Where Medications Failed, Epilepsy Surgery Finally Succeeded
'This was my chance to be seizure-free and have a normal life again'

By Susan Guynn
Special to EpilepsyUSA
Posted: April 12, 2006

Most people would agree that a new health insurance plan and finding new doctors can present some hassles. But for Frederick, Md., native Michelle (Greene) Brazelton, what could have been a hassle actually brought new hope to her life. Brazelton has epilepsy.

Diagnosed at 15 months of age, following a series of fever-induced convulsions, Brazelton, now 38, was troubled by occasional complex partial seizures into young adulthood.

When she was a child, "they called it 'seizure disorder,'" said Brazelton, who recently moved to Sterling, Va., with her husband, Rick Brazelton.

"I don't remember any of them," she said. "My mom could tell by the look on my face. My eyes, I wouldn't respond. I just had a 'spaced out' look." She said the seizures were brief and were sometimes referred to as "staring" or "focal" seizures, now known as complex partial seizures. Prior to a seizure, some people may experience "signs," such as a bad taste in the mouth, or "auras," which Brazelton described as "a feeling that something's not right." She did not.

Typically, the seizure starts with a blank stare and loss of contact with surroundings. This is frequently followed by chewing movements with the mouth; picking at or fumbling with clothing; mumbling; and performing simple, unorganized movements repeatedly.

The last seizure Brazelton had as a teen was in ninth grade, and during her senior year, she was taken off all antiepileptic medication.

"I went to and graduated from college with no problems," said Brazelton, who attended Frederick Community College, Frostburg State University and received an MBA from Mount St. Mary's University.

The Seizures Return

"Come and sit in my office. We think you had a seizure."

Brazelton recalls her supervisor saying these words to her, but not why.

That incident occurred about nine years ago, while she was working for an HMO, "where there were a lot of nurses around," she said. Initially, they thought their co-worker was just dehydrated.

"I thought it was because I was tired and stressed," said Brazelton, who, at that time, was commuting daily to work roughly 30 miles each way.

That episode sent her back to a neurologist who prescribed an antiepileptic medication. "I decided not to drive during that time," she said, following her doctor's recommendation. "I had friends in Frederick I could carpool with." But, she said, co-workers noticed she was "still having problems."

After returning home from a beach getaway with some friends, she went to work out at the gym. That's the last thing she recalled when she woke up in the intensive care unit at Frederick Memorial Hospital a short time later.

At the gym, she had experienced a grand mal seizure.

A second antiepileptic medication was prescribed. "But I was still having (complex partial) seizures about every three or four months," said Brazelton.

New Life, New Hope

In 2001, a new job and a new health insurance plan brought new hope to the Brazeltons, who are avid swing dancers.

"The doctor said, 'Don't do anything that's stressful or gets you hot," said Brazelton. "So there were some things we were afraid to do."

"Adequate sleep is essential," said Brazelton. "You just have to be careful."

Before visiting a new neurologist, the couple decided they needed to learn more about epilepsy and traveled to Las Vegas to attend an Epilepsy Foundation conference. "There were speakers (talking about) drugs and treatments, and vagus nerve stimulation, which is kind of like a pacemaker for the brain," said Brazelton.

The goal in treating epilepsy is "minimal drugs and no seizures," she said. So when she heard one of the speakers say, "If you're already taking two drugs, most likely a third isn't going to help," something clicked and she knew she needed more than medication to control the seizures.

Back home in Frederick, she visited another neurologist, Boyd Dwyer, M.D. "Lo and behold, he said, 'I just went to a conference and they said if you're taking two drugs, a third is not going to help,'" said Brazelton. "Wow!"

After a few months of trying different antiepileptic medications, Dwyer referred her to Gregory Bergey, M.D., at the Johns Hopkins Epilepsy Center in Baltimore, Md., in early 2002. Test results showed she had a scar on her mesial temporal lobe, possibly caused by the high fevers she had as a toddler. He suggested she may be a candidate for a temporal lobectomy, but first, he wanted to rule out success with medication.

A third drug was added to her daily medications. The side effects of the three drugs – fatigue, nausea and blurred vision – began to impact her daily life. When she returned to Bergey's office, he recommended evaluation for the surgery. The goal was to locate the area in the brain that was the source of the seizures. "If they can localize it, then they see if you can go ahead with the surgery," said Brazelton.

The evaluation started with living in a hospital room for a week. Her every move was monitored electronically in hopes of recording seizure activity.

Because her seizures occurred only occasionally, Brazelton was skeptical of the process.

"I said, 'Nothing's going to happen. I only have them every three or four months,'" she said.

On one visit, however, her husband brought a swing-dance video so they could practice. "Lo and behold, in comes the doctor," said Brazelton.

"She had had a seizure but they couldn't record it because of all the moving around we were doing," said her husband.

It was followed by more seizures and the doctor was then able to determine the scar was the site of the problem, making her a candidate for the lobectomy.

"So I could go on to the next step," she said, which was a Wada test, named for the doctor who first performed it, Juhn Wada, M.D.

Following the tests, Brazelton was given the go-ahead for the surgery and an 80 percent chance of becoming seizure-free. The surgeon removed the tissue from the area where the seizures began. "It took about eight hours. It was the longest day of my life," she said. "I wasn't scared. We have a very strong faith.

"I would tell people this is my chance to be seizure-free and have a normal life again," she said of her decision to have the surgery.

With 52 staples and an incision that ran from her ear to her forehead, Brazelton said recovery involved "tremendous headaches. I lived with ice packs on my head for weeks because of the trauma to the head," she said. "I was very quiet. I was like a baby," she said with a laugh. "All I did was eat and sleep."

She couldn't drive for a year after the surgery, but once she was able to return to work, friends offered to drive her. "I was having to go from Frederick to Herndon ( Va. ) everyday," said Brazelton, who is a billing manager at Washington Gas Energy Services. For the year prior to and after her surgery, two friends from a Bible study at First Baptist Church in Frederick, volunteered to take her to and from work. "They were my angels," she said. "We weren't even members of this church yet. They all just kind of picked up and helped." Her mother also helped with transportation.

Seizure-free

Now three years after the surgery, she takes one medication, twice a day, and has been seizure-free. "I don't care if I have to take this the rest of my life," said Brazelton of the medication.

"The longer you go without a seizure, the less likely they are to return," said Brazelton. "If you're seizure-free the first year, that's a milestone."

Since the surgery, Brazelton's husband says his wife has more energy. "It's a relief to see her better and not have seizures anymore."

Brazelton said she does whatever she wants now, including driving. "We dance, we go. We are, of course, getting our sleep," she said.

And she's become active in mentoring programs for people with epilepsy. She's been a mentor to patients who are being evaluated for and undergoing the surgery, and she's training to be a volunteer with Helping Other People with Epilepsy (H.O.P.E.), a program of the Epilepsy Foundation.

"I feel like we were very fortunate. I didn't feel like I was sick enough (for the surgery), even though I was a candidate," she said.

She wants to encourage others with epilepsy, too. "You can go out there and you can get help," she said. "Don't give up until you get the answers you want."