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Epilepsy Care

CHI Health Immanuel Epilepsy Center is designated as a Level 4 Epilepsy Center by the National Association of Epilepsy Centers (NAEC)

This is the highest designation possible. It means that the Epilepsy Center has the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.

  • Over 3 million Americans have epilepsy.
  • About 200,000 new cases are diagnosed annually in the United States.
  • There are about 20,000 patients with epilepsy in Nebraska.

What is a Seizure?

A seizure is an abnormal electrical discharge in the brain which leads to a change in behavior. It is like an electrical storm which leads to different manifestations depending upon where this electrical storm occurs. If it happens in the motor control region of the brain you get motor activity, if it occurs in the sensory area then you can get numbness/tingling, and if it occurs in the temporal lobe then the person can go into a blank stare.

What is Epilepsy?

Anyone who has two or more unprovoked seizures has Epilepsy, or if there is a single seizure with a high tendency of having a second seizure. Epilepsy is a chronic seizure disorder.

There are two main types of seizures:

  • Generalized – the electrical storm involves the whole brain.
  • Focal/Partial – the electrical storm starts from a part of the brain.

Focal/Partial seizures are much more common than generalized seizures. The treatments differ based on the type of seizure you have.

Warning Signs/Symptoms

Some, but not all, people with epilepsy notice sensations and behavior changes hours or even days before a seizure. Called prodrome, these feelings are separate from the seizure, but are often considered a warning that a seizure may soon occur. An aura is warning symptom which can be a feeling, sensation, thought or behavior that occurs just prior to a seizure – and is sometimes considered part of the seizure.

According to the Epilepsy Foundation, warning signs of seizures include:

  • Odd feelings, often indescribable
  • Unusual smells, tastes or feelings
  • Unusual experiences – “out-of-body” sensations; feeling detached; body looks or feels different; situations or people look unexpectedly familiar or strange
  • Jerking movements of an arm, leg or body
  • Unexplained confusion, sleepiness, weakness
  • Tingling, numbness or feelings of electricity in the body

Generally, seizures are unpredictable and brief. While symptoms vary widely, they tend to be stereotypic or remain similar from episode to episode. This is why people with epilepsy are advised to keep track of feelings and behaviors that occur before or during a seizure.

Risk factors/Causes

Males and females of all races, ethnic backgrounds and ages are affected by epilepsy. In most cases, the cause of epilepsy is unknown. Some known conditions that affect the brain can cause epilepsy. According to the Centers for Disease Control and Prevention, these include:

  • Stroke
  • Brain tumor
  • Brain infection, such as neurocysticercosis (a parasitic infection)
  • Traumatic brain injury or head injury
  • Loss of oxygen to the brain (during childbirth, for example)
  • Genetic disorders, such as Down syndrome
  • Other neurologic diseases, such as Alzheimer’s disease

While genetic factors play a role in many cases of epilepsy, most children of a parent with epilepsy will not develop seizures or epilepsy. Researchers are still working to understand the genetic component of this condition.

Patients with seizures require two tests – Brain MRl and an EEG. 

Magnetic Resonance Imaging (MRI): An imaging technique that utilizes a special seizure protocol to identify abnormalities of the brain.

  • Positron Emission Tomography (PET): This scan assesses 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 be easily identified.
  • Single Photon Emission Computed Tomography (SPECT): This scan assesses the blood flow to the brain. The brain autoregulates 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.

Electroencephalography (EEG:

  • Routine EEG: a short, 20-30 minute recording of the electrical activity of the brain. Routine EEGs generally place around 23 electrodes on the scalp.
  • Video EEG (VEEG): A prolonged recording of the electrical activity of the brain that is performed as an inpatient and lasts 3-4 days. There are roughly 30 electrodes placed on the scalp.

The main treatment for Epilepsy is medications and almost 60% of patients respond to medications. Those who do not respond to initial treatment require further work up as described below.

  • Wada Test: This test is only undertaken if a patient is a candidate for epilepsy surgery. A Wada test localizes a patient’s language and memory functions. First, a cerebral angiogram is done to determine the circulation. A drug is then injected to “deaden” one hemisphere of the brain at a time, and a standardized memory and language test is administered to determine the required information.
  • Intracranial Video-EEG Monitoring: This procedure is only performed in a select few patients where further localization is needed to clearly delineate the seizure onset area. It involves intracranial monitoring. 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.
  • Epilepsy Surgery: This involves the actual surgical procedure to remove the seizure focus.
  • Vagal Nerve Stimulation (VNS): This is an FDA approved form of treatment for medically refractory epilepsy. A VNS involves implanting a pacemaker into a patient’s chest. Leads are placed on the vagal nerve in the neck which sends frequent electrical impulses to the brain to alleviate seizures.