Epilepsy: The MUSC Comprehensive Epilepsy Program

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Epilepsy:  The MUSC Comprehensive Epilepsy Program




Guest:  Dr. Jonathan Edwards – Neurosciences

Host:  Dr. Linda Austin – Psychiatry


Dr. 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.


Dr. 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. 


These 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 epilepsy.


Dr. 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 controlled?


Dr. 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. 


But the 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.


Dr. 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 deeply about.


Dr. Jonathan Edwards:  It is.


Dr. Linda Austin:  When did this program start?


Dr. 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.


Dr. Linda Austin:  But the team approach is really getting under way now?


Dr. Jonathan Edwards:  It’s really blossoming now.


Dr. Linda Austin:  And, I understand you also are anticipating new arrivals, new additions, to the team.


Dr. Jonathan:  Yes.


Dr. Linda Austin:  Who will be joining us?


Dr. 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 Forest University and coming down to MUSC in November.


Dr. Linda Austin:  So, that’s just right around the corner.


Dr. Jonathan Edwards:  Yes.


Dr. Linda Austin:  And what a great addition that will be too.


Dr. Jonathan Edwards:  Absolutely.


Dr. 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?


Dr. 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 role.


Dr. Linda Austin:  What are some of the reasons that patients have trouble holding down a job or may have to make a job change?


Dr. 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 patients. 


There 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.


Dr. 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?


Dr. 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.


Dr. Linda Austin:  Are patients with epilepsy sometimes handled exclusively by family practice docs?


Dr. 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.


Dr. Linda Austin:  Thank you very much.


Dr. 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.


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