Take Action Against Strokes

De'sa Fuller, an assistant principal in West Georgia, greeted teachers in the hallway like every other morning. But her day turned upside down when she lost her balance and couldn’t rise from the floor. Thanks to the immediate actions of those around her—from the teacher who called 911 to emergency medical services and her Wellstar team—De’sa recovered and is back to school. Her story is a powerful testament to how recognizing symptoms of a stroke, calling for help right away and having highly coordinated care can lead to remarkable outcomes.

Getting help when things go wrong

At 34, De'sa Fuller was living a vibrant life. She was a 6th grade assistant principal at Gardner Middle School in LaGrange. She loved her job, enjoyed traveling and was saving up to buy her first home. April 15 started out like any other day. Smoothie in hand, she greeted teachers in the hallway as she made her way to her office.

“I felt a little off,” De'sa recalled. “I just thought I was going too fast—I didn’t put much thought into it.” Then she fell. A concerned teacher asked if she was okay. De'sa, thinking she had simply tripped, said “Yes.” Her vision blurred as she tried to get up and she fell again. “I said, ‘I am not okay.’”

What began as a typical morning turned into a race against time. One teacher's quick thinking to call 911 activated a rapid chain of events that would save De’sa from permanent disability.

The critical first minutes

“The ambulance got there quickly. It was like they were around the corner,” De'sa remembered. 

“We got a call that EMS was bringing in a female who had been found on the floor at work, experiencing right-sided weakness,” explained Ginger Truitt, stroke coordinator at Wellstar West Georgia Medical Center, a Primary Stroke Center. The EMS professionals also reported confusion, headache and vomiting. “Those symptoms suggest stroke. We activated quickly.”

As a result, Dr. Reginald “Ashley” Orr, an emergency medicine physician, was ready for her arrival. 

“I was worried about an acute stroke by their description of her symptoms,” he remembered. “I evaluated her on the stretcher when she came through the door.”

A Code FAST was called with the goal of speeding up the time to start treatment to improve De’sa’s chances for better outcomes. They skipped the emergency department and took her for a CT scan. Then she was seen by the onsite neurologist, and the team quickly administered tenectoplase—or TNK—a clot-busting drug.

“Her symptoms were markedly improved,” Dr. Orr noted. “She was more awake.”

However, the CT angiogram showed an MCA M1 occlusion—a blockage in a major blood vessel in the brain. While she had shown some improvement, it wasn’t enough. De'sa needed a thrombectomy, a procedure to remove the clot and restore vital blood flow to the brain.

A seamless transfer

De’sa needed an immediate transfer to a thrombectomy center, and there are only a few in the state of Georgia. After a quick virtual consult with Dr. Ovais Inamullah, a telestroke neurologist at Wellstar Kennestone Regional Medical Center—a Comprehensive Stroke Center—she was accepted for transfer. The Marietta-based Neuro Care program performs one of the highest volumes of thrombectomy and aneurysm treatments in the country.

Because time is of the essence with successful stroke treatment, transport by air is preferred. However, weather conditions threatened the flight’s safety. The ground EMS crew dutifully stood by in case they needed to drive De’sa. 

Mercifully, the clouds lifted after a few tense moments and she began her trip to Wellstar Kennestone via helicopter.

“When we have this type of emergency, our goal is to get patients out the door for a thrombectomy in 90 minutes,” Ginger said. “In De’sa’s case, we did it in 102 minutes, which was still impressive because there was cloud cover and we weren’t sure at first if she would be able to fly.”

Upon arrival, De'sa was taken directly to the angio suite where Dr. Ahmad Khaldi, a Wellstar neurosurgeon, and his team were waiting. “Every minute counts,” he emphasized.

A thrombectomy is a procedure that treats a stroke without open brain surgery. A tiny catheter is threaded through a blood vessel in the arm or leg to the brain to remove a clot, restoring blood flow to help prevent permanent disability or even death.

“We finished surgery by 11:25 AM,” Dr. Khaldi said—just 20 minutes after the procedure began.

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.

This article was originally published on Atlanta Business Chronicle on May 19, 2023.

Stroke is the fifth leading cause of death in the United States. The Georgia Department of Public Health reports the state had the 12th highest stroke death rate in the country. Georgia is also part of the “stroke belt,” an area of the southeastern United States with stroke death rates 30% higher than the rest of the nation.

