The Center for Epilepsy cares for both pediatric and adult patients with uncontrolled seizures. The Center cares for patients with complex neurological disorders using advanced diagnostic techniques, pharmacological therapies, epilepsy surgeries and vagus nerve stimulation (VNS). The Center also participates in clinical research. Among procedures the Center provides are: 

• Advanced neuroradiology
• Epilepsy surgery
• Neurodiagnostics
• Neuropsychology
• Vagus nerve stimulation

Epilepsy Surgery
Surgery is a promising treatment option for epilepsy that cannot be controlled with anticonvulsant drug therapy. The goal of surgery is to remove the cause of the seizure disorder such as a brain tumor, arteriovenous malformation or lesion. To be a surgical candidate, a child’s grids and strips must show a localized area on one side of the brain that will not affect important brain functions if removed. Surgery is an accepted treatment for the control of seizures and is covered by most health care plans.

When seizures arise from one area of the brain, a surgeon can perform a lobectomy, an operation to remove part or all of a brain lobe. The most common surgery is a left temporal lobectomy. Of the patients who receive this surgery, 70% are seizure-free after one year and 90% show marked improvement.

If seizures originate from multiple areas of one hemisphere, a more extensive operation such as a hemispherectomy or hemispherotomy may be required. A hemispherectomy involves the removal of all or most of one hemisphere. This does not impair thinking ability, but may cause weakness and loss of movement on the opposite side of the body. A hemispherotomy disconnects tissue but does not remove it. Of the patients who undergo one of these surgeries, 70% are seizure-free after the first year and all show improvement.

To prevent seizures from spreading from one hemisphere to the other, some patients receive a corpus callostomy. Severing the corpus callosum, which connects the two halves of the brain, does not stop seizures, since it does not affect the hemisphere in which the seizures originate. But the surgery does usually make seizures less severe.

Epilepsy Evaluation

The first step to a possible seizure-free existence is admission to the epilepsy monitoring unit for seizure evaluation by continuous EEG and video monitoring. Electrodes, attached to the patient’s scalp with glue, report electrical activity of the brain during evoked seizures. The seizures are also videotaped to observe behavioral changes, which assists in a definitive diagnosis. Other diagnostic tests required as part of the neurodiagnostic workup include: 

• MRI (Magnetic Resonance Imaging). This test provides structural information about any abnormal area of the brain.
• PET (Position Emission Topography) and SPECT (Single-Photon Emission Computed Tomography). These techniques show the energy metabolism and perfusion in the brain, helping to clarify specific seizure types and the possible location of seizure onset.
• Neuropsychological testing is completed to confirm normal function of the unaffected areas of the brain.

After completion of the neurodiagnostic workup, the patient’s case is presented at the epilepsy surgery conference. At this conference, adult and pediatric neurologists, epileptologists, neurosurgeons, neuroradiologists, neuropsycholgists, nuclear medicine physicians, and social service and patient care specialists discuss the outcome of the neurodiagnostic process. The team then establishes an individualized treatment plan for optimal seizure control.

A patient identified as a surgical candidate may be readmitted for a craniotomy to undergo surgical placement of subdural grids or depth electrodes directly on or within the brain prior to undergoing one of the procedures discussed above. These grids or subdural electrodes allow for simultaneous video and EEG recording of seizure activity directly from the brain. Intracranial monitoring provides the neurologist and neurosurgeon with additional information related to the area of the brain where the seizure activity originates, information that electrodes attached to the outer surface of the skull cannot obtain. The time involved with this intensive monitoring is usually four days. If a focal area or areas of seizure activity are identified and will not affect important areas of the brain such as speech and motor function, the patient returns to surgery to have that area removed. Patients who are not candidates are taken back to surgery to have the electrodes removed.