Carol Gutierrez had a bad feeling.
An EEG measures and records the electrical activity from the firing of neurons in the brain. Electrodes that read that activity are attached to the scalp and connected to a computer via wires. The brain's electrical activity is tracked on the computer, and any abnormal activity, like a seizure, can be recorded. During a video EEG, the patient is videotaped while the EEG is being recorded.
Although she had been having odd sensations throughout her body, seeing auras, and blacking out, that wasn't the cause of her feeling. She was just having a hard time believing the diagnosis her doctor had given her.
"Epilepsy? I am fine my whole life and then I have epilepsy at 52?"
She decided to get another opinion. She made an appointment at New York Methodist Hospital's Comprehensive Epilepsy Center, the largest dedicated epilepsy center in Brooklyn, and was referred to Andrew Dawson, M.D., attending physician in NYM's Department of Neurosciences.
"Immediately, I felt at ease with Dr. Dawson. He was accessible and attentive, and had such a compassionate manner. I could tell he was really listening to my history and my concerns; I was a real person to him, not just a puzzle of problems." Dr. Dawson continued to treat Ms. Gutierrez for epilepsy-a neurological disorder characterized by recurrent seizures caused by abnormal electrical brain activity-but insisted on running additional tests to further investigate her symptoms, especially the blackouts, which were still occurring.
"Despite the fact that we kept increasing her seizure medicines, she kept on having these episodes, which was unusual," remembers Dr. Dawson. "I strongly recommended that she come in for video EEG monitoring. I told her that it was very important to make an accurate diagnosis because although we had increased her medication to the highest recommended dose, she was still having episodes and they seemed to be getting worse."
"Up to 30 to 40 percent of people admitted for video EEG monitoring are labeled as having epileptic seizures when, in fact, they have something else, such as a movement disorder, sleep disorder, cardiac issues or psychogenic event."
Dr. Dawson admitted Ms. Gutierrez to the Center's Electroencephalogram (EEG) Suite for observation. "I was in the EEG Suite for four days, and no abnormal activity had been recorded, so I was preparing to go home when bam! I get hit with a seizure that sent me sprawling. When I came to, there was Dr. Dawson, who was excitedly telling me that they had captured the entire episode on the computer and on the video-and the data showed that I did not have epilepsy at all!" remembers Ms. Gutierrez.
"In fact, the problem lay with her heart. During the seizure, her heart rate significantly slowed down and in the EEG her brain waves did not show any seizure activity. In fact, the background brain wave pattern showed significant slowing and flattening, which coincided with the slowing of the heart rate. This meant that the brain was not getting enough oxygen," says Dr. Dawson. "I showed Ms. Gutierrez the event on the video monitor, which can be very helpful for patients because seeing the event reinforces the importance of taking medications and getting follow-up treatment. I also showed the data to a cardiologist. She was immediately transferred to the Division of Cardiology."
Next thing she knew, Ms. Gutierrez was placed in the care of David Benson, M.D., associate director of the Division of Cardiology's Electrophysiology Laboratory. "I remember him saying to me, 'I am the electrician. When there is a problem with the electrical system, that is where I come in.' It turns out that my blackouts were caused by my heart actually stopping. My heart would stop, and I would pass out," Ms. Gutierrez recalls. She had a condition called sick sinus syndrome, which describes a number of heart rhythm disorders, including her specific issue: sinus arrest. With sinus arrest, the heart's sinus node fails to initiate the impulse for the heart to beat, essentially causing the heart to cease beating. Dr. Benson determined that Ms. Gutierrez needed a pacemaker. A pacemaker is a small device that uses electrical pulses to prompt the heart to beat at a normal rate.
"I was nervous," Ms. Gutierrez recalls, "but Dr. Benson truly comforted me. I asked him to look at me as if I was his mother: Would he counsel her to have the same procedure? He replied that yes, he absolutely would. Just like Dr. Dawson, he was such a compassionate man. In fact, the entire staff made me feel comfortable and assured me that everything would be fine. I work in the healthcare industry, with many care providers, and I can tell you that beyond the excellent care of the epilepsy and cardiology staffs, it was the little things they did-the extra smiles, the encouragement and sincere support-that made the difference for me."
"Since my pacemaker was implanted, I haven't had one single episode-no auras, no blackouts," says Ms. Gutierrez. "I am followed by a cardiologist, Sorin Brener, M.D., director of NYM's Cardiac Catherization Laboratory, and he works closely with Dr. Benson, whom I see every three months to get what I call my 'bionics' checked. I truly feel like Dr. Dawson and Dr. Benson gave me my life back. Before, I couldn't drive; I could barely do anything. The fear of blacking out completely compromised my life. Now I am living my very busy life to the fullest, and am thankful for every minute of it."
Read more real life patient stories in the 2011 NYM Annual Report.