Comprehensive Epilepsy Program

The Comprehensive Epilepsy Program is a multidisciplinary program involving experts in the coordinated care of patients with uncontrolled seizures. The Epilepsy Program evaluates patients who might benefit from a better definition of their seizure type or a surgical treatment of their seizures.

Epilepsy monitoring and surgery is far from unusual or investigational. Since Victor Horsely's first craniotomy in 1886 for a cerebral tumor producing seizures, over 5,000 of these procedures have been performed. Currently, there are over 100 centers in the U.S. and the world providing long-term monitoring and a surgical treatment with excellent results. Generally 85% of patients have at least a 90% seizure reduction.

Many questions are typically raised by the suggestion of epilepsy monitoring and surgery. Following are answers to some of the most frequently asked questions.

Frequently Asked Questions

I'VE HEARD OF EPILEPSY MONITORING, WHAT IS IT FOR?

Epilepsy Monitoring is the use of simultaneous video-EEG recordings on an inpatient basis.

Long-Term monitoring has several potential uses:

• It can establish the diagnosis of epilepsy
• It can be used in differentiation of seizure types
• Long-term monitoring localizes the brain region of seizure onset
• Video-EEG monitoring quantifies seizures frequency

WHAT HAPPENS DURING YOUR ADMISSION?

You are admitted to Froedtert Memorial Lutheran Hospital at 8:00 a.m. You are connected to scalp electrodes and then escorted to the Neurology Floor to a designated monitoring room and connected to the monitoring equipment. The equipment receives the EEG and incorporates digitalized EEG with the video image onto a videotape. Two VCRs run in an alternating fashion allowing twelve hours of recording. A technician is present the majority of the time to maintain the quality of the EEG and video recording.

An on-line computer constantly monitors EEG changes. When a seizure has occurred the computer records the time and a brief EEG sample of that event.

Patient medication is tapered by approximately 33% each day and therefore shortens the monitoring time.

Prior to admission, neuropsychological tests are given to the patient and scored. In addition, CT scan or Magnetic Resonance Imaging (MRI) is ordered or reviewed prior to admission.

Once the evaluation is complete, a Neurosurgical consultation is obtained. The Neuropsychologist, Neurologist, and Neurosurgeon review the patient's test to decide if there is an isolated seizure focus. This will indicate if surgery or more testing is necessary. The patient is informed of the results either at discharge or in a subsequent appointment following discharge. Contact is maintained with your referring physician during and following the hospitalization.

WHY ARE BOTH VIDEO AND EEG MONITORING NEEDED?

The simultaneous use of video and EEG monitoring is needed to verify when the seizures begin and what they look like.

WHAT MAKES UNCONTROLLED EPILEPSY SEVERE ENOUGH TO CONSIDER A SURGICAL TREATMENT?

Persistent seizures may be perceived as nonthreatening to the patient, but seizures do restrict patient freedom or provide risk of injury. Other treatment options, like surgery, may not be an option if the severity of the patient's limitations are too difficult to appreciate. Seizures should not be allowed to restrict a patient's life when they might be seizure free with a surgical treatment.

CAN ROUTINE EEG PICK THE GOOD SURGERY CANIDATE?

Routine EEG can be a useful tool in classifying a patient's seizure syndrome. Unfortunately, EEG is limited by the amount of time which can be sampled. The prevalence of any specific abnormal discharge is difficult to estimate from standard EEG. Video-EEG monitoring can record all the patient's typical seizure manifestations. If the recordings all have unilateral onset, then surgery may be successful.

IS SURGERY ALWAYS POSSIBLE?

Not all patients whose seizures are resitstant to medical therapy can be helped by surgery. The involvement of functionally important brain areas of both sides of the brain in the seizure onset, often excludes a surgical treatment. Trials of newer antiepileptic medications are available to patients where surgery is unavailable.

HOW CAN NEUROPSYCHOLOGY HELP WITH SURGERY?

Neuropsychology can localize an area of function loss in the brain. This area of dysfunction is strongly correlated in epilepsy with the area of seizure onset.

HOW CAN I LEARN ABOUT THE EPILEPSY MONITORING AND SURGERY PROGRAM?

Explaining epilepsy surgery may be complicated. Many concerns about the possible difficulties from the surgery are not able to be answered prior to the monitoring admission.

Patients who would like more information are urged to call the Comprehensive Epilepsy Program at (414) 259-3641 or write our physicians with any inquires that they might have.