One 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.
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.
Vagus Nerve Stimulation
Another 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.
Corrective 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.
Brain Mapping During "Awake" Surgery
The 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.
During "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. These areas remain untouched while areas causing seizures are removed.
Implanting Electrodes for Brain Mapping
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.