EEG looks okay even if the patient does end up having epilepsy. That’s why we need the more advanced tools like long-term video EEG monitoring that allows us to record for a week to 10 days at a time, if necessary, to actually see a seizure happen and look at it with video and see what happens to the brain waves during the seizure.
That helps determine treatment. Or it might involve referring patients to our colleagues to actually take out part of the brain where the seizures are coming from. There are now a couple of new treatments that involve implantation of devices into the brain itself that can detect seizures and kind of defibrillate the brain before the seizure starts. It is really cool.
Epileptic spike and wave discharges monitored with EEG.
What is it about epilepsy that interests you?
I think that what fascinates me is how a seizure is something that can happen to any person’s brain, even if they do not have epilepsy. If you stress the brain enough, a seizure will happen.
You can have a person with a fully functional brain, but every once in a while, their life just comes crashing down. As an epilepsy specialist, I can, hopefully, figure out what is going on pretty quickly and come up with a treatment plan that will completely eliminate that catastrophic event. It makes such a huge difference in their life, and that makes it kind of special within the world of neurology. There is a lot of stuff that neurologists take care of that we cannot really fix. This is an area in which we have a much better chance of making a person whole again. I think that is what I like most about epilepsy, that and the physiology. What I like most about neuroscience is that it is about brain cells talking to each other. In a seizure, it is about brain cells yelling at each other.
What is the prevalence of epilepsy?
Start with seizures. A seizure is an episode of change in body function as a result of electrical activity in the brain. Epilepsy is defined as more than one seizure that is not caused by some acute insult, such as a head injury.
The causes of epilepsy are many, probably thousands of different reasons why a person might develop epilepsy. You could be born with it. You could inherit it. You could acquire it because of some problem during birth. You could acquire it because of an exposure to a toxin, a traumatic brain injury, an infection. Or you could acquire it later in life because of a brain tumor, a stroke, or multiple sclerosis. Epilepsy is not a disease; it is a syndrome or a problem.
About 1 in 10 of us will have a seizure at some point in our life. It’s a very common problem. About 1 in 50 to 1 in 100 of us will develop epilepsy. At any point in time, about 1 percent of the population has epilepsy.
Are your epileptic patients mainly from Wyoming, or do you draw from that “black hole” in the map you were talking about?
I draw some. At the same time I started here, another guy with a background like mine set up an epilepsy center in Boise, Idaho. Two years later, a friend of ours set up another center in Missoula, Montana. We work very closely together and have actually built a consortium (Western States Epilepsy Consortium) of small epilepsy centers that covers the western states, and now has more than 30 members. We interact with larger epilepsy centers to arrange for appropriate patient transfers and have close associations with an epilepsy surgical program in Seattle. We have a representative that is a part of the National Association of Epilepsy Centers. That being said, I do not get tons of referrals from there, but I do travel up to Billings on a regular basis and see epilepsy patients as part of the Billings Clinic. They send patients down to here for monitoring. We also get referrals from South Dakota, Nebraska and throughout Wyoming, and big parts of Montana.
What’s the difference for patients when they have access to an epilepsy center?
The most important thing is the access to an epileptologist. Because I am here, I have also trained lots of people that I work with to provide a higher level of service to people with epilepsy. Access to that expertise, the availability of inpatient EEG monitoring, the availability of high-resolution imaging modalities that are specifically tailored towards seeing problems that cause epilepsy, which we have here.
We also offer behavioral health services with involvement of psychiatry, psychology, neuropsychology, social workers, etc. What we do not have is involvement of neurosurgeons to do epilepsy surgery, as that is highly specialized. We formed our consortium in order to develop meaningful relationships with what are called Level IV Epilepsy Centers so that we would have a place to send patients who need surgery.
We will do most of the workup here and determine whether or not they need surgery. We actually participate in the discussion with the surgeons about the right course of action. If more testing is needed, we will do it here. That is much better for the patient and for continuity of care. It is probably the highest level of care and it can only happen if you have an organized center that has a meaningful relationship with an academic center.
About Dr. Wheeler
David B. Wheeler, M.D., Ph.D., is board certified in neurology and clinical neurophysiology. He is a Rhodes Scholar and was the 2010 Wyoming Medical Center Physician of the Year. He serves on the boards for Wyoming Medical Center, Wyoming Dementia Care and the American Heart Association (Southwest Affiliate.) He is also director of the Wyoming Epilepsy Center. He practices at Wyoming Neurologic Associates, 1020 E. Second St., Suite 100 in Casper. For a referral or an appointment, call (855) 39-BRAIN.
Further reading
Alzheimer’s Awareness Month: Q&A with neurologist Dr. David Wheeler, chairman of Wyoming Dementia Care
‘Like a miracle:’ Douglas woman’s stroke is case study for a fast, efficient system of care
Meet our Docs: Neurologist Dr. David B. Wheeler, from high school dropout to a Ph.D.