VA Maryland Health Care System
Treating Epilepsy in Veterans
Not long after Army Veteran and Delaware resident Brian Farkas, now 45, returned home from serving in the Gulf War, he suffered his first seizure. At the time of the seizure, he was a passenger in a friend's car, and he lost consciousness. Concerned, his friend drove straight to the closest emergency room, but upon awakening as they arrived, Farkas had no recollection of the seizure or of being unconscious, did not believe he suffered a seizure, and refused to go inside. Soon after, he suffered a second seizure with lost consciousness, prompting his then fiancée to call 9-1-1. He was transported by ambulance to an emergency room, and thus began his odyssey to try to discover what was happening to him, what was causing these seizures.
"People think of the Gulf War as being technology-heavy, but there were boots on the ground too--around the perimeters-- and I was among those boots on the ground," Farkas said. "A lot of us in the Gulf War returned to find that later we had all kinds of things wrong with us like tumors growing in our heads and neurological problems," he said. "I didn't know anything was wrong with me or affected me until those seizures started."
Family members took him to Johns Hopkins Medicine where doctors discovered he had a lesion on the back of his brain. A biopsy revealed that although benign, the lesion contained an overabundance of white blood cells, and for nearly 20 years, he and his family believed the lesion caused the seizures, which were increasing and growing worse. "Finally, at the Wilmington VA, my neurologist referred me to the Baltimore VA Medical Center, and that's when I started getting some answers."
The Baltimore VA Medical Center houses one of VA's 16 Epilepsy Centers for Excellence where Farkas was admitted into the Epilepsy Monitoring Unit and where doctors could determine an accurate diagnosis for the cause of the seizures by monitoring his brain activity.
"I was surprised at how well I was treated there. Once they attached the monitors to my head, I thought I'd be in that room alone, but people came in and checked on me every half hour. They treated me warmly and took care of me," he said.
After days and nights of testing using monitoring devices that also recorded video of him asleep, doctors told him that the lesion in his brain was not the cause of his seizures. In fact, the seizures and the lesion were not connected at all.
"I was diagnosed with epilepsy," he said.
Epilepsy is sometimes described as having a storm in the brain, an electrical discharge that can be manifested in a variety of external behaviors depending on where in the brain the electrical discharge is taking place. For Farkas, having the correct diagnosis and a new found knowledge of his condition brought a deeper understanding of what was happening to him. "I now have some answers. At least now my family understands that I just wasn't being difficult on purpose. Also, the seizures interfered with so many things, such as my ability to work and to provide for my family."
"Considering that epilepsy is an inhibiting factor to joining the military, it's startling that many veterans end up being diagnosed with it," said Dr. Allan Krumholz, director of the VA Maryland Health Care System's Epilepsy Center of Excellence and a professor of neurology at the University of Maryland School of Medicine. "But military service members may be exposed to risk factors while serving, such as head injuries, traumatic brain injuries, among others, that can cause epilepsy. The VA recognizes that many Veterans are struggling with seizure disorders and established the network across the nation of Epilepsy Centers of Excellence with the goal and mission of improving the health and well-being of Veterans with seizure disorders through integrating clinical care with outreach, research and education," Krumholz said.
The old name for epileptic seizures is "grand mal seizure," and often, says Krumholz, people think of the dramatic grand mal seizures when they think of epilepsy. Now referred to as "generalized convulsive tonic-clonic seizures" −when the body stiffens and the arms and legs jerk – these dramatic seizures consist of only one type of manifestation of epilepsy.
"There are two kinds of seizures. There are the dramatic ones—the generalized convulsive tonic-clonic seizures—that everyone associates with epilepsy, and then there are the other ones—the ones that might consist of a brief loss of consciousness with few or no symptoms when patients aren't even sure they're having one. They may be aware that something is different, that they lost time that they cannot account for," he said.
Because the electrical discharges that character seizure disorders can occur in any part of the brain, seizures can appear differently each time.
"Patients often don't know when they've had a seizure, and they can't remember having had it," Krumholz said.
Also, "complex partial seizures" (or what are now called localized seizures with an alteration of consciousness) often consists of a person staring, perhaps doing something else like picking up things or fumbling with objects−behaviors called automatisms−and a vacancy within the person suffering the seizure.
At the VA Epilepsy Center of Excellence, the goal is to manage epilepsy so that seizures are rare and controlled. "The ideal is for a patient to experience no seizures, and this comes from a combination of patient education and treatment," Krumholz said.
The structure of the VA Epilepsy Center of Excellence—all networked to each other and to Polytrauma Centers across regions and thus the country—enables the VA to link Veterans with the highest quality of care, including state-of-the-art diagnostic and therapeutic services, regardless of where they live. In addition to educating patients and families about epilepsy treatment and care, the Center of Excellence works to educate other health care providers and clinicians about the disorder to enhance their understanding of this complex condition to improve the care provided to veterans with seizure disorders.
"Epilepsy care is truly a collaborative approach with the medical team, patient and family. In order to be successful, we seek and need input from all parties. Caring for a loved one with epilepsy can be challenging and tiring," said Regina McGuire, a nurse practitioner who works with caregivers for veterans with epilepsy. "Family members/caregivers need support as well. Education is a part of that. Knowledge is power and giving the caregivers the advanced knowledge of what to do and when to do it helps alleviate a lot of anxiety/worries as does the knowledge that the caregivers have someone to contact," she said.
At the Epilepsy Center of Excellence, patients and family members work with a designated person to contact on a consistent basis, which has improved the timeliness of responses. "I truly enjoy working with the Veterans and their family members. It is very rewarding," McGuire added.
For Farkas and his family, the enhanced quality of life that comes from the treatment and understanding of epilepsy are invaluable. "The VA helped me. It took a while. It took some patience and persistence. Other Veterans struggling with this issue should have patience as well because the VA figured out what was wrong with me, and they're helping."