Question from gammagirl:
I had gks in 2001 at UVA for MTLE. The doc says that I still have a “nub” of a scar up there. I am taking 5000 mg of Keppra per day and I would like to come off of it, as it seems like a VERY HIGH dose to me. Is it possible that the “nub” could have changed even more, since my last MRI, which has been a few years ago? I used to have auras after the surgery, now I have nothing. I am curious. The docs don’t seem too concerned about me, I guess, since the study is over? Thanks!
Dear Gammagirl,
Gamma Knife surgery has been utilized widely in Europe to treat mesial temporal lobe epilepsy. Its use in the U.S. has been more limited. In the U.S., this indication was studied part of an NIH protocol of which the University of Virginia was one of five participating centers.
We have seen improvements in seizures in some patients with mesial temporal lobe epilepsy and other types of structural lesions (e.g. AVM’s and certain kinds of tumors) even when the lesion has not totally disappeared after Gamma Knife surgery. The appearance of subtle changes on previous MRI’s should be followed up with a more recent MRI. In consultation with a neurologist, it may be possible to reduce the dose of anticonvulsant you are currently on.
I would ask that you arrange to see myself or your neurologist to arrange for a follow-up brain MRI and consultation.
Sincerely,
Jason Sheehan
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