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.

Destination Clinic

CHI Health Neurological Institute at CHI Health Immanuel offers true patient-centric care to a destination clinic. Destination clinic visits work like this: our multidisciplinary team anticipates a patient’s needs so when he or she arrives, the patient will see a neurologist, get help from a physical therapist if necessary and perhaps consult with a neurosurgeon. If tests are necessary, the patient will know results by the end of the day. There will be no appointments “three months out” and the visits are in succession, all under one roof. The patient benefits from no more long waits to see the experts, get test results, be diagnosed, and begin treatment.

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.

The Nebraska Epilepsy Foundation holds a support group every third Tuesday of the month.

Tests

Patients with seizures require two tests – Brain MRl and an EEG. Those who do not respond to initial treatment require further work up as described below.

Treatments

• The main treatment for Epilepsy is medications and almost 60% of patients respond to medications.
• If medications fail, then epilepsy surgery becomes an option. Epilepsy surgery involves finding the area of the brain that is giving rise to seizures and making sure that this area is not responsible for any vital function. Then, this seizure focus can be surgically removed.
• The next option is a vagal nerve stimulator. This is an FDA approved form of treatment for medically refractory epilepsy.

Epilepsy Center Protocol: 4 Phases

Phase I

Phase I of the epilepsy treatment and monitoring program is the most critical. The Epilepsy Center offers all services needed for the treatment of medically refractory epilepsy, including:

• Video-Electroencephalography (VEEG) monitoring
  This test is performed as an inpatient. Its purpose is to determine what kind of seizures the patient is having and to establish the most optimal treatment strategy for that patient.
• Magnetic Resonance Imaging (MRI) with a special seizure protocol to identify structural abnormalities of the brain.
• Positron Emission Tomography (PET) scan 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 be easily identified.
• Single Photon Emission Computed Tomography (SPECT) 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.
• Neuropsychological testing tests brain function by neuropsychological tests. It can take almost a full day to complete these tests.

Phase 2 - WADA Test

This phase is only undertaken if a patient is a candidate for epilepsy surgery.

The 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.

Phase 3 - 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.

Phase 4 - Epilepsy Surgery

This phase involves the actual surgical procedure to remove the seizure focus.

• Vagal Nerve Stimulation: Vagal nerve stimulation 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. The electrical impulses are adjusted with each patient to provide optimal success.