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Ceasing Seizures: Mayo Clinic Collaboration Delivers Results for Complex Epilepsy Patient

Thursday, April 25, 2019 1:11 PM

Jonathan Heck’s first seizure came out of nowhere, terrifying his parents and shocking the young college student as he woke up on a hospital gurney. More than a decade has passed since that traumatic day and, thankfully, Heck’s complex epilepsy is now under control. It has been a long and complicated journey to determine the nature of Heck’s brain abnormality. Today, the now 35-year-old Heck from Chicago’s Jefferson Park neighborhood remains grateful for the ongoing comprehensive and collaborative care quarterbacked by his NorthShore Neurologist Susan Rubin, MD.

Cracking the Code
When Heck first came to Dr. Rubin for treatment of his seizures, she ordered an MRI, which revealed some subtle abnormalities in the brain. It would be the first of many diagnostic tests—including bloodwork and a spinal tap—as Dr. Rubin hoped to determine the source of Heck’s brain inflammation. 

“It’s unusual to have a case this complex, yet most of the initial tests came back with normal results,” explained Dr. Rubin, who holds an academic appointment at the University of Chicago Pritzker School of Medicine.

As part of NorthShore’s ongoing collaboration in the Mayo Clinic Care Network, Dr. Rubin helped facilitate a second-opinion consultation with Mayo Clinic’s Sean Pittock, MD, an expert in the relatively new area of autoimmune neurology.

Joining Forces on New Options
After the previous exhaustive testing provided no answers, Drs. Pittock and Rubin agreed that a brain biopsy was the next logical step. “We try to make a diagnosis doing everything we can without taking out brain tissue—but in Jonathan’s case, with the uncontrolled nature of his seizures, there was no other option,” said Dr. Pittock.

The biopsy revealed inflammatory cells around the brain’s blood vessels and within the brain tissue itself, explained Dr. Rubin. The new finding dictated treatment with an immunosuppressant to decrease the inflammation. That, in addition to other medication, quickly eliminated Heck’s seizures.

“The immunosuppressant drug stopped Jonathan’s immune system from fighting his own nervous system. Repeat imaging showed that the inflammation in his brain was greatly diminished,” added Dr. Pittock.

Amazing Outcome
The positive results of the treatment plan have been a godsend for Heck, who is married and works in information technology customer service. He has been seizure-free for more than a year and is once again able to drive. 

“I know there’s a lot of trial and error to get people on the right meds for seizures, and other patients have had it far worse than me,” noted Heck. “Dr. Rubin is so nice and kind. She knows what she’s doing, and the care at Mayo also has been very good.”

Fortunately, Heck tolerates the new medications with virtually no side effects. He continues to be monitored with MRIs and clinical visits every six months, said Dr. Rubin.

“I’ve known Jonathan for a long time now, and it’s so nice to see him leading a normal, active life,” she added. “His case shows the benefits of our Mayo Clinic collaboration, and the value in getting support and suggestions from a fellow expert like Dr. Pittock in managing these rare cases.