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Epilepsy Star: For the month of December, our epilepsy star is Enrique Feoli, M.D.

The Epilepsy Star featured in our December 2022 issue is Dr. Enrique Feoli. 

Our epilepsy star for this issue is adult epileptologist, Dr. Enrique Feoli. We sat down to ask him about his decision to become an epileptologist, his day-to-day life in this role and his research interests, and lastly, what he hopes to see in the future in the field of epilepsy care. 

How did you decide to become an epileptologist?

The idea of becoming an epileptologist began when I was a resident at New York University because the epilepsy center had a significant presence in our training. Also as a resident and later, chief resident, we were covering the epilepsy monitoring unit calls, and also assisted in the surgical planning and surgical procedures of patients with epilepsy. My interest in becoming an epilepsy fellow and then an epileptologist was mainly driven by my mentors at NYU and then at Cornell were I witnessed how they strove to help their patients that were significantly affected by epilepsy.  In addition, the complexity of the surgical procedures and the surgical evaluations for epilepsy as well as the amount of details that go into the surgical planning intrigued me.

What is your day-to-day life like as a doctor who specializes in epilepsy and seizures?

There are two different parts to my day-to-day work: 

On the weeks that I cover the call on the epilepsy monitoring unit, I usually start by 7 in the morning, read all the patients' electroencephalograms (EEGs) who are on the unit including children, neonates, and adults. Once that is completed, I continue by conducting bedside rounds, usually accompanied by the resident students and the nurse practitioner. Those rounds are usually over by 12 noon and then everything is documented. During my hospital week there are also surgical cases that require I go to the operating room to participate in stereo electroencephalography or intercranial grid placement.  During these hospital-based weeks I also work on other specialty procedures such as bedside cortical mapping that is used to determine where the patients' language, motor, and vision centers are in preparation for later epilepsy surgery.

On my other weeks, I work in the outpatient setting/office. I usually start at 8:00 AM reviewing and preparing for all the cases that I will be seeing later that day in the clinic. Cases can be very complex requiring a consultation that can last up to an hour to an hour and a half to other cases that are less complicated and then, follow-up visits usually only last somewhere from 15 to 20 minutes.

Lastly, I have days that are dedicated to RNS (responsive neuro stimulation) programming. During those days I spend anywhere from 45 minutes to an hour per patient programming the intracranial device.

What are your main research interests? 

My primary interest is in post-traumatic epilepsy.  With this epilepsy, we know what "time 0" is, that means, we know exactly when that the epilepsy began. This opens a huge window for potential research.

I am also very interested in generalized epilepsy and especially in non-pharmacological treatments such as the use of neuro stimulation.

What innovations would you like to see in the future for those living with epilepsy and those working with epilepsy?

What I would like to see in the future for persons living with epilepsy involves one of the biggest quality-of-life issues: driving restrictions.  Once someone loses their driving privileges often it impacts their ability to get to work and right now, there is no clear solution to this.  Once patients are diagnosed and especially when their seizures are not well controlled, they face major difficulties and may even lose their jobs.  I think there should be a system whereby patients, through their insurance, could apply for some sort of ride-hailing service until their epilepsy is under control. In this way, they could at least not stress about how they will get to work.

In terms of therapy, I think the biggest issue is that still 30 to 35% of the patients are pharmaco-resistant and there has been no significant improvement to this number in the last 50 years of pharmacological development.  I would like to see our medical field make substantial improvements to this in the near future.

Thank you Dr. Feoli.  We can see that the Epilepsy Star recognition you are receiving in this issue is well-deserved!

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