Epilepsy Program
Diagnosis & Treatment Options

DIAGNOSIS

Classification of Seizures

For patients with seizure-like spells, or any type of clinical events that have resulted in alteration of consciousness as part of the symptoms, EEG monitoring may be needed to capture the clinical event and correctly classify the seizures. Proper treatment can then be offered. For the most elusive cases, an in-patient video-EEG study can be offered to search for evidence of epileptic seizures as the cause for the spells.

Evaluation and Referral for Epilepsy Surgery

For patients with partial epilepsy that is uncontrolled by two or more anticonvulsants, epilepsy surgery can offer seizure freedom with a success rate of about 70 percent. The pre-surgical evaluation process includes comprehensive assessment in the Epilepsy Center, neuro-radiological imaging studies, a complete neuro-psychological evaluation, a WADA test to identify which side of the brain is dominant for language and memory and in-patient continuous video-EEG monitoring to localize the seizure focus. The patient also will be seen in the neurosurgeon’s office prior to the surgical treatment.

TREATMENT

Medication controls seizures in many people with epilepsy. If medicine alone does not control seizures, other treatment options include:

• Surgery to remove damaged tissue in the brain or the area of brain tissue where seizures begin.
• A special diet called the ketogenic diet. Patients on this diet eat more fat and fewer carbohydrates. This diet reduces seizures in some children with epilepsy.
• A device called a Vagal Nerve Stimulator (VNS) is implanted under the skin near the collarbone. It sends weak signals to the vagus nerve (in the neck) and to the brain to help control seizures. The VNS is reserved for epileptic patients who are resistant to anticonvulsants and deemed not good candidates for epilepsy surgery.

Management of Refractory Epilepsy

Patients with refractory seizures are usually taking more than one anticonvulsant. Antiepileptic medications can have significant side effects that affect a patient’s quality of life. This program will help patients to strike the best possible balance between obtaining seizure control and minimizing medication side effects.

Evaluation for Vagal Nerve Stimulator (VNS) Implantation

For those patients who have undergone pre-surgical evaluation for epilepsy surgery but are deemed not good surgical candidates, VNS can be implanted as an alternative treatment for refractory epilepsy. The VNS will be titrated and managed in the Epilepsy Clinic.