Epilepsy Monitoring and Treatment
What is epilepsy?
Epilepsy is a serious neurological disorder that affects more than two million people in the U.S. and 50 million people worldwide. The disease, which varies in severity and can begin at any age, is characterized by abnormal electrical activity in the brain, which causes seizures. Common symptoms of seizures may include involuntary repetitive non-productive movements or jerking movements, muscle rigidity, an appearance of daydreaming, brief loss of consciousness or a period of deep sleep after the seizure has ended.
Epilepsy can result from a brain injury before, during or after birth; head trauma; certain infectious diseases; or brain tumors. However, in over half of the cases the cause is unknown. For about 80 percent of people who have epilepsy, seizures can be successfully controlled with modern medications, surgery or alternative treatments such as Vagus nerve stimulation.
What is the typical course of treatment for patients who enter the Comprehensive Epilepsy Program?
Treatment begins with a thorough evaluation of each patient's symptoms, seizure history and prior medical care. An epileptologist (a neurologist who specializes in seizures) reviews this information with each patient and discusses further diagnostic and treatment options. Video-EEG monitoring, magnetic resonance imaging (MRI) and other neuro-imaging tests confirm the diagnosis and suggest the best treatment options for each person.
These options include new anti-epileptic medications, "awake" surgery to remove the part of the brain causing seizures and implanting the Vagus nerve stimulator, a tiny device that sends an electrical signal to stop seizures.
What is epilepsy monitoring?
The term "epilepsy monitoring" refers to the use of simultaneous video-EEG recordings over the course of several days.
Because of the time required, this monitoring is performed on an inpatient basis. Long-term monitoring helps verify the diagnosis of epilepsy, distinguish different types of seizures, identify the brain region in which seizures begin and quantifies seizures' frequency.
What happens when patients are admitted for epilepsy monitoring?
After being admitted to the hospital in the morning, patients are connected to scalp electrodes, escorted to a monitoring room on the Neurology floor and connected to the video-EEG monitoring equipment. The equipment receives the EEG signal, converts it to a digital signal and records it, along with a digital video image. The electroencephalogram and the video are recorded during several days continuously. During epilepsy monitoring, patients' medication is decreased or sometimes discontinued altogether, in order to increase the probability of recording a number of seizures.
After the monitoring period, the neuropsychologist, neurologist and neurosurgeon review the video-EEG results, along with neuropsychological and neuro-imaging test results, to decide whether patients might benefit from surgery. Patients are informed of the results either before being discharged or during a subsequent appointment. Patients maintain contact with their referring physicians throughout and following their hospitalization.
Why are both video and EEG monitoring needed?
The simultaneous use of video and EEG monitoring is needed to verify the presence of epileptic seizures and the localization of the seizure origin.
Can routine EEG pick the good surgery candidate?
Routine EEG — as opposed to long-term video-EEG monitoring — can be a useful tool in classifying patients' seizure syndrome. But because routine EEG samples only a brief period of time, it is difficult to determine the frequency and type of seizures using this method alone. Video-EEG monitoring provides much more information about patients' seizures and helps physicians determine whether surgery is likely to help.
When is surgery appropriate?
Persistent seizures restrict patients' freedom and increase their risk of injury. In such cases (and when medications have been ineffective), surgery to remove brain areas causing seizures should be considered. For some patients whose seizures are resistant to medications, surgery may not be possible. For example, surgery may not be appropriate if seizures occur in brain locations that are functionally important — or example, areas that govern speech or movement. When surgery is not an option, patients may benefit from other treatments, including Vagus nerve stimulation or experimental trials of newer anti-epileptic medications.
When is Vagus nerve stimulation appropriate?
Vagus Nerve Stimulation may be appropriate when medications have been ineffective and when patients cannot or choose not to have surgery, or when surgery has failed to control seizures. In addition, patients must be in good general health, with no progressive illnesses, in order to be candidates for Vagus nerve stimulation.
Are there special considerations for women with epilepsy who are pregnant or planning to become pregnant?
Women with epilepsy who become pregnant might experience a change in seizure frequency. Pregnancy also causes changes in the way the body processes anti-epileptic medications, so physicians must closely monitor seizures and medication levels during pregnancy. Taking vitamin supplements and folic acid during pregnancy can help prevent certain kinds of birth defects, especially when these vitamins are taken beginning before conception.
Eating a healthy diet, getting enough sleep and exercising regularly are also especially important for women with epilepsy who are pregnant. Finally, because women with epilepsy and their developing babies are at a heightened risk for some prenatal complications, they may undergo extra prenatal testing to monitor the mother's and the baby's health.