Epilepsy: The MUSC Comprehensive Epilepsy Program
Guest: Dr. Jonathan Edwards – Neurosciences
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. Jonathan Edwards
who is Director of the Comprehensive Epilepsy Program and Associate Professor
of Neurology here at the Medical University of South Carolina. Dr. Edwards, I know that the Comprehensive
Epilepsy Program is your brainchild and you’ve come here, to the medical
university, from Michigan
to develop this program. Tell me what
the philosophy is in your thinking and developing a comprehensive program.
Jonathan Edwards: Well, I think there’s
been epilepsy treatment here, at MUSC, and very good epilepsy treatment, for
several years. But the goal that we’re
working towards, as a group, now is creating seamless care for the whole
spectrum of patients with epilepsy, including neonates, through childhood,
through teenage years, through adulthood, into the elderly, to address all the
many different needs of those patients.
One of the things that we’ve learned is that, for patients living with
epilepsy, the seizures are only part of what is causing an impairment in their
quality of life. For some patients, it
is also medication side effects. It may
be financial issues. It may be
depression or anxiety about living with seizures or not knowing when the next
seizure is going to come on. For some
patients, there are very significant concerns about employment, or
unemployment, or underemployment. Many
patients are bothered by feeling that they’re very dependent on their family because
they can’t drive, or they rely on their family for other reasons.
many different issues cause a lot of problems for our patients. The goal of the Comprehensive Epilepsy
Program is to not just address the seizures.
We do want to address those seizures and we want to do so very
well. But, at the same time, we want to
have mechanisms in place, and the personnel in place, so that we can be
addressing the whole range of things that cause problems for patients with
Linda Austin: So, let’s imagine, a
patient comes to you. They have their
neurologic workup. You, as a
neurologist, are treating, certainly as well as you can, in state of the art
treatment for the seizures, how do you, then, begin to figure out, though, if
that patient may have other needs, other than just getting the seizures
Jonathan Edwards: Well, for one thing,
you have to ask. You have to ask
questions about depression. For example,
early in my career, when I was fresh out of my residency and fellowship, if you
had asked me, what percentage of your patients with refractory epilepsy have
depression? I probably would have said, oh, I would guess, probably at least 5 or 10
percent of my patients. Well, then,
literature started to suggest that it may be as high as 55 percent of our
patients have depression. So, unless you
ask, you don’t know.
other big part of what we’re trying to do is, we have a comprehensive team, so,
rather than the patient just coming in and seeing a neurologist, we work as a
team. So, we have developmental
psychologist who will see our adolescents that are dealing with seizures and
epilepsy and all the social and developmental problems that my come along with
that. We have a partnership with
vocational rehabilitation. We have a
partnership with the Department of Psychiatry.
We have epilepsy nurses. We have
a dedicated social worker that sees our adults and our children that are living
with epilepsy. So, it really is a team
approach, rather than the old model of just a patient seeing a neurologist and
getting their prescription refilled.
Linda Austin: How wonderful that you
have that approach. And there’s a
special look in your face as you talk about that. Obviously, this is something you care very
Jonathan Edwards: It is.
Linda Austin: When did this program
Jonathan Edwards: Well, officially, we
have launched the Comprehensive Epilepsy Program this summer, although patients
have been getting excellent epilepsy treatment at MUSC for many years.
Linda Austin: But the team approach is
really getting under way now?
Jonathan Edwards: It’s really blossoming
Linda Austin: And, I understand you also
are anticipating new arrivals, new additions, to the team.
Linda Austin: Who will be joining us?
Jonathan Edwards: Well, one of the most
significant new arrivals is our new colleague, Dr. Steven Glazier, who is one
of the best epilepsy surgeons in the country.
He is leaving Wake
and coming down to MUSC in November.
Linda Austin: So, that’s just right
around the corner.
Jonathan Edwards: Yes.
Linda Austin: And what a great addition
that will be too.
Jonathan Edwards: Absolutely.
Linda Austin: When you talk about
depression associated with epilepsy, do you think that is a psychological
response to getting a new diagnosis and whatever the difficulties are
associated with it, or do you see that as a byproduct of the epilepsy itself,
almost in a more, say, physical or biological way?
Jonathan Edwards: I think the depression
that goes along with epilepsy is a product of many different factors. And, for patients, the different factors are
playing different roles. For example, receiving
a diagnosis of epilepsy is a real shock to patients, and that alone can be a
problem. But many patients get a
decreased sense of self worth because they’re having trouble holding down a
job. They’re dependent on their family
for transportation; sometimes if they can’t drive. Then the medications that we use, for some
patients, those medications can cause depression as a side effect. Some patients have epilepsy because a
particular part of the brain is not functioning properly, and we know that depression
is a condition that has a biological cause.
The same parts of the brain that might not be working properly and
causing seizures may also be causing the depression. I think the best way to say it is that it’s a
multifactorial problem. And, for
different patients, the different factors may be playing more or less of a
Linda Austin: What are some of the
reasons that patients have trouble holding down a job or may have to make a job
Jonathan Edwards: Well, there are certain
jobs that may be risky for someone with epilepsy. There are activities that are not safe. For example, we recommend that patients with
epilepsy not drive unless their seizures are under very good control. Well, if driving is what you do for a living,
it hard for you to maintain that job.
Many patients have transportation issues. Just getting to work is a problem for many
are other jobs that are risky, such as operating heavy machinery, working with
sharp tools, working around open flames or around deep water, which could be
very risky if you have episodes in which you lose control of your body or lose
consciousness. Another problem is that
medication side effects sometimes slow a patient down and it can impair their
work performance. Another problem is
that some employers worry about having a liability of having someone with
epilepsy in their company. Now, the
Americans with Disabilities Act does not allow someone to be fired because they
have a disability, but there are employers who find their way around this by
finding other reasons to let a patient go.
Whatever the costs, some patients find themselves without a job, and our
goal is to work with them so that they can find meaningful employment.
Linda Austin: If a patient is being
treated by a neurologist who is not at MUSC, can they avail themselves of the
treatment options that the rest of the team offers?
Jonathan Edwards: Yes. First of all, they can certainly refer a
patient to us for evaluation, or they can even take advantage of certain
aspects without the patient having to be referred for their clinic visits at
MUSC. Additionally, we do a lot of
telephone consultation with community physicians who just have a couple of
questions they need to run by somebody who sees epilepsy everyday. And sometimes their referring physicians just
want to know they’re on the right track, and so often a simple telephone
conversation can help with that.
Linda Austin: Are patients with epilepsy
sometimes handled exclusively by family practice docs?
Jonathan Edwards: Yes. There are some patients whose seizures
respond very well to the first medication they try and they’re not having any
side effects, and they’re doing very well.
Our goal is to be there when we’re needed. We certainly don’t feel that every patient
with epilepsy has to be treated at MUSC, but we want to make sure that we’re
here for those who need it.
Linda Austin: Thank you very much.
Jonathan Edwards: My pleasure.
If you have any questions about the services
or programs offered at the Medical University of South
Carolina or if you would like to schedule an
appointment with one of our physicians, please call MUSC Health
Connection: (843) 792-1414.