Epilepsy Care

When you or a loved one seeks care for seizures and or epilepsy, the right treatment is vital to achieve the quality of life you deserve. Our multidisciplinary team of experts at EvergreenHealth Neuroscience Institute treat all types of epilepsy, seizures and conditions imitating seizures.

Conditions We Treat

• Epilepsy: Recurring seizures, which are abnormal bursts of activity in the brain. Seizures cause problems with movement, muscle control, sensations, vision, speech and/or awareness.
• Intractable Epilepsy: Intractable epilepsy is epilepsy that has failed to respond to two anti-seizure medications taken either together or alone. Medications can help control seizures in many people with epilepsy; however, medications can have debilitating side effects, and about one-third of patients with epilepsy do not respond to medication.
• Nonepileptic seizures: Nonepileptic seizures (NES) are like epileptic seizures, however, there is no abnormal electrical discharge in the brain. The causes can be psychological or physical. Physical causes of NES include fainting, sleep disorders, low blood pressure, complicated migraines, tremors, hypoglycemia, and other medical conditions

Diagnosing Epilepsy

Our multi-specialty team takes time to understand your concerns and symptoms. With state-of-the-art testing and imaging, we're able to diagnose and plan the appropriate treatment to meet your individual needs and improve your quality of life.

Our testing for epilepsy includes:

• Electroencephalogram (EEG): This noninvasive test records your brain's electrical activity and can help tell us where seizures begin. We can also perform outpatient ambulatory multiday EEG recordings or inpatient video EEG monitoring.
• Diagnostic imaging: Brain imaging can show areas where seizures begin and signs of other conditions that might be causing seizures.
  • Diagnostic imaging for epilepsy can include:
    • Computed tomography (CT) scan: Specialized X-ray equipment to produce cross-sectional images of the brain.
    • Magnetic resonance imaging (MRI): Radio waves and powerful magnets to create detailed images and identify abnormalities that may be causing seizures.
    • High-density EEG: Identifies areas in the brain where seizures may be originating and provides a three-dimensional view of the brain.
    • Positron emission tomography (PET) scan: A radioactive tracer is injected to provide a picture of the brain metabolism and assists in a more precise location of seizure activity.
    • Single photon emission computed tomography (SPECT) scan: Utilizing a radioactive substance, we are able to see blood flow of the brain during seizures.
• Neuropsychological tests: The series of tests assesses a comprehensive range of cognitive and behavioral functions. The tests evaluate memory, attention, concentration, language, problem solving and other aptitudes, and oftentimes identify dysfunction in particular areas of the brain.
• Wada (Intracarotid Amobarbital Procedure) Test: In preparation for surgery, a Wada test locates the areas in your brain that control speech and memory. This allows the team to plan a surgical approach that effectively treats seizures while preserving brain tissue.
• Neuro Monitoring Unit (EMU): The monitoring unit is a way to conduct more in-depth testing through monitoring brain wave activity over several days. The multidisciplinary team tracks symptoms in order to plan a more effective treatment for drug resistant epilepsy or recurrent seizures.
• Epilepsy Treatments: We offer the latest epilepsy treatments, and we work with you to build a customized treatment plan to help control your seizures as much as possible.

Nonsurgical Treatments

• Medications: There are more than 25 epilepsy medications available today, and they work in different ways to control seizures. After evaluation and testing, our multidisciplinary team will discuss different options to treat your seizures. You may need to try different medication to find the right one, or the right combination. We will continually assess your progress and adjust medications as needed.
• Nonsurgical Therapies: Depending on the symptoms and type of seizures you're experiencing, nonsurgical therapies may be right for you. Options include:
  • A ketogenic diet, which is tailored to an eating plan with low carbohydrates, moderate proteins, and high fats.
  • Psychological counseling with our neuropsychologists helping patients manage emotions and thoughts through cognitive behavioral therapy (CBT) and behavior modification therapy.

Surgical Treatments

Surgery for epilepsy is no longer considered the last resort. Epilepsy surgery may be able to offer relief when medications either cannot control seizures or cause unmanageable side effects.

Epilepsy surgery is a safe, effective option to evaluate and treat seizures. We perform numerous types of epilepsy surgery, including:

• Functional Mapping: This type of surgery involves placing electrodes directly on the brain by our neurosurgeons. The electrodes record the activity of the brain in a more precise manner. This allows us to plan for surgery by showing where seizures begin while also identifying critical brain function, such as language, sensation and movement.
• Focal Resection: This is a type of surgery where we aim to remove the seizure focus area of the brain. It may be a brain lesion, or part or all of the brain lobe. This type of procedure is performed on persons who have seizures in one area of the brain that can be safely removed.
• Corpus Callosotomy: The corpus callosum is a band of nerve fibers connecting the two halves (hemispheres) of the brain. The band of fibers shares information across the brain, but it also contributes to seizure impulses. The surgical intervention separates the corpus callosum to stop seizures from spreading between the hemispheres.
• Temporal Lobectomy: This type of surgical procedure removes part of the temporal lobe, which is an area near the temples and ears. Temporal lobectomy is the most common type of epilepsy surgery.
• Laser Interstitial Thermal Therapy: Our neurosurgeons perform a minimally invasive procedure to access a seizure focus through a small opening in the skull. A laser wire is guided to the seizure focus and heat is applied to destroy the brain tissue.
• Neuromodulation Devices: A neuromodulation, or neurostimulation, device is a treatment option for people who have drug-resistant epilepsy and who are not candidates for epilepsy surgery.
  
  Our neurosurgeons implant the device in the body or brain, and wires from the devices send mild, painless electrical pulses to control seizures. The devices are implanted beneath the skin, with no external wires. They are programmed and controlled by external paddles. Each neuromodulation device therapy works differently.
• Deep Brain Stimulation (DBS) is helpful for people who have focal seizures in one or more areas of the brain. Electrical pulses are delivered at specific levels and intervals to help prevent or reduce their frequency.
• Responsive Neurostimulation (RNS) is used to help those who have focal seizures in only one or two well-localized areas of the brain. It can help stop seizures before they begin by monitoring brain waves and sending pulses to interrupt the uncommon electrical activity.
• Vagus Nerve Stimulation (VNS) is like DBS however the stimulation leads do not have to be in the brain. The impulse travels along the vagus nerve to the brain. It is less invasive however and may not be as effective as DBS or RNS.