What is Epilepsy?
Epilepsy is a neurological disorder characterized by seizures. Epilepsy can begin at any age, and has several different causes. A seizure is a transient electrical disturbance in the brain. Seizures affect people in different ways. During a seizure, a person may experience feelings of confusion, or a loss of consciousness, or involuntary movements in their arms, legs, or body. Any symptom that might be suggestive of a seizure should be evaluated by a physician experienced in diagnosing and treating seizures.
How is Epilepsy Diagnosed?
At our center, patients who have had a seizure or who have already been diagnosed with epilepsy may be referred to an epileptologist. An epileptologist is a board-certified neurologist with fellowship training in the diagnosis and treatment of epilepsy. The physician will obtain a medical history, perform a neurological exam, and order appropriate testing which may include a brain MRI (Magnetic Resonance Image) and an EEG (Electroencephalogram). Some patients may require additional Video EEG Monitoring for diagnosis.
How is Epilepsy Treated
Our goal with each individual patient is to achieve seizure freedom and improve quality of life. Success can often be achieved by obtaining an accurate diagnosis and selecting an appropriate anti-seizure medication (s). In patients who do not achieve seizure freedom with medication, additional treatment options may include epilepsy surgery or neuromodulation in selected cases.
Anti-seizure medication is used to stabilize the abnormal electrical activity in the brain that causes seizures to occur. Most patients with epilepsy — between 60 and 70 percent — will achieve seizure freedom by taking an anti-seizure medication. Today, there are several anti-seizure medications available to choose from, and our doctors help guide patients in choosing an appropriate one for them. The aim of taking an anti-seizure medication is to achieve seizure freedom without any side effects.
Approximately 30% of patients who suffer from epilepsy have seizures that are difficult to control with anti-seizure medications. This form of epilepsy is described as medically refractory (or intractable or pharmaco-resistant). In carefully selected patients with medically refractory epilepsy, treatment with epilepsy surgery can be performed safely and effectively to help patients achieve seizure freedom. Potential candidates for epilepsy surgery are discussed at a Patient Management Conference held in conjunction with experts from the Cleveland Clinic Epilepsy Center in Cleveland, Ohio to determine if epilepsy surgery should be considered.
When seizures are difficult to control with anti-seizure medication, and epilepsy surgery is not an appropriate treatment option, neuromodulation may be offered as an alternative treatment strategy. Neuromodulation can be employed using Vagus Nerve Stimulation (VNS) or Responsive Neurostimulation (RNS or Neuropace).
State of the Art Technology
Cleveland Clinic Florida’s Epilepsy Center is recognized by the National Association of Epilepsy Centers (NAEC) as a Level 3 epilepsy center. Level 3 epilepsy centers have the professional expertise and capability to provide optimal medical care and noninvasive epilepsy surgery evaluations. Our Florida epilepsy center is fully integrated with our Level 4 epilepsy center in Cleveland, Ohio, which is equipped to perform invasive EEG evaluations with subdural grids or stereotactic EEG (SEEG) and is recognized internationally for its expertise in evaluating and treating complex epilepsy.
Epilepsy Monitoring Unit
At the forefront of our diagnostic capabilities is our Epilepsy Monitoring Unit, designed for a detailed evaluation, diagnostic testing, and patient monitoring 24 hours a day, 7 days a week. Patients stay in a comfortable, private room and undergo continuous electroencephalography (EEG) and simultaneous video monitoring under the supervision of our epileptologists working together with our specially trained technicians and nurses.
The Epilepsy Monitoring Unit serves several purposes: (1) to confirm the diagnosis of epilepsy, (2) to classify the epilepsy syndrome, (3) to make anti-seizure medication adjustments, (4) to diagnose non-epileptic events, and (5) to perform pre-surgical evaluations in patients who continue to have disabling seizures in spite of optimal medical therapy.
The Epilepsy Center is equipped with additional state-of-the-art technology. Testing is tailored to the needs of individual patients, and may include:
- High-quality 3-Tesla magnetic resonance imaging (3T-MRI)
- Functional MRI, which analyzes blood flow to map language and motor function in the brain
- Single-Photon Emission Computed Tomography (Ictal SPECT), which helps to localize the area of the brain where seizures originate
- Positron Emission Tomography (PET), which measures brain metabolism to identify abnormalities
- Magnetoencephalography (MEG), which displays abnormal brain activity by recording magnetic fields generated by electrical activity in the brain
- Neuropsychological testing, to assess language, memory, and cognitive function