Comprehensive Epilepsy Program
Magnetoencephalography (MEG)Froedtert & The Medical College recently became the first healthcare organization in the state to use magnetoencephalography (MEG) imaging in patient care. This non-invasive technology helps patients with brain cancer and severe epilepsy cases. It's a diagnostic tool helps neurologists and neurosurgeons evaluate and map brain activity before surgery.
Advanced Brain MappingFroedtert & The Medical College of Wisconsin have played a pioneering role in the development and innovative use of advanced diagnostic techniques to map the functional areas in the brain prior to surgery. These highly specialized tests are performed by interventional radiologists, epileptologists and neuropsychologists. These tests are performed while the patient is awake and reduce the risk of loss of speech and memory functions and help in deciding on surgery as a treatment. This results in a higher level of care for neurology and neurosurgery patients.
Intracarotid Sodium Amobarbital Test: This test determines which side of the brain is responsible for vital cognitive functions. A drug is injected into first one hemisphere of the brain and then the other hemisphere. Knowing whether the left or right side of the brain supports language and memory helps with making decisions on surgery to treat epileptic seizures.
Functional Magnetic Resonance Imaging (fMRI): This specialized MRI scan maps the different types of functions, like language, memory, attention, motor and the visual processes. It provides detailed images quickly and moment-to-moment changes in brain activity. The fMRI allows surgeons to pinpoint the functional areas of the brain and to improve outcome following surgery.
Pioneering TreatmentsOne of the first epilepsy programs in Wisconsin, the Comprehensive Epilepsy Program's exceptional physicians have performed more "awake" surgeries than any other program in the state. The program has also assisted more adult patients than any other Wisconsin hospital using the Vagus Nerve Stimulator, an implantable device that blocks seizures before they occur.
Pharmacological Treatment Medication is widely used as the first step in treatment of epilepsy. Clinicians at the Comprehensive Epilepsy Program have a vast amount of knowledge of the latest drug therapies available depending on the type and frequency of the patients' seizures. This knowledge is essential in optimally treating persons with epilepsy, as eight new medications have been released in the past few years.
Epilepsy SurgeryCorrective surgery is another treatment option for some patients and the Comprehensive Epilepsy Program employs all of the latest, state-of-the-science techniques and strategies. Neurosurgeons with vast experience in epilepsy surgery provide their technical expertise and care.
For those patients that have non-controlled seizures and a localized seizures focus in the brain, surgery provides seizure freedom inmost cases. In others, seizures are diminished making it possible to reduce drug therapies.
In any surgical procedure, a detailed "map" of the brain is needed so that only the seizure-producing areas of the brain are removed. Cortical mapping is a highly accurate technique used by epilepsy neurosurgeons to localize both the region of the brain generating seizures as well as the areas that are responsible for thought and movement. For obtaining a map of the brain two techniques are used:
- Prolonged monitoring with electrodes over the surface of the brain (called subdural electrodes). These electrodes allow recording of the brains electrical activity associated with function and with seizures; and
- "Awake" surgery where the brain is mapped during surgery with the help of the patient. During this highly sophisticated technique, the patient receives local sedation and actually responds during the procedure. The surgery exposes the part of the brain believed to be involved in the cause of the seizures. A neurosurgeon places electrodes directly on the brain to provide an accurate reading of the brain waves. The brain is then stimulated with electric current and the response is recorded. This pinpoints the origins of motor, language and sensory functions so the surgeon can avoid putting them at risk when removing the area that causes seizures.
Vagus Nerve Simulation
Another innovative option for the treatment of non-controlled seizures is Vagus Nerve Stimulation. This treatment involves the surgical implantation of a generator device (similar to a pacemaker) in the left side of the chest. The generator provides an intermittent electrical signal to the Vagus nerve in the left front part of the neck that is connected to the brain. The stimulator provides remarkable seizure reduction in many patients. Moreover, it empowers the patient with a tool to stop seizures while they occur by applying a special magnet over the generator and providing an extra electrical current.