Naledi Centre Takes Epilepsy Treatment to the Next Level
Posted on 28 August 2018
Mediclinic Bloemfontein brings brain specialists together to offer epilepsy patients unprecedented expertise and care.
In August 2018, the Naledi Epilepsy Centre at Mediclinic Bloemfontein opened its doors to patients who require advanced treatment solutions. The Centre is the first of its kind in central South Africa, and brings together three specialists: neurologist Dr Rowan Nichol, consultant neurologist Dr Elmarie van Rensburg, neurosurgeon Dr Wynand van Jaarsveld and neurophysiologist Leona Botes.
Naledi, or “star” in Southern Sotho, aptly captures the aims of Mediclinic Bloemfontein’s new dedicated epilepsy treatment centre: to bring the light of new answers into patients’ lives. After just a month, the facility is already addressing a pressing need in the area.
“By bringing a range of specialists together into the Naledi Centre we are able to offer a comprehensive diagnostic and therapeutic service,” says Dr Nichol. “Our aim is to ensure our epilepsy patients are diagnosed correctly and treated appropriately – and the Centre equips us to do that.”
Epilepsy may be difficult to diagnose and at times may be complicated to treat, she says. “Sometimes I’ll see patients with heart problems, who are having seizures, or anxiety, when they experience what we call pseudo-seizures. They therefore don’t have epilepsy, however, and so I then refer them appropriately for further required treatment.
The Naledi Centre now offers patients unprecedented access to specialists – a particularly important consideration for patients who present with very complicated cases. “Before we established the Centre, most of our patients were being appropriately diagnosed and treated by general practitioners, internal physicians or neurologists in the area. Naledi is therefore able to assist with further interventions or then treatment as so required where the patient presents with refractory seizures. But often they had no access to neurologists – such as in the Northern Cape region.”
Many patients with epilepsy can be effectively treated by GPs and internal physicians. A smaller percentage of patients who suffer from seizures may not ever be fully seizure-free. But epilepsy patients present with varying degrees of severity, and careful monitoring can further assist with the refractory patients being correctly diagnosed and treated.
The Naledi Centre is designed to provide epilepsy patients with what Dr Nichol refers to as the “next level” of care. “Typical epilepsy treatment involves initiating appropriate medication and titrating upwards according to the patient’s response,” Dr Nichol says. “This unit allows us to refine that process, which helps us settle on the best course of treatment a lot more efficiently.”
The unit is equipped with a 24-hour monitoring video service, which correlates to a continuous electroencephalogram (EEG). Whereas the video footage is trained on the patient, the EEG examines the patient’s brain for abnormal electrical activity
“Together, these allow us to see in detail both how a patient experiences a seizure, and what occurs in the brain when they do,” says Dr Nichol. “This ensures we have the comprehensive clinical overview we need to fine-tune our treatment plans – to identify where seizures originate, and adjust medications accordingly.”
This continuous monitoring is impossible to provide in a general hospital ward. “When we talk about adjusting treatment, what we also mean is possibly withdrawing medication,” she says. “We need to see where in the brain the seizure activity is coming from, and for that we need to watch the patient very carefully around the clock.”
Part of that next level is brain surgery. “Patients who don’t respond to treatment will require advanced treatment,” says Dr Nichol. “Especially patients who have been on two drugs for more than two years, and are still experiencing uncontrolled seizures – in those cases, we will have to consider surgery.”
Continual patient support is the Centre’s watchword. “We believe in establishing a close, one-on-one relationship with our patients,” says Dr Nichol. “A lot of them come in when questions: they don’t know when their seizures will occur, or why this is happening to them. This is scary, of course. Our goal is to try to help find those answers.”
Dr Nichol remembers a family who visited her practice recently. “Their child was having refractory seizures and needed surgery, and I referred him to Dr James Butler, who has established the standard of excellence for an epilepsy unit in Cape Town. Now, at the Naledi Centre, we are hoping to be able to provide that surgical option, if it is necessary, closer to home.”
Dr Nichol recalls how the parents had expressed such relief that there may possibly be a further solution for their son. “No-one had discussed that option with them yet. That is the kind of hope we want to provide our patients.”