As the leading — but preventable — cause of disability, stroke can happen at any age.

Stroke is a medical emergency, meaning the blood flow to an area of the brain is cut off, depriving brain tissue of oxygen and nutrients. When this happens, brain cells start to die and abilities controlled by that area of the brain, such as speech or muscle control, are lost.

New drugs and new advanced treatments — such as the Tigertriever and Artemis — are helping reduce the death and disability impact of stroke, as well as comprehensive care programs and innovative hospital partnerships that expand stroke services into rural areas.

Physicians from Wellstar Health System and the CEO of a hospital in northeast Georgia joined Atlanta Business Chronicle to discuss stroke prevention and the future of stroke care.

Panelists & moderator

• Dr. Rishi Gupta, Endovascular Neurologist and Co-Medical Director of Neuro Care
• Dr. Ashis Tayal, Vascular Neurologist, Wellstar, Director of Neuro Care Network
• Van Loskoski, CEO, Stephens County Hospital
• David Rubinger, Market President & Publisher, Atlanta Business Chronicle; Moderator

What is stroke, screening and secondary prevention

David Rubinger: Dr. Tayal, set the stage for us about the definition of stroke.

Dr. Ashis Tayal: A stroke is a sudden injury of the brain due to blockage or rupture of an artery in the brain. Injuries to the brain and disability can vary significantly.

The most common, ischemic stroke injury, is due to obstruction of an artery that causes a loss of blood flow to a critical part of the brain which damages the brain rapidly.

The other type of stroke is hemorrhagic stroke, where there’s a rupture of an artery, bleeding into the brain, or the surfaces of the brain, and that is called an intracerebral hemorrhage or a subarachnoid hemorrhage.

Rubinger: I think Americans have become a little better educated as to who’s at risk for stroke, but why don’t you walk us through that. Who would be a potential stroke candidate?

Tayal: High blood pressure, or hypertension, is the most common risk factor for both ischemic and hemorrhagic strokes. High blood pressure is an extremely common but controllable condition. Almost 80% of people have hypertension as they’re getting older.

Other risk factors include diabetes associated with elevated blood sugars causing accelerated blockage of arteries and high cholesterol, which can be related to diet and genetics.

Atrial fibrillation, a common heart arrhythmia that occurs as people get older, also places people at risk for the most severe and disabling types of strokes. And plaque buildup in specific arteries of the neck and brain also leads to an increased risk of stroke.

Smoking is another risk factor. Many adults still smoke despite a lot of progress in stroke treatment, and smoking puts people at risk for different types of stroke.

Rubinger: What about atmospheric things like stress and other areas like that? How does that play into it? Or do those things manifest themselves because of the other underlying physical conditions?

Tayal: I don’t view stress, in and of itself, as a risk factor for stroke. I think that’s more related to people’s environments and their own personalities and how they respond to stress. I do think people who are under undue stress can have poor lifestyle habits, and those poor lifestyle habits, whether poor eating habits, smoking, weight gain or lack of exercise, can lead to conditions that increase the risk for stroke.

Rubinger: So how is the healthcare system doing treating strokes? Do you believe that what’s going on at the primary care provider’s office is helping or do we have a way to go?

Tayal: In the United States, preventive care has improved the treatment of risk factors that lead to stroke, but communities must maintain routine checkups as many of the risk factors are silent.

There are improved treatments for hypertension, more aggressive treatment for diabetes, and more efforts at smoking cessation. Just the fact that we treat hypertension better than we did a generation ago has had a great impact on lowering the prevalence of stroke.

That being said, some of the most exciting work on stroke has often been done in the area of acute treatment of stroke with clot-busting drugs, catheter-based treatments and medications to protect the brain during an acute injury.

Rubinger: Has pharmacology gotten better in terms of the hypertension medicines that are out there? Have anti-cholesterol medicines improved in recent years?

Tayal: In the past, healthcare providers were often undertreating people with hyperlipidemia — high cholesterol — and not fully appreciating the benefits of significant reductions in cholesterol levels. For example, we’ve learned that driving cholesterol down into much lower ranges under 55 mg/dL can benefit our patients who have vascular disease as a cause for their stroke.

In the fight against high cholesterol, newer medications that prevent the absorption of cholesterol are now available. Recent developments have led to the discovery of a new underutilized class of drugs called PCSK-9 inhibitors that are highly effective.