Marie Collier and epilepsy device

Dr. Marie Collier, a Billings Clinic epileptologist, adjusts an AspireSR device on patient Christina Idukas.

On Oct. 7, Christina Idukas shared a bit of encouraging news with the Billings Clinic epileptologist who’s been treating her for seizures that have plagued her for 20 years.

“I haven’t had any seizures since before July,” she said. “That’s the first time in 20 years that has happened.”

Dr. Marie Collier, the epileptologist, responded by grinning and holding up her hand, followed by an enthusiastic demand for a high five and the two women slapping palms.

For two-thirds of her life, Idukas has suffered from regular monthly seizures, and at times it seemed like there was no effective treatment or end in sight, as medications weren’t effective enough and surgery wasn’t an option.

But that all changed earlier this year, thanks to Collier and a cutting-edge implant that helps to regulate and stop the seizures, sometimes before Idukas even realizes it’s happening.

Called the AspireSR 106, the silver dollar-sized device is implanted near Idukas’ left collarbone and adds an extra layer of seizure therapy by sending small electric pulses up her left vagus nerve and to the brain in an effort to prevent, stop and regulate seizures.

Idukas is one of just six people in Montana with the new device, which gained federal approval within the last year, but around 80,000 people have been implanted with earlier versions since its approval in the late 1990s.

Collier, who joined Billings Clinic last year, is excited with the technology’s effects so far. She noted that the implant is really only an option for people with medication-resistant epilepsy and for whom surgery on the part of the brain where the seizures originate isn’t an option.

“I have seen tremendous improvements in quality of life,” Collier said. “It doesn’t replace medication; it’s adjunct to it. It’s another level of therapy for them to get. That’s really the beauty of it.”

One in 26 people will have epilepsy in their lifetime, making it the fourth-most common neurological disorder in the United States. Collier said that if somebody has two or more unprovoked seizures in their lifetime, they have epilepsy.

Idukas was born with a condition called schizocephaly, an anomaly that resulted in abnormal clefts in her brain and can lead to seizures, which began for her at the age of 11.

“I had three seizures in one day, and they were all grand mal seizures,” she said. “I went to the doctor, and they diagnosed me with epilepsy.”

The seizures continued occasionally but mostly stopped during high school. But when Idukas was about 25, they started up again.

Married and the mother of two boys — Griffin, 9, and Eddie, 4 — Idukas began to suffer from them regularly. For years, she’s often worked two jobs as a hairstylist and hostess, and the continued seizures, which Collier likened to getting struck in the head by lightning each time, made it difficult to work.

“I started having them once a month, every month,” Idukas said.

Numerous different medications didn’t work — a little less than half of newly diagnosed epilepsy patients are seizure-free after treatment with one medication, and about one in three people with epilepsy have drug-resistant epilepsy — and doctors couldn’t get them to stop.

About four years ago, Idukas and her family moved to Montana and now live in Glendive. Earlier this year, she met Collier, who’d recently started working at Billings Clinic, and realized she’d never sat down with an epileptologist before to talk about her condition.

“It’s been 20 years since I’ve had this,” she said. “I needed to figure out what’s going on and what’s my next step. I needed something different.”

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After the two spoke, Collier recommended the AspireSR, and Idukas agreed to the surgery.

Dr. Mark Piedra, a neurosurgeon at the clinic, performed the 90-minute implant surgery, and Idukas went home the next day.

The surgery is a fairly standard implant procedure. Through a pair of incisions, one just below the left collarbone and another a few inches above and near a crease in the neck, Piedra put in the small disc that generates the electric pulses — similar to pacemakers used for heart conditions — and attached the lead by wrapping three wires around the vagus nerve, one of a dozen cranial nerves that ferry impulses around the brain and to parts of the body.

Built by a medical technology company called Cyberonics, the AspireSR Idukas uses is the newest federally approved model and uses what is called Vagus Nerve Stimulation Treatment.

It works with three different modes, starting with a normal setting that uses regularly timed pulses, say for 30 seconds every five minutes, to stimulate the nerve.

The next setting lets Idukas manually activate a pulse. The device comes with a magnet, often worn on the wrist and similar in appearance to a new smartwatch, that patients hold over their chest for a few seconds to deliver an extra dose.

Collier said that setting is a useful option because it allows patients like Idukas to address a seizure if they feel one coming on or are in the middle of one.

Finally, the third setting monitors the patient’s heart and automatically sends out a pulse if it senses a rapid increase in heart rate. About eight out of 10 people who suffer from seizures experience a quick rise in their heart rate before or during a seizure and the AspireSR device sends out a pulse the moment such an increase is sensed.

Overall, it can help to stop seizures before they happen, shorten them if they do, decrease their intensity and speed up recovery time after.

“This gives you the ability to feel like you have some control in a situation where your legs have been swept out from underneath you,” Collier said.

As is standard procedure, Idukas had a few meetings with Collier to adjust the pulses before the device was turned on. Now, she has occasional appointments in which Collier, among other things, can read data on the device’s activity.

On one of her first appointments after turning it on, Collier showed Idukas how the auto-stimulation feature had gone off once, possibly stopping a seizure in its tracks.

“I told her, ‘I didn’t even know I might’ve had one,’” Idukas said.

The most common side effect from the implant is an occasional hoarseness of the voice, and the device’s battery must be replaced roughly every six years.

Collier said that people diagnosed with epilepsy often feel like they’re on their own in dealing with it and that feelings of helplessness are common. She pointed to cases like Idukas’ as proof that that’s not the case.

“I want people to know that they’re not alone, and every patient with epilepsy deserves to see an epileptologists at least once. It’s my passion. It’s what I’ve got extra training in.”

For Idukas, knowing that she’s got another tool to help deal with her seizures has allowed her to rest a little easier.

“It hasn’t happened since I had (the AspireSR) put in,” she said. “That gives me peace of mind.”

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