Coordinated Epilepsy CareThe Comprehensive Epilepsy Program at Froedtert & the Medical College of Wisconsin is one of the few in the country with a multidisciplinary approach, providing expert, coordinated care for people with epilepsy. The center is designated a level 4 epilepsy center — the highest rating — by the National Association of Epilepsy Centers. Patients are referred to the Comprehensive Epilepsy Program from throughout Wisconsin and northern Illinois.
Team members include four epileptologists, an epilepsy fellow, neuropsychologists, neurosurgeons, neurodiagnostic technicians, epilepsy nurses, a psychologist and social workers. They take a holistic approach, addressing not only patients’ seizures, but also aspects of their lives that might be affected by epilepsy, such as social and workplace challenges.
About 250 patients are referred by neurologists to the Comprehensive Epilepsy Program each year for video EEG monitoring.“In recent years, our program has grown in the volume of patients we see and the number of surgical procedures we are able to offer — averaging about 30 per year,” Manoj Raghavan, MD, PhD, Medical College of Wisconsin epileptologist and director of the Comprehensive Epilepsy Program said.
Vagus Nerve StimulationWhen medication is ineffective and a patient is not a candidate for — or chooses not to have — brain surgery, vagus nerve stimulation (VNS) is a treatment option for patients with partial epilepsy. VNS involves implanting a pacemakerlike device in the chest under the skin. A wire connects the device to an electrode attached to the vagus nerve, located in the front of the neck.The nerve relays information to and from the brain. The stimulator is programmed to generate pulses of electricity at regular intervals. The intermittent stimulation of the vagus nerve has been shown to reduce seizures significantly over time in most patients. When the patient or a witness realizes a seizure is about to occur, they can sometimes also use a magnet to activate the stimulator and potentially stop the seizure.
Studying Women With EpilepsyThe Comprehensive Epilepsy Program is also one of the few programs in the country with resources dedicated to addressing the unique challenges of women with epilepsy.“ Very few programs in the country have the appropriate system of referrals — to endocrinologists, obstetrician/gynecologists, and other physicians – to completely evaluate the many disease variables in women with epilepsy,” Dr. Raghavan said.“We have a strong research focus and our system of referrals allows us to collect in-depth data on issues pertaining to the health of women with epilepsy. For patients, this provides easy access to appropriate specialists and better informed clinical decisions.”
Advanced DiagnosticsThe Comprehensive Epilepsy Program uses advanced neuroimaging methods to evaluate patients’ seizures and determine if they are most likely to benefit from surgery or other treatments.
“Brain imaging methods are being used increasingly to gather information about normal and abnormal brain areas without doing invasive tests. Techniques such as high resolution MRI, single photon emission computerized tomography, and positron emission tomography are now widely available,” Dr. Raghavan said. “Our center is actively involved in collaborations to develop new imaging techniques. For example three-dimensional visualization of the brain depicting abnormal and normal areas all on the same image can greatly refine our approach to epilepsy surgery. Our center has been actively involved for years now in studying the applications of functional MRI (fMRI) for epilepsy surgery. fMRI provides a non-invasive way to assess language and memory functions.We have also been studying a new MRI technique called diffusion tensor imaging, which allows us to visualize nerve fiber bundles that connect different parts of the brain.Another emerging imaging technique is electrical source imaging, which uses computers and 3-D brain models to determine where electrical currents related to seizures come from in the brain.”
Clinical Trials“Our program offers patients opportunities to participate in a variety of clinical research trials,” Romila Mushtaq, MD, Medical College of Wisconsin epileptologist said. “Many aspects of epilepsy are still under-studied. Patients who join the studies help us gain knowledge to treat others through new medications, treatment and fMRI studies.
Source: Froedtert Today
Date: June 2006
|Medical Reviewer: ||Manoj Raghavan, MD, PhD|
|Medical College of Wisconsin epileptologist|
|Director, Comprehensive Epilepsy Program|