Save Lives, Don’t Drive—When to Call 911

Robert Frederick was living a typical life, going to work and spending time with his mother, siblings and children. But then it became hard to breathe when walking short distances or climbing stairs. He got dizzy. Perhaps most disturbingly, he passed out several times—once at a Braves baseball game he attended with his siblings.

"I didn't know what was going on!" Robert recalled.

Difficulty controlling AFib with medication

After passing out the first time, he went to urgent care and was then taken to the hospital by ambulance. He learned his symptoms were caused by atrial fibrillation (AFib), an irregular heartbeat.

Robert began to see Dr. David Caras, a Wellstar general cardiologist, and learned AFib is related to high blood pressure. Successfully managing high blood pressure often helps people keep AFib under control. Despite their efforts, AFib sent Robert to the emergency room two more times.

Suspicion of HCM

Dr. Caras reviewed Robert’s hospital records and found he had increased wall thickness of the left ventricle and a gradient—a pressure difference between the left ventricle and the aorta when the heart pumps. These findings were consistent with a condition called hypertrophic cardiomyopathy (HCM). Characterized by abnormal thickening of the heart muscle, this disease makes it difficult for the heart to pump blood effectively.

Dr. Caras referred Robert to Dr. Melissa Burroughs, an HCM specialist at Wellstar. As a Center of Excellence designated by the Hypertrophic Cardiomyopathy Association, Wellstar is one of the leading providers of comprehensive HCM care in Metro Atlanta.

"We have physicians in the group—designated HCM specialists—that are the point person of the patient’s care," Dr. Burroughs explained. “This includes close communication and collaboration with electrophysiologists, surgeons, advanced heart failure specialists, social workers and behavioral health professionals.”

A rare finding leads to Mayo Clinic Care Network collaboration

Robert said, “Dr. Burroughs wanted to do genetic testing to verify that I had HCM."

But genetic testing revealed a rare genetic variant—one not known to be associated with HCM. Dr. Burroughs called it a “diagnostic conundrum.” The genetic variant found was typically associated with a different cardiac disease that Robert did not have. However, he did have clear signs of HCM.

To investigate further, Dr. Burroughs collaborated with other HCM experts through the Mayo Clinic Care Network, of which Wellstar is a member. Mayo Clinic, which is also an HCM Center of Excellence, provided access to its unpublished database, finding Robert’s rare mutation was present in two other family groups with HCM.

“It’s very important that we add to the science—that we include our patients in the registry to enhance what is already known about HCM,” Dr. Burroughs said.

Robert added, “Dr. Burroughs is very persistent. She wanted to know, ‘Why are you having these problems? What’s the root cause?’ She went above and beyond to find that out.”

Having or witnessing a seizure can be frightening. But clinicians have made remarkable advances in diagnosing the causes and preventing future seizures with medications and surgery.

“Seizures often seem scarier to bystanders than to patients,” said Dr. Thomas Holmes, a Wellstar neurologist. “Most patients don’t even remember them.”

Epilepsy is more common than many realize—about 1 in 26 people will be diagnosed in their lifetime. On WSB’s The Weekly Check-Up, Dr. Holmes explained how epilepsy is diagnosed, why not all seizures mean epilepsy and what treatments are available.

As director of neurodiagnostics at Wellstar, Dr. Holmes helped Wellstar Kennestone Regional Medical Center earn Level 3 Adult Epilepsy Center accreditation, recognizing its advanced care for patients with hard-to-treat seizures.

Diagnosing epilepsy

According to Dr. Holmes, a seizure happens when there's an “abnormal firing of neurons in the brain.” This electrical disturbance can cause a range of symptoms—some more visible than others. A person having a seizure may briefly lose consciousness, and other signs can include:

• Trouble breathing or temporarily stopping breathing
• Sudden falls without warning
• Jerking movements or a sudden loss of muscle control
• Loss of bladder or bowel control
• Not responding to sounds or voices for a few moments
• Staring spells, sometimes with rapid blinking

It’s important to know that not all seizures are caused by epilepsy. Other conditions like stroke, brain injuries, infections or tumors can also trigger them. That’s why gathering details from someone who witnessed the seizure—like a family member—can be helpful for doctors trying to make an accurate diagnosis.

When someone experiences a seizure, the first step is usually brain imaging. An MRI is often ordered to look for structural causes, and an EEG, which records the brain’s electrical activity, can help detect abnormal patterns. In some cases, patients may be asked to wear a portable EEG at home for several days to capture activity that doesn’t happen regularly. Both MRIs and EEGs are safe and painless.

For more advanced monitoring, Wellstar offers inpatient epilepsy monitoring units (EMUs) at Wellstar Kennestone, Wellstar MCG Health and Wellstar North Fulton Medical Centers. These specialized units provide around-the-clock observation and are among the few in Georgia offering this level of epilepsy care.

Medications and surgery for seizures and epilepsy

For most people with epilepsy, medication is the first and most effective treatment option. How long someone needs to stay on medication depends on several factors, including what’s causing the seizures and what clinicians find during ongoing monitoring.

Sometimes a seizure is triggered by a specific event, like a head injury. In those cases, Dr. Holmes explained, long-term medication may not be necessary. But if tests reveal a structural issue in the brain—like an area of damage—it usually means a higher risk of future seizures and longer-term treatment is often recommended.

“You don’t necessarily need to be on medication for life, even if you have epilepsy,” said Dr. Holmes. Patients are regularly monitored, treatment plans are highly personalized and care plans are revisited to ensure the best outcomes possible.

“If someone has been seizure-free for two to three years, has a normal EEG and no visible brain lesion, we’ll often discuss tapering off medication if the patient is open to it,” he said.

Some people may struggle with seizure control despite medication. About 10% of patients don’t respond well to drugs—but there are additional treatments available.

Wellstar’s EMUs can help determine where in the brain seizures are starting. In some cases, surgery to remove a small area of brain tissue can significantly reduce or even stop seizures. According to Dr. Holmes, this approach is successful in nearly 70% of cases.

Other advanced options include laser surgery or a responsive neurostimulation—when a small device is implanted in the brain to detect abnormal activity and deliver a pulse to stop a seizure before it starts.

Looking ahead, Dr. Holmes is optimistic. “There are going to be many options that are not drug-related,” he said. “Less invasive procedures are on the rise, and we’re learning more about the genetic causes of epilepsy—especially in children. Research and clinical trials may even lead us to gene therapies in the near future.”

Epilepsy care is evolving rapidly, and for many patients, that means more control, fewer side effects, and real hope for the future.

Epilepsy and Seizures Program at Wellstar

Our Epilepsy and Seizures Program is one of only a few such programs in Georgia. It provides comprehensive care to help children and adults manage seizures. The program also offers a streamlined pathway to determine if a patient is a candidate for advanced treatments, including minimally invasive surgery and deep brain stimulation.

Wellstar Children's Hospital of Georgia and Wellstar MCG Health in Augusta are Level 4 Comprehensive Epilepsy Centers, the highest designation by the National Association of Epilepsy Centers. Wellstar Kennestone is a Level 3 Adult Epilepsy Center.

Learn more about the Epilepsy and Seizures Program and Wellstar providers.