Dr. Chelsea White

“I've had epilepsy for 14 years now. When people learned of my condition, they used to say being a doctor wouldn't be a good job for me, but I just couldn't let it go. I’ve wanted to be a physician my whole life. Having epilepsy fueled the fire I have for it now, and I don't think anybody can put it out.”

Even though she didn’t know what they were at the time, Dr. White will never forget her first seizures. She was just 19, a sophomore at the University of Georgia studying biology, and was trying to follow along with lectures and labs when she’d have a few minutes where words suddenly didn’t seem to make sense anymore.

“I knew nothing about epilepsy; knew nobody that had epilepsy, much less focal seizures, which is what I was having. I'd be listening to somebody talk to me and not be able to understand or remember what they said,” Dr. White explained.

Unlike the more widely known convulsive or “grand mal” seizures, focal or partial seizures can be limited to a small portion of the brain and can cause a wide variety of symptoms – some of which can be subtle. During a study break with her classmates one day, Dr. White started looking up her symptoms and first suspected that she might be having seizures.

Her campus health center referred her to a neurologist who ran tests and found a lesion in her brain, but Dr. White didn’t have a seizure during testing, which is common because the tests can be brief – only an hour or two – and might miss symptoms that only occur every few days or weeks. Doctors classified Dr. White as having spells, which are sudden episodes of altered brain function.

When the episodes became more frequent, her mom picked her up from college to get a second opinion at the Mayo Clinic in Jacksonville, a trip that would change the trajectory of her life. Through a battery of new testing and a review of her results with an epileptologist, a neurologist specializing in seizures, doctors diagnosed Dr. White with temporal lobe epilepsy and started her on medication.

“I didn't want to go around saying I had epilepsy because it's so stigmatized, but it was good to have the diagnosis because, by that point, I knew something was definitely wrong,” she said.

Unfortunately, despite the number of available medications, Dr. White couldn’t eliminate her seizures. This is referred to as “drug-resistant epilepsy,” and it affects up to 40% of patients with seizures. For those who have tried two different seizure medications, for example, there is only a 1% chance a third drug will eliminate seizures. After failures of two or three seizure drugs, the next recommended step is an evaluation for epilepsy surgery. That’s what happened to Dr. White.

Broadly, there are two main types of surgery for epilepsy: (1) removing or damaging the part of the brain responsible for seizures, and (2) neuromodulation: using a medical implant to deliver electrical pulses to the nervous system to interrupt the abnormal brain rhythms that cause seizures.

Dr. White’s first surgery occurred in 2017; an MRI-guided wire was inserted into a lesion in her temporal lobe, the area that was judged to be causing her seizures, and a laser was used to burn the abnormal tissue.

“The earlier you can stop a patient’s seizures, the better. The fact that I went years with ongoing seizures was not good for me. I stayed on medications after the ablation and was seizure-free for about two years, enough to get me through the end of medical school and out to Colorado, but in my second year of residency at Swedish, I started having seizures again,” Dr. White said.

Seizures may start in a single area of the brain, but repeated and untreated seizures, like Dr. White’s, can sometimes begin to corrupt or recruit other parts of the brain, causing seizures in other places too. This process is called kindling, like building a fire. This happened to Dr. White. Her surgery in 2017 was initially effective, but she later began having more seizures from the area around the part of her brain that had been treated.

When she first arrived in Colorado, Dr. White was under the care of Dr. Edward Maa, who is now the Medical Director of Epilepsy Services for HealthONE. Dr. Maa is an expert in medication-resistant seizures and their treatment. Many of his patients have undergone surgery with neuromodulation techniques, including Vagus Nerve Stimulation (VNS) and Responsive Neurostimulation (RNS). Both aim to control seizures, but in different ways.

The vagus nerve transmits signals between the brain and organs in the neck, chest and abdomen. In VNS, a tiny wire is wrapped around the vagus nerve in the neck. A pacemaker delivers electrical pulses that travel along the nerve to the brain, reducing seizures. But the vagus nerve also travels to the vocal cords, and some patients experience voice changes, hoarseness and sleep issues.

RNS, by contrast, is a medical implant that is inserted into the brain. The device monitors brain activity and is able to judge when a patient is about to have a seizure. In response, the implant automatically delivers a short, painless electrical pulse to part of the brain in an effort to prevent or stop the seizure. Patients cannot feel these pulses, so side effects are uncommon.

Dr. Matthew Mian, Director of Functional Neurosurgery at Swedish Medical Center, performs these procedures and teaches about them to the neurology residents. Dr. White witnessed many of his procedures and studied them closely in hopes of being able to better treat her future patients, but she had never thought she could be a candidate.

“I was just concerned because other people had said another surgery would mean I’d have to take a year off in residency, and that just wasn't appealing to me. But we were able to made it work with Drs. Maa and Mian,” she said.

One day, when her medications were starting to fail again, Dr. Maa reviewed Dr. White’s earlier brain scans and suggested she consider RNS. “A good candidate for RNS is an adult with drug-resistant epilepsy, who cannot have a procedure to remove or destroy the place in the brain where seizures are starting or someone who’s had a destructive procedure and their seizures have returned,” said Dr. Maa. “Dr. White fit that criteria, and it was critically important to her to preserve not only her fellowship track, but the ability to care for future patients as she advanced in her career. In studies, RNS patients show a significant increase in quality of life, with an average 82% reduction in seizures for patients using the device for three or more years.”

Dr. White took a week off of residency for a visit in the Epilepsy Monitoring Unit (EMU). An EMU is a crucial step in the evaluation for surgery. Patients stay in the hospital for several days, during which a set of electrodes on the scalp, an electroencephalogram, or EEG, is used to monitor for seizures. Dr. White had three seizures in the EMU, helping to pinpoint where her seizures were arising from. Next, she underwent an MRI and a CT scan, which helped to plan her surgery.

“I’d watched Dr. Mian do this numerous times before my surgery, but that didn’t scare me. I know it sounds a bit intense, but my quality of life was just so bad with continuous seizures that doing nothing was just unacceptable. I was ready for relief,” Dr. White said.

She had the RNS device implanted in May 2023. Dr. White’s first breakthrough seizure was more than two months later, in August. The device learns from each seizure it stops and the ones that get through. Her next breakthrough wasn’t until late October. And since then, she’s been free of debilitating seizures.

“I like to be independent. I like to be able to do everything myself. And I had that stolen from me just after I went off to college, right after gaining that independence we all crave in our teen years,” Dr. White said. “The procedure has been life changing. I can't believe I've gone this long and nothing's happened. I told Dr. Maa, ‘You know, this was not just life changing for me; but it was career saving, which is everything to me. Everything I trained for.’”

Now Dr. Chelsea White is on her way to become an epileptologist herself, with a fellowship at the Mayo Clinic in Scottsdale, Arizona, a facility in the same network of hospitals that initially diagnosed her condition and inspired her to serve others with the disorder. And she found out she was accepted into their program in the most amazing way.

When Drs. Maa, Mian and White decided to move forward with RNS, they scheduled the first available surgical date. Dr. Mian’s procedure went beautifully, and Dr. White stayed overnight, which is typical, in the Neuro Intensive Care Unit. The next morning, as she’s waking up to her care team made up of some of her closest colleagues, her phone dings. It was the Mayo Clinic announcing she was selected as their only epilepsy fellow for the incoming class.

“I just feel so fortunate, and it's hard to believe sometimes. This has probably been the best year of my life!”

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Learn more about HealthONE’s epilepsy program, Swedish Medical Center’s neurological experts and Graduate Medical Education at Swedish. Find your doctor by visiting our physician listings here.