Wir überwinden Grenzen

(30.06.2016) The patient actually leads a completely normal life. But he regularly hears screams and music that no one else can hear. Professor Andreas Schulze-Bonhage succeeds in curing the patient with a precisely planned brain operation.

Markus F.* is in his mid-20s, studies a humanities subject and has a somewhat reserved nature. But since he was six years old, he had hallucinations several times a day: sometimes the voice of the person he was talking to seemed to get so loud that it hurt; sometimes it sounded angry and sometimes like singing. After ten to 15 seconds, it was all over.

"The disorder was very distressing for the patient, although he knew very well that the hallucinations were not real - in contrast to patients with schizophrenia, for example," says epileptologist Professor Dr. Andreas Schulze-Bonhage, head of the Epilepsy Center at the Freiburg University Medical Center. Because those affected are often regarded as mentally ill, they frequently conceal their problems.

The patient only told the Freiburg epileptologist about his hallucinations when asked. The reason for his appointment at the Freiburg Epilepsy Center was that his epilepsy was becoming increasingly severe. Six years earlier, at the age of 20, Markus F. had suffered his first major epileptic seizure. In the meantime, two to three seizures were occurring every month, mostly during sleep.

Around one in a hundred people suffer from epilepsy

Epilepsy is one of the most common neurological diseases. One in ten people suffer a major epileptic seizure once in their lifetime. In around one in a hundred people, the seizures occur repeatedly. This is known as epilepsy. During an epileptic seizure, the person affected loses consciousness and the muscles tense involuntarily, often in combination with a cry at the beginning of the seizure. After a few seconds or minutes, the person falls into a deep sleep or slowly recovers as consciousness returns. The reason for this is a disturbance in brain activity, of which there are two different forms: If the entire brain is affected from the beginning, it is called a generalized seizure. If the seizure originates in a specific region of the brain, a so-called seizure focus, it is called a focal seizure.

If medication does not work, surgery can help

A course of medication that Markus F. had been taking in his home country had to be discontinued due to impending liver failure. Other medication did not work. "One in three epilepsy patients does not respond to medication. But only five to ten percent undergo surgery. We could help many more people. Nowadays, we can often identify focal seizure foci very well and remove them surgically without any disadvantages for the patient," says the epileptologist.

Markus F. came many hundreds of kilometers from northern Germany to Freiburg for an outpatient consultation - and did not yet know that this would solve both of his problems. First of all, Professor Schulze-Bonhage and his team of doctors carried out an electroencephalogram, or EEG for short, on the patient. This uses electrodes on the scalp to measure brain activity before and during a seizure: "In the area of the auditory cortex, which processes acoustic stimuli, we found brain activity typical of epilepsy. This was the first time we had confirmation of the suspicion that the two phenomena could be connected," says Professor Schulze-Bonhage.

The seizure focus is precisely localized and then removed

In order to better localize the affected area, the Freiburg doctors implanted electrodes directly into the suspected brain region of the patient for a few days. This enabled them to narrow down an area of 1.5 square centimeters in the auditory cortex that was triggering the seizures.

The suspicious brain tissue was removed in a two-hour operation. "Because the auditory cortex is located in both hemispheres of the brain and ears are connected to both sides, the patient has no disadvantages from the removal," explains Professor Schulze-Bonhage. "There is a 70 to 80 percent chance that he will remain permanently seizure-free."

The operation not only stops the major epileptic seizures, but also the auditory hallucinations. "This confirmed that the hallucinations were actually also minor epileptic seizures, so-called auras," says Professor Schulze-Bonhage.

Sensory auras are not uncommon

Around 80,000 people in Germany suffer from such hallucinations, known as sensory auras. They can affect all sensory impressions: Flashes of light, sensations of smell and taste, or the feeling of having to burp are not uncommon. However, mild seizures can also take other forms: some people have fits of laughter, anxiety or a racing heart. "An aura is nothing more than a minor epileptic seizure. They often get stronger over time. However, if they are recognized, they can be treated well in many cases," says Professor Schulze-Bonhage. In particularly difficult cases, an operation is necessary.

Markus F. is doing very well one month after the operation. So far, he is completely seizure-free and can devote himself fully to his studies.

*Name changed by the editors