The CHI Health Epilepsy Center at Creighton University Medical Center (CUMC) is dedicated to the treatment and education of patients with epilepsy, providing a multidisciplinary approach to the physical and emotional needs of patients with seizures. The center is led by Sanjay P. Singh, M.D., an internationally recognized expert in the treatment of epilepsy.
The CHI Health Epilepsy Center at (CUMC) has been designated as a Level 4 Epilepsy Center by the National Association of Epilepsy Centers (NAEC). This is the highest designation possible. It means the CUMC center has the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.
What is Epilepsy?
Epilepsy is chronic seizure disorder that affects people of all ages. A seizure occurs when the brain has a burst of abnormal electrical signals over a short period of time. It is like an electrical storm within the brain, which leads to a change in behavior, depending upon where the electrical activity occurs. These signals cause the body and brain to react in certain ways.
Types of Epilepsy Seizures
There are two main types of seizures. The most common is a partial seizure in which an “electrical storm” originates in part of the brain.
If the seizure happens in the motor control region of the brain, an individual will experience involuntary muscle movement. If it occurs in the sensory area, the patient may experience numbness and tingling. If the seizure occurs in the temporal lobe, the patient may have a blank stare. Less common is a generalized seizure which involves the whole brain. Anyone who has two or more unprovoked seizures has epilepsy.
Diagnosis and Treatment
Proper identification of the type of seizure as well as the precise location of the malfunctioning area of the brain is critical in the treatment and management of epilepsy. Diagnosing epilepsy starts with magnetic resonance imaging (MRI) of the brain to look for any anomalies in structure. The patient will also have another test, an electroencephalogram (EEG), which analyzes electrical function. Both tests are non-invasive and painless.
Nearly 60 percent of epilepsy patients respond to medications. If medications are not effective, (medically refractive epilepsy), the Creighton Epilepsy Center provides state-of-the-art procedures using a phased approach to ensure the best course of treatment for each patient.
Non-invasive testing help identify the location of the seizure focus point.
Video-Electroencephalography (VEEG) monitoring helps determines what kind of seizures is the patient having and to establish the most optimal treatment strategy for that patient. This test is performed as an inpatient.
Magnetic Resonance Imaging (MRI) with a special seizure protocol to identify structural abnormalities of the brain.
Positron Emission Tomography (PET) scan to assess the metabolism of the brain. The malfunctioning area (seizure focus) of the brain doesn't utilize glucose as well as the rest of the brain and thus can easily be identified.
Single Photon Emission Computed Tomography (SPECT) scan assesses the blood flow to the brain. The brain auto regulates its blood supply. The area of the brain that triggers seizures has a decreased blood flow when the patient is not having a seizure and an increased blood flow during a seizure.
Neuropsychological testing tests brain function by neuropsychological tests. It can take almost a full day to complete these tests.
This phase is only undertaken if a patient is a candidate for epilepsy surgery.
WADA testing localizes a patient’s language and memory function to identify patients who are candidates for epilepsy surgery. First a cerebral angiogram is done to determine the circulation. A drug is then injected to quiet one hemisphere of the brain at a time. A standardized memory and language test is administered to determine the required information regarding language and memory.
This procedure is only performed in a select few where further localization is needed to clearly delineate the seizure onset area. During the procedure, a flap of the cranial bone is removed so that electrodes can be placed directly on the brain to localize the seizure onset area.
In some instances, surgery is needed to find the area of the brain causing seizures and, if the area is not responsible for any vital functions, surgically removing the malfunctioning area of the brain (seizure focus.)
Vagal Nerve Stimulation
The final option is a vagal nerve stimulator, an FDA-approved form of treatment for epilepsy patients who cannot be treated with medication alone. A pacemaker is implanted in a patient’s chest. Leads are placed on the vagus nerve in the neck, which sends frequent electrical impulses to the brain to alleviate seizures.