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Epilepsy Assessment and Treatment

(732) 321-7010

Comprehensive Epilepsy Center

The Comprehensive Epilepsy Center at the Neuroscience Institute is comprised of a multi-disciplinary team that includes adult and pediatric neurologists, adult and pediatric neurosurgeons, neuro-psychologists, neuro-pathologists, registered nurses, clinical nurse practitioners, neuro-radiologists and neuro-rehabilitation specialists. The team offers a comprehensive approach to address the medical, surgical and rehabilitation needs of each patient with epilepsy.

Philosophy of the Center

The team works with the patient’s primary care physicians and referring neurologists to offer an individualized program for each patient and family.

Above and beyond state-of-the-art technology, the Epilepsy Center at the Neuroscience Institute uses the human touch as the mainstay of the management of patients and their families. The goal of the center is to eliminate the patient’s seizures as completely as possible and to help the patient re-emerge into a productive and rewarding lifestyle.

Diagnostic Services

After the epileptologists obtain a detailed history of the patient and complete a careful neurological examination, further diagnostic testing is often recommended in order to establish both the type and cause of the patient’s epilepsy.  Such tests may include EEG, video-telemetry monitoring, blood tests, neuroimaging studies, and neuropsychological evaluations. The Neuroscience Institute offers a secure and comfortable environment in which patients go through these evaluations.

Electrophysiology

Electroencephalograms and EEG studies measure the brain waves of patients between or during the patient’s episodes. Patients can undergo various brain wave evaluations with or without simultaneous video monitoring.

The center uses state-of-the-art computerized digital equipment to analyze these EEG studies in order to determine whether the episodes that the patient is experiencing are due to epileptic seizures or non-epileptic events. These studies can also help to determine what part of the brain is causing the seizures.

Types of EEGs performed include:

  • Routine EEG
  • 24-hour ambulatory EEG
  • Video EEG monitoring
  • EEG monitoring with implanted electrodes

Neuroimaging

The NJ Neuroscience Institute has state-of-the-art imaging technology using MRI, PET, and SPECT scans.  These scans can identify structural abnormalities of the brain such as vascular malformations, brain tumors, congenital anomalies and scar tissue. These lesions can often irritate the surrounding brain tissue and lead to seizures.

Treatment Options

Based on information obtained from the clinical evaluation, Video EEG and neuroimaging evaluations, the Epilepsy Center will coordinate a plan of treatment with the patient’s referring physicians. An extensive educational program will be developed for the patient, their friends, and family members.

Treatment recommendations may include medication dose adjustments, adding a new medication, or starting an investigational medication as part of a clinical drug trial. Alternative therapies, such as the ketogenic diet and hormonal treatment, may be considered in appropriate patients. Patients and their families are assisted in their attempt to regain a more normal life by both psychologists and social workers. These efforts can help to minimize the depression and anxiety that patients frequently encounter when they attempt to start new employment and families.

Medically Intractable Seizures

Most patients with epilepsy will experience good control of their seizures with medications. However, some patients will continue to have debilitating seizures despite aggressive medication management. These patients may be able to benefit from various surgical procedures. The Neuroscience Institute is one of only 50 centers around the country that offer advanced surgical procedures which include:

  • Temporal lobectomy
  • Extra-temporal lobectomy
  • Selective Sub-pial cortisectomy
  • Selective Amygdalo-Hippocampectomy
  • Hemispherectomy
  • Corpus Callosotomy
  • Vagal Nerve Stimulation

Patients are evaluated by the comprehensive team at the Epilepsy Center to identify the size and location of the patient’s epileptic focus. Most patients have their epileptic focus identified by video-telemetry sessions and non-invasive neuroimaging studies. The seizure focus is not clearly localized with these non-invasive evaluations in a small percentage of patients. These patients will need to undergo invasive monitoring to more accurately identify the location of the seizure focus.

Invasive Monitoring

Invasive monitoring requires a surgical procedure to place electrodes either on the surface of the brain or inside the brain using computer-guided surgical tools. The incisions are then closed. The wires of these electrodes are passed through the skin and are connected to the video-telemetry equipment. This enables a more accurate map of the patient’s seizure focus.

Functional Mapping

Once the location of the patient’s seizure focus is identified, the team will attempt to determine how safe it would be for the patient to undergo surgical resection of the focus. Select patients will be asked to undergo various functional evaluations of their brain to identify which portions of their brain is responsible for specific functions such as speech, language, memory, and motor control.

Patients with invasive electrodes will undergo functional mapping with the use of small currents of electricity sent through the electrodes individually as patients are asked to perform certain language, memory, or motor activities. In this way, stimulation of the region of the seizure focus will be able to predict what if any functional problems might occur after surgical resection of the focus.

Neuropsychological evaluations and a Wada test also help to determine the potential risks of surgery. The patient’s language function and memory are tested during the Wada test while the area of the seizure focus is temporarily lulled into sleep and the rest of the brain remains awake. This test will help predict how much of a problem the patient might have with language and/or memory if the seizure focus was to be surgically removed.

Multi-disciplinary Epilepsy Patient Management Meeting

Each patient’s case is presented and discussed in detail by our multi-disciplinary team at our weekly meetings. The medical and surgical treatments of choice depend upon the results of the evaluations performed to locate the seizure focus and to determine how safe it would be to remove it. Surgery is approved only if all tests support its long-term benefit.

For a consultation with an epilepsy specialist or additional information, call (732) 321-7010.