As a young neurology resident, Dr. Jorge Burneo was drawn to epilepsy research by two factors: its potential to improve patients’ lives and to take back valuable knowledge to his native Peru, where epilepsy rates are three times higher than in Canada.
Although there’s currently no cure for the chronic neurological condition, improving patients’ quality of life by treating the repeated seizures characterizing the disease was compelling.
“Even though it’s a challenge to stop the seizures, once you achieve that, it’s amazing to see how patients can have a very fruitful life,” Burneo said.
Today, as co-director of Western’s epilepsy program, Burneo has realized his early aspirations, impacting lives in Canada, his homeland and beyond.
Epilepsy affects one in 100 Canadians, and some 50 million people worldwide. It is one of the most common neurological disorders, affecting children and young adults most often.
Head injuries, complications at birth, or infections from parasites cause certain types of epilepsies. Yet, for 50 per cent of cases worldwide, the cause is unknown. “That is one of the difficulties in treating epilepsy,” Burneo said, and one of the many questions he’s exploring as the Jack Cowin Chair in Epilepsy Research.
Anti-seizure medication stops seizures from happening for 70 per cent of patients. The remaining 30 per cent live with treatment-resistant epilepsy. Their futures are uncertain, their lives compromised.
“Epilepsy can put a brake on everything they’ve planned—working, studying, socializing,” said Burneo, who is also a professor of neurology and epidemiology at the Schulich School of Medicine & Dentistry.
“For those patients, surgery can be a life-changing option,” he said, and one of the key drivers of Western’s longstanding epilepsy program.
Canada’s largest epilepsy monitoring unit
The program started 45 years ago, thanks to the foresight of Western professors Dr. Warren Blume, a neurologist and epileptologist, and Dr. John Girvin, a neurosurgeon and neurophysiologist. They recognized the need for a specialized inpatient epilepsy unit served by a multidisciplinary team of health-care professionals with expertise in the condition.
Today, the tradition across disciplines continues, with neurologist and epileptologist Burneo co-directing the program with neurosurgeon and clinical neurological sciences chair Dr. David Steven.
At the heart of the program is an 11-bed, in-patient EMU monitoring unit, at University Hospital, London Health Sciences Centre. Here, seizure activity is monitored to help determine if treatment-resistant patients could benefit from surgery.
“The unit is the largest in the country, and has been since its inception in 1977,” Burneo said. “It’s something we’re proud of, and with more than 50 per cent of the patients coming from outside our catchment area, it says a lot about our program.”
The multidisciplinary treatment team includes neurologists, neurosurgeons, psychologists, electroencephalogram (EEG) technologists, neuropathologists, neuroradiologists and neurophysiologists, as well as nurses, occupational therapists, radiologists, social workers and a patient navigator.
Each unit bed is equipped with a camera, microphone, and an EEG tracing electrical impulses in the patients’ brains, capturing seizures in real time to help the treatment team pinpoint their origin.
Understanding where seizures begin is key to determining if surgery is an option.
“The epilepsy unit is where the challenges are,” Burneo said. “That’s where you interpret findings and put everything together, and plan for the surgery to be a success. It’s also where we do clinical research, using imaging to assess how patients responded to certain types of medical or surgical interventions.”
Research in electroencephalography, surgical outcomes, neuroimaging, and basic science has been integral to growing knowledge in the different areas of epilepsy and made possible through strong links with Robarts Research Institute and the Institute of Clinical Evaluative Sciences.
International training ground
Besides patient care, one of the most important aspects of the unit for Burneo is education. The program supports the largest epilepsy and EEG fellowships in Canada, attracting five fellows per year.
“This is where we train our future epilepsy doctors,” he said. “The most attractive part of our training program is having this large unit where trainees see a variety of patients and where we do more than 120 surgery procedures each year.”
More than 30 neurologists and neurosurgeons have come from numerous countries to learn about complex epilepsies, including those from the Middle East and Latin America. This is significant in addressing the epilepsy treatment gap globally and the lack of training of health-care providers to recognize, diagnose and treat epilepsy.
In 2008, Burneo led a collaborative partnering effort between Western’s epilepsy program and the Instituto of Ciencias Neurologicas in Lima, Peru. The goal was to establish a program in Peru by modelling and sharing expertise from the London, Ont., program. Through workshops led by Burneo, Peruvian neurologists learned how to operate their own video-EEG unit to identify surgical cases.
In 2011, Steven joined Burneo on a trip to Peru to lecture on epilepsy surgery and the multidisciplinary aspect of the epilepsy team. One year later, the pair acted as advisors during the country’s first epilepsy surgery – a left temporal lobectomy, performed at the Instituto Nacional de Ciencias Neurologicas. The patient remains seizure-free today.
The International League Against Epilepsy recently named Burneo the 2021 Ambassador for Epilepsy for his instrumental work in improving epilepsy surgery services in Latin America.
Giving back to his country was a “very nice experience,” Burneo said. “With the expertise we have here at Western, it’s important to teach and collaborate with other groups from around the world.”