A world-renowned health care provider and insurer, Pittsburgh-based UPMC is inventing new models of accountable, cost-effective, patient-centered care. It provides more than $888 million a year in benefits to its communities, including more care to the re
Anto Bagic is the head of epilepsy treatment at UPMC and a national leader in using magnetoencephalography, or MEG, a way to determine where the epicenters of seizures are in the brain.
The prospect of brain surgery can be frightening.
Not only can a doctor remove a part of what makes you you, but the legacy of brain surgery is clouded by such crude procedures as frontal lobotomies.
And yet, when it comes to epilepsy, surgery is being vastly underused, says Anto Bagic, director of the University of Pittsburgh's Comprehensive Epilepsy Center.
Epilepsy affects 2.5 million to 3 million people in the United States, and nearly 1 million of those patients have uncontrolled seizures -- periodic electrical firestorms in their brains that cannot be governed by medications.
The MEG machine uses extremely sensitive detectors to map the magnetic fields created by the brain's electrical activity, and because epilepsy involves "a critical mass of brain cells firing together in a violent way," Dr. Bagic said, it can help pinpoint the source of seizures in the brain.
"It's like trying to reconstruct a car accident by studying the wreckage rather than by watching the accident," Dr. Bagic said.
Sometimes, doctors need to be even more precise about the epicenter of a seizure.
In those cases, they bring patients into the hospital, remove a part of their skull, place an electrode grid directly on the surface of the brain and then wait for them to have a seizure.
The electrode array can pinpoint where the disturbance erupts.
Even if every epilepsy patient eligible for surgery could get it, there would still hundreds of thousands more with uncontrolled seizures, Dr. Bagic said.
Dr. Bagic's MEG device would be of great value if it were only used for his epilepsy diagnoses, but because it sits in a major research institution, it is also being employed for several scientific studies.
The MEG machine is currently being used for studies of dementia, depression and amyotrophic lateral sclerosis, or Lou Gehrig's disease.
Dr. Bagic is also using it to chart the progress being made by UPMC's first hand transplant recipient, Josh Maloney, who lost his right hand in a Marine training exercise explosion.
As a founding board member of the American Clinical MEG Society, Dr. Bagic has lobbied for regular insurance coverage for MEG scans used in epilepsy diagnosis and mapping tumors and other brain lesions.
As explained by epilepsy specialist Dr. Anto Bagic at the University of Pittsburgh, the FDA mandates only a set of factors defining the pharmaceutical equivalence of a brand drug and its generic formulations.The FDA requires the same amount and purity of active ingredients in both.
Chief of the Epilepsy Division of the University of Pittsburgh Medical Center and director of the University of Pittsburgh Comprehensive Epilepsy Center, Dr. Bagic said that, technically speaking, for a generic product to be considered equivalent it has to have a similar measurements of the medication's distribution in the body and the medication's rate of reaching its greatest concentration in the bloodstream.
"Since antiseizure medications must be maintained at a certain therapeutic level in a patient's bloodstream, a switch from a brand-name to a generic drug or between generic versions can have various undesired results," he said.
"When a generic is approved there is an FDA process they go through, but they are never compared with each other," Dr. Bagic said.
Dr. Bagic said he has seen the problem for the past few decades, as older antiepileptic medications became generic.
Dr. Bagic himself has a patient who had been stable for more than a year and then experienced a seizure three or four weeks after she switched to a generic medication.
But before a doctor can blame the generic, Dr. Bagic said, other issues must be considered: "Has she been taking her medication regularly?
"Fortunately, most patients have no problems associated with the switch," Dr. Bagic said.
Dr. Bagic added that patients should also involve their pharmacist and document the manufacturer and lot number of their generic medication.
Then, unwanted results could be reported to the FDA.
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