Last Christmas, one of my patients gave me a gift that she had made herself. It was a needlepoint design of a small lighthouse on a deserted beach. The present took me by surprise. Over the previous 2 years we had tried everything to control her seizures, but nothing had helped her very much. If anything, her seizures were worse. She told me she wanted me to know that she appreciated what I was doing for her, because I wouldn’t give up on her.

In my neurology practice I see only patients with epilepsy. I have been doing this for a number of years and have treated over one thousand patients. I chose epilepsy as my specialty for two reasons, one academic, and the other practical. First, the functional anatomy of the brain has fascinated me since I was a student. I knew that trying to understand how the brain works could challenge me enough for an entire career. Second, as a practicing physician I wanted to take care of people I could really help. During my neurology residency, it appeared as though we couldn’t do much for patients with most neurological diseases, such as muscular dystrophy, stroke, or dementia. But epilepsy patients were dramatically different. Once a correct diagnosis was made and the proper medication was prescribed, seizures could be stopped. I was lucky to learn from teachers who were experts in treating epilepsy. Patients came from all over the world to see them. I saw that many people with epilepsy had their seizures completely controlled, and almost all of them experienced significant improvement. Sometimes epilepsy surgery actually cured someone.

I did a fellowship in electroencephalography because I liked the idea of studying brain waves and learning how to identify an epileptic focus. Now I apply my technical expertise to help people with epilepsy control their seizures.

One might think that the patients I remember best are those with the most successful outcomes, the ones whose seizures vanished. But that’s not true. The way things work, I rarely have time to think about the patients who do well. I see patients only once a year after their seizures come under control. When they do come to the office, the visits are pleasant but usually brief. I refill their prescriptions, we smile, shake hands, and they’re gone for another year.

It is the patients with recurrent seizures whom I remember best because I see them again and again every few weeks. I find their charts on my desk with notes from the on-call physician describing yet another side effect, an injury from a seizure, or a visit to the emergency room. Their clinic visits are long and arduous. I listen to their tales of frustration about not being able to drive. Their faces are grim, and sometimes I sense anger in their voices when they tell me about another job lost because of a seizure. They list their epilepsy medications and struggle to remember the dosages. Many take an antidepressant, and with good reason. Together we grope for answers. Is there an anticonvulsant we haven’t tried? Should we experiment with an investigational drug? Should we consider brain surgery, even if it only stops most but not all of the seizures?

For some patients with difficult-to-control epilepsy, our cooperative struggles against their seizures yields worthwhile results. We reduce medications from three to two then to one. Seizures decrease from twice a week to twice a month. Side effects diminish. Phone calls taper off. The visits become shorter and less frequent. For other patients, piles of seizure calendars, anticonvulsant drug levels, and dictated notes accumulate. Their charts grow into behemoths and threaten to explode at the seams. Bottle after bottle of expensive drugs with exotic names, telephone calls with complaints of dizziness, hospitalizations for epilepsy monitoring, and innumerable office visits do not seem to get us anywhere. Yet we continue to try. We know that without the medications the seizures would be worse.

Each year I attend the American Epilepsy Society meeting. Investigators from around the world present the results of hundreds of research projects. I reassure my patients that millions of dollars and many of the world’s finest scientific minds are devoted to understanding their disorder. There will be therapeutic advances. Next year, or the year after, we will have something else to try. And this time it just might work.

What reassures me is the picture of the lighthouse on my wall, symbolic of what our patients unselfishly give us and what we give them in return.

The beacon is burning. The promise of progress illuminates the night.

The Brainstorms Healer: Epilepsy In Our Experience edited by Steven C. Schachter, M.D. and A. James Rowan, M.D., Raven Press, 1998, Lippincott Williams & Wilkins