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Comprehensive Epilepsy Program
Video EEG MonitoringEpilepsy is known as a "historical disease" because doctors generally don't have the opportunity to observe seizures — they have to rely on the patient's description. For some patients with epilepsy, whose seizures respond well to medication, this "historical" information is sufficient. But when medications are not effective (a condition known as refractory epilepsy), a higher level of diagnostic care and treatment is called for.
In such cases, patients are admitted to the hospital for video EEG monitoring. During this procedure, the patient is connected to EEG monitoring equipment. The equipment receives the EEG read-out, translates it into digital format and merges it with simultaneous digital video recording, allowing for a continuous record of seizures over several days.
A technologist monitors the recording, and an online computer monitors the EEG changes. Such monitoring allows the physician to diagnose the type, frequency, and precise location of patients' seizures.
Other Advanced DiagnosticsIn addition to video EEG monitoring, the Comprehensive Epilepsy Program uses several advanced neuro-imaging strategies to evaluate patients' seizures and determine whether they are most likely to benefit from surgery or other treatment options. These
include:
- Magnetoencephalography (MEG), a non-invasive test that improves the detection of potential sources of seizures by revealing the location of abnormalities with exact timing and ultra-fine temporal resolution. MEG offers unprecedented temporal precision in identifying the activity of the area to be removed in surgery, allowing more complete removal while identifying brain tissues that must be spared. MEG can help determine who may benefit from surgery for epilepsy. Read how the MEG test helped one patient regain control of her life.
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- Magnetic resonance imaging (MRI), a scanning technique with special high resolution imaging protocols specifically designed for patients with epilepsy.
- Functional magnetic resonance imaging (fMRI), a related technique that provides detailed images of moment-to-moment changes in brain activity.
- Brain Single Photon Emission Computerized Tomography (SPECT) scanning, a method of tracking blood flow through the brain to identify the location of seizure activity.
- Positron Emission Tomography (PET), that provides an image of the metabolic state of the brain.
Epilepsy SurgeryThe Froedtert & The Medical College of Wisconsin Comprehensive Epilepsy Program was one of the first facilities in the state to offer surgery for epilepsy patients while they are awake — an innovative method that allows the neurosurgeon to more precisely determine which brain tissue should be removed.
Patients that require brain mapping where critical brain function may be indicated receive local anesthesia but are awake and alert for surgery. The surgeon opens the skull to expose the part of the brain that is responsible for seizures, places electrodes on the brain to record brain activity and stimulates the brain during surgery to identify areas that govern functions such as speech and movement, so that these areas can be left untouched while areas causing seizures are removed.
Another method for brain mapping is done by implanting electrodes (grids) on the surface of the brain, bringing the patient out of surgery and completing the brain mapping at their bedside using the implanted electrodes for the stimulation process.
This type of surgery is very effective. Some patients experience complete freedom from seizures; for others, seizures are greatly diminished, so much so that they can reduce their medications.
Vagus Nerve StimulationAnother treatment option, when medication is not effective, is the Vagus Nerve Stimulator. Froedtert & The Medical College of Wisconsin were instrumental in developing this alternative therapy. The Vagus Nerve Stimulator is a disc-shaped, pacemaker-like device that is implanted in the left side of the chest. The stimulator provides an intermittent signal to an electrode connected to the Vagus nerve, located in the left front part of the neck. When patients or witnesses realize a seizure is about to occur, they can use a magnet to activate the stimulator and stop the seizure.
One benefit of Vagus nerve stimulation is that it does not produce many of the side effects that medications sometimes cause, such as drowsiness, dizziness, unsteadiness, slowness of thinking or speaking and potential changes in the function of the bone marrow or liver. Vagus nerve stimulation does require the initial implantation of the device, but this is a brief surgery. Likewise, adjustments to the amount of electricity administered through the device are made during outpatient visits.
A Special Focus on Women with Epilepsy Froedtert & The Medical College of Wisconsin's Comprehensive Epilepsy Program is one of the few programs in the country dedicated to addressing the challenges that are unique to women with epilepsy. The program's multi-disciplinary approach — drawing on the expertise of epileptologists (neurologists specializing in epilepsy), obstetricians and gynecologists, endocrinologists, psychologists, psychiatrists, nurses and social workers — ensures that women with epilepsy receive expert and coordinated care.
Date: Apr. 7, 2010 Last Review Date: July 11, 2011 Online Editor(s): Kathryn Adam |
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