The beginning stages of epilepsy diagnosis are very important. This is because treatment will largely depend on several factors, mainly:
Where in the brain your seizure originated
What type of seizure you have had
When one of our specialists evaluates you, he or she may recommend that you receive a thorough evaluation in our Epilepsy Monitoring Unit at MedStar Georgetown University Hospital.
Specialized diagnostic center
Our Epilepsy Monitoring Unit (EMU) at MedStar Georgetown University Hospital is a sophisticated diagnostic center not available at most hospitals. Staffed by specially trained neurologists, nurses, and technicians, the unit is designed to accommodate patients while they are video-recorded and monitored by an electroencephalogram (EEG) around the clock, for an extended period of time.
This prolonged recording provides a more complete picture of brain activity before, during, and after seizures. This helps your neurologist better define the type of seizure and identify precisely the area in the brain where the seizure originates. This valuable information helps with determining and delivering the most effective treatment option.
Your doctors may determine that they want to perform a Phase I evaluation, which is a type of pre-surgical testing. You can expect to be admitted as an inpatient for 5 to 7 days. We will watch and analyze your seizures. Your doctors will be particularly interested in the specific area in your brain that is producing the seizure and will run the following tests:
Single photo emission computed tomography (SPECT): When you begin to experience a seizure, injected radioactive isotopes will reveal the blood flow in your brain. The results will be superimposed onto a CT scan, thus highlighting the anatomical surgical target. The more that doctors know about where the seizure is occurring, the more precisely they can plan your surgery.
Positron emission tomography (PET): Doctors use this test to identify areas in your brain that display hypometabolism, or decreased sugar consumption. These areas are likely the focal point of the epileptic episodes and are responsible for the seizures.
Magnetic Resonance Imaging (MRI): This imaging method uses magnets to produce pictures of your brain. These images will reveal any physical abnormalities in your brain structure that may have caused your seizures. An MRI is not a tool to diagnose epilepsy. It gives your doctors more information about your brain and its physical structures.
Wada test: This test is used to assess your memory and language skills. Using medication, your doctors will try and isolate each hemisphere of your brain in order to establish where your language and memory skills originate.
Robotic Stereotactic Assistance (ROSA): ROSA provides various types of cranial interventions and pre-surgical data for proper diagnosis and treatment. In addition, ROSA allows precise location in the cranial area and accurate positioning and handling of instruments during the process.
Functional Magnetic Resonance Imaging (fMRI): This imaging technique measures the small changes in blood flow that occur with brain activity. It may be used to examine the brain's functional anatomy (determine which parts of the brain are handling critical functions), to evaluate the effects of stroke or other disease, or to guide brain treatment. fMRI may detect abnormalities within the brain that cannot be found with other imaging techniques.
Phase II study
If your doctors have been unable to pinpoint the exact brain location that is producing seizures, they may need to do a Phase II study. This involves implanting electrodes in the area of your brain that your doctors suspect may be responsible for the epileptic episodes.
Although no cure exists for epilepsy, medication can keep you seizure free for significant periods. Your doctors will try to keep your condition under control using a single, effective medication. If this is not successful, your doctor will prescribe a combination of medications. Your medical team will select the medications that are most effective for your type of seizure disorder.
Approximately 30 percent of patients with epilepsy do not respond to medications. If you have tried several and have not found seizure relief, your seizures are known as intractable. Your doctors will provide you with more appropriate treatment options. Certain individuals are candidates for dietary treatments, which include the ketogenic diet.
Our bodies function on energy derived from glucose. When our glucose stores run out, our bodies begin to go into starvation mode and burn fat instead. This process is known as ketosis. The ketogenic diet continues this process by maintaining a low calorie count, while making fat the primary dietary component. The diet forces the body to remain in ketosis for long periods.
For reasons not fully understood, ketosis and the ketogenic diet can contribute to seizure control for some individuals. The diet is most often prescribed for children who have not responded well to medication. The success rates can vary:
Full success: Approximately one-third of children on the ketogenic diet gain excellent control over their seizures. They become seizure free or almost seizure free. If the diet appears to be successful for your child, doctors may recommend continuing it for about two years. You and your child will receive guidance and be followed closely by your medical team.
