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Treatment Services
No single treatment is perfectly suited to all patients with epilepsy.
Therefore, we make available all of the methods useful in the treatment of
seizures, including: therapy with all medications presently available in the
United States, new experimental drugs, the ketogenic diet, vagal nerve
stimulation, and epilepsy surgery.
Drug Therapy
Many new medications for the treatment of epilepsy have been
developed over the last few years. These medications must be utilized in a
methodical, careful manner, often requiring months to determine the best
single drug or combination of drugs. The goal of this treatment is to
control seizures completely while keeping side effects to a minimum. We have
experience using all the approved medications for epilepsy.
We are also involved in ongoing trials utilizing newly developed epilepsy drugs. Particular patients may meet the criteria for these new medications.
Ketogenic Diet:
This dietary form of therapy has been known for most of this
century, and its effectiveness has long been recognized. In the past ten to
fifteen years, certain aspects of the diet have been improved and the
importance of rigid adherence to the diet has become better understood. The
diet can be extremely effective in children who have not responded to drugs
and who are not candidates for epilepsy surgery.
Vagal Nerve Stimulation:
This method of treatment may also be useful for the treatment of patients
who have poorly controlled seizures which have not responded to medication.
Although we do not understand why stimulation of the vagus nerve helps
epilepsy, this procedure has proven effective in a number of children.
During a minor surgical procedure by Dr. Mark Lee, an electrode is surgically implanted around the vagus nerve in the neck. A small box controlling the electrode is implanted under the skin of the chest and connected to the electrode. The electrode transmits an electrical current that stimulates the nerve. The optimum treatment for the seizures is accomplished by adjusting the electrical characteristics of the stimulation. The period of adjustment may require eight to ten months to achieve the best results for the seizures.
Surgical Treatment for Epilepsy:
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When seizures do not
adequately respond to the above measures, we help families consider the
option of surgical therapy. In general, a child who is a candidate for
surgical treatment of seizures usually has seizures
arising from one part of the brain. In order to determine if the child is a
candidate for epilepsy surgery, he or she first undergoes a "Phase I"
evaluation in our Epilepsy Monitoring Unit (EMU). The EMU is a combined
adult and pediatric epilepsy six-bed unit where the child is connected to
continuous EEG monitoring with video camera recording. The purpose of this
procedure is to capture a seizure in progress and to determine the specific
portion of the brain which is causing the seizure. A test called an ictal
SPECT scan may also be performed along with an MRI to determine the exact
area of the brain involved. One of our neuropsychologists, Dr. Cohen or Dr.
Greg Lee, may then administer tests to determine the impact of the epilepsy
on learning abilities, according the specific area of the brain found to be
affected.If the "Phase I" evaluation is positive, but the results are not
sufficient in order to plan surgery, a "Phase II" evaluation is performed.
Here, Dr. Mark Lee surgically implants a grid for electrical monitoring over
the surface of the brain. This is done to assess even more carefully the
area of the brain involved.After all the information is collected, the
patient's problem is discussed at a joint conference among the epilepsy
physicians, neurosurgeons, and neuropsychologists. In this conference, the
best possible surgical approach is developed.
