Treatments

Vagus nerve stimulator, epilepsy brain surgery

At the Epilepsy Center, treatment of each individual patient begins with a comprehensive evaluation by a board-certified epileptologist, a neurologist who specializes in epilepsy and seizure disorders. Some patients with epilepsy will experience relief from their seizures after trying only one or two medications. Others will have a form of epilepsy that is more difficult to treat. And still others who come to us, after a thorough evaluation, will learn that they do not have epilepsy.

Treatment of complex epileptic conditions is overseen by a multidisciplinary team. Our specialists collaborate during all phases of this treatment — from testing and diagnosis, to discussion of treatment options, to execution of the optimal treatment strategy.

Members of our team include five epileptologists, a neurosurgeon who specializes in epilepsy surgery, neuropsychologists, nursing specialists, registered EEG technologists, bioengineers, social workers, and occupational, physical and speech therapists.

Treatment options include:

Medications

Antiepileptic drugs (AEDs) are a mainstay of treatment. There are more than two dozen that physicians can prescribe. Drugs can be prescribed alone or in combination with each other. Approximately 70 percent of patients with epilepsy will be able to control their seizures completely, or almost completely, with medication. Some patients will become seizure-free with one medication, others with a combination of medications. A patient who continues to have seizures after trying at least three antiepileptic medications, alone or in combination, is said to have medication-resistant epilepsy.

Surgery

Approximately 30 percent of people with epilepsy will not be able to control their seizures with medication. A subset of these patients will be candidates for epilepsy surgery. During epilepsy surgery, a skilled neurosurgeon removes the region of the brain where seizures are originating. Patients who are being considered for surgery undergo extensive testing to locate the source of their seizures and to ensure that removing that region of the brain will not impact their speech, mobility or quality of life. Surgical procedures intended to eliminate, or greatly reduce, seizures that originate in a specific area include temporal lobectomy, cortical excision and modified hemispherectomy.

Palliative Surgery (Callosotomy)

Some surgical procedures are performed when the origin of seizures cannot be determined. The intent of these procedures is to limit the spread of seizures and to reduce the risk that uncontrolled seizures will cause injury to the patient. A callosotomy can be performed to sever the communication pathways between the left and right sides of the brain.

Vagus Nerve Stimulation (VNS)

VNS is a surgical treatment that involves wrapping a wire around the vagus nerve in the neck and connecting it to a generator implanted under the skin near the collarbone. A physician programs the generator device, which produces electrical signals that travel along the vagus nerve to the brain at regular intervals. The signals help prevent seizures.

Multiple Subpial Transections

This surgical procedure involves the creation of small incisions in the brain. The incisions interfere with the spread of seizure impulses. The procedure can be used alone or in combination with a lobectomy.

NeuroPace® RNS® System

The UC Epilepsy Center is now offering a new therapy for people whose seizures are not controlled by medication and who are not candidates for traditional surgery. The device, recently approved by the U.S. Food and Drug Administration (FDA), reduces partial-onset seizures by detecting abnormal electrical activity in the brain and then delivering small bursts of electrical stimulation. The NeuroPace® RNS® System aims to normalize brain activity before a seizure occurs.

Electrical stimulation is delivered through electrodes that are placed, by a neurosurgeon, near the location (or locations) where seizures originate. The patient is unaware of the stimulation when it occurs.

An epilepsy specialist can program the detection and stimulation parameters of the implanted RNS device non-invasively to customize therapy for each individual.

Michael Privitera, MD, Medical Director of the UC Epilepsy Center, served on the FDA committee that reviewed the device.