Moderate success: One-third of children see significant reduction in seizure activity, but still experience occasional seizures.
Unsuccessful: One-third of children see no improvement, either due to no response or to inability to maintain compliance. The diet can be difficult to adhere to, and children may need lots of encouragement to continue. If your child has failed to respond to both medication and the ketogenic diet, surgery may be recommended.
While there are some misconceptions about surgery for epilepsy treatment, there is no doubt that surgery can sometimes be the best treatment for those patients who are drug resistant to appropriate medications. In fact, if you have tried two or three anti-seizure medications that have not helped, you may want to consider pre-surgical monitoring to discover if epilepsy surgery might be right for you.
MedStar Health offers some of the most sophisticated surgical techniques in the world to treat people with this condition. So if our doctors do recommend surgery, you should know you are in the best possible hands. Brain surgery is very delicate and complicated work, and our highly skilled surgical team will work hard to ensure the best possible outcome for you using the following surgical options:
Temporal lobe resection removes all or part of the temporal lobe, where many partial seizures originate.
Extratemporal cortical resection removes all or part of other lobes of the brain if seizure activity is traced to those locations.
Lesion resection removes any brain lesions that are causing seizure activity. Brain lesions may be tumors or other brain abnormalities that have been detected by MRI during the diagnostic process.
Corpus callosal section severs the nerve pathways connecting the two halves of the brain. Successful surgery ensures that any seizure activity originating in one-half of the brain will be unable to spread to the other half of the brain.
In the following video, neurosurgeon Christopher Kalhorn, MD explains the benefits of having surgery to improve epileptic seizures.
Dr. Christopher Kalhorn Explains the Benefits of Epilepsy Surgery
In recent years, technology has provided doctors with effective means of treatment for difficult-to-control cases of epilepsy.
If you have intractable seizures that have not responded to medication, and you are not a suitable candidate for surgery, doctors may decide to treat your epilepsy with one of several sophisticated devices, which may include:
Vagal nerve stimulation (VNS) prevents seizures by sending small electrical signals directly to your brain, via the vagus nerve in your neck. An electrical stimulator is inserted under your skin during a brief surgical procedure and provides the electrical signals to an outside magnet. The device resembles a cardiac pacemaker, but stimulates your brain instead of your heart. VNS is currently available to qualifying adults and children over the age of 12.
Deep brain stimulation may be used to prevent seizure activity by sending small electrical signals directly to your brain. A surgically implanted neurostimulator, implanted in specific areas within your brain, delivers the electrical signals.
Responsive neurostimulation (RNS) disrupts seizures by detecting abnormal electrical activity in the brain and delivering electrical pulses to interrupt the beginning seizure. A surgically implanted neurostimulator, implanted in specific areas within your brain, detects the seizures and provides the electrical pulses in order to stop them.
How to give first aid for seizures
Watching someone you love go through a seizure can be quite frightening. It is important to remember, however, that first aid for seizures is actually very simple:
Secure the environment: If the person experiencing the seizure begins to jerk, convulse, and fall to the ground, make sure that the area is free of dangerous or sharp objects that might harm them. Wait until they are no longer stiff and the seizure is at its end. Turn their entire body to the side and loosen anything that is tied around their neck, so that they can breathe easily. Do not attempt to hold the person down or restrain him or her in any way.
Time the seizure: It is important to note how long the seizure lasts. Seizures should last no more than a minute or two. In general, the seizure will run its natural course—you can do nothing to shorten it. Rarely, drugs may be needed to stop a very lengthy seizure, but this is not typically the case.
Remain calm: Seizures may look frightening, but are not usually a medical emergency. Stay calm and wait for the seizure to end. As the person regains consciousness, stay with them and reassure them. Allow them to rest and recover afterwards. Most of the time, the person recovering from a seizure will be able to resume activities with minor assistance. However, do not let the person drive or operate dangerous equipment. If you find that this is not true for your loved one, seek emergency care.
If this was your first seizure, you will want to seek medical care and begin the diagnostic process. MedStar Health boasts an impressive team of epilepsy experts who will take you from early diagnosis to treatment, and make sure that you feel taken care of, every step of the way.
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