Overview

Overview

We are committed to our epilepsy patients -- providing excellent clinical management and applying advanced diagnostic and therapeutic techniques and approaches.

Why Choose Cleveland Clinic's Epilepsy Center?

Cleveland Clinic has one of the largest, most comprehensive programs in the world for the evaluation, medical and surgical treatment of epilepsy in children and adults. Our goal is to help you or your loved one manage this disease in order to enjoy a fuller, more productive life.

Team Approach

Our team of dedicated physicians, healthcare professionals and support staff participate in the evaluation and treatment of our epilepsy patients who come here from across the country and around the world.

Pediatric and adult neurologists; neurosurgeons; neuroradiologists; nuclear medicine physicians; nurse specialists; pharmacologists; physical, occupational and speech therapists; dietitians; neuropsychologists and psychiatrists; educational counselors and social workers; and an array of scientists and technologists all work together to offer individualized care to adults and children.

Advanced Diagnosis,Treatment & Care of Future Patients

Cleveland Clinic's Epilepsy Center team:

  • Diagnoses and treats more than 10,000 patients with epilepsy each year
  • Delivers highly specialized care for adults and children in state-of-the-art facilities for evaluating patients for and performing epilepsy surgery
  • Provides state-of-the-art diagnostic approaches and therapies
  • Has established comprehensive research programs for testing anticonvulsant drugs and monitoring blood-drug levels, as well as other research to advance epilepsy treatment for adults and children
  • Trains the most promising future academic pediatric and adult neurologists, epileptologists, neurophysiologists, educators and other specialists interested in epileptology

Appointments

To make an appointment call us locally at 216.636.5860 or toll-free at 866.588.2264.

Experienced, Comprehensive, Compassionate Care

Each year, our internationally renowned team of physicians and medical professionals sees more than 3,500 patients, ages 18 years and older, in our epilepsy outpatient clinics and evaluates more than 350 patients in our dedicated state-of-the-art Epilepsy Monitoring Unit.

Highly Skilled Doctors & Care Providers

Our coordinated, multidisciplinary team offers a comprehensive range of skills and knowledge.

The staff of the Section of Adult Epilepsy includes eight board-certified epileptologists, two epilepsy neurosurgeons, neuroradiologists, clinical neurophysiologists, neuropsychologists, and a dedicated team of nurses, nursing assistants and EEG technologists.

Technologically Advanced Diagnosis & Treatment

We monitor more than 800 adults in the Epilepsy Monitoring Units, dedicated units that pinpoint the focus of seizures. Our newly expanded monitoring units feature state-of-the art, all digital video-EEG monitoring equipment and are fully staffed 24 hours a day, seven days a week.

Facilities include a self-contained, ten-bed Adult Epilepsy Monitoring Unit located at Cleveland Clinic main campus. Staffed by experienced nurses and EEG technologists specializing in adult epilepsy, the unit is overseen by our dedicated team of epileptologists.

Our clinicians use a variety of medical and surgical treatment options for the control and prevention of seizures. Treatments are based on an individualized assessment of the nature, type and severity of the patient’s disorder. In March 2009, Cleveland Clinic launched the first SEEG (stereoelectroencephalography) program in North America for patients with uncontrollable epileptic seizures.

Since 2008, Cleveland Clinic's Epilepsy Center has been among a select number of institutions in the world with MEG (magnetoencephalography), a technique used to better identify epileptic sources in patients in whom the area of the brain causing the seizure would otherwise be difficult to identify. More than 700 studies have been performed in our MEG laboratory since its inception. 

Special services for patients with epilepsy include:

In addition novel treatments with the use of investigational antiepileptic drugs and devices are available.

High Surgical Patient Volumes & High Success Rates

We perform more than 250 adult epilepsy surgeries each year. Our epilepsy surgeons have performed more than 3,800 surgeries since 1996. One year after temporal lobe resection, 80 percent of Cleveland Clinic patients continue to be seizure-free; at the 10-year mark, 68 percent continue to be seizure free.

More than 100 adult patients with medication-resistant epilepsy undergo surgical procedures annually, making Cleveland Clinic’s Surgical Epilepsy program one of the foremost programs of its kind in the world.

Cleveland Clinic was one of the first medical centers in the country to perform intracranial brain mapping in patients with epilepsy using electrical stimulation. Advancements of this technique using three-dimensional computer images of the brain now help our physicians to determine the precise location of the seizure focus and its relation to the functional areas of the patient’s brain.

Care for the Special Needs of Children

One percent of children in the United States have some form of pediatric epilepsy. If your child is affected by this condition, you want the best medical and/or surgical care available.

The Pediatric Section of our Epilepsy Center was established at Cleveland Clinic to meet the unique needs of children with epilepsy and has been expanded recently to accommodate an ever-increasing patient population.

Compassionate, Highly Trained Pediatric Doctors & Care Providers

Our pediatric epilepsy team includes five board-certified pediatric epileptologists, two epilepsy neurosurgeons, pediatric neuroradiologists, clinical neurophysiologists, pediatric neuropsychologists, and a dedicated team of pediatric nurses, nursing assistants and EEG technologists.

Each year, our team sees more than 2,000 children with pediatric epilepsy in our outpatient clinics, and evaluates more than 550 children in our dedicated state-of-the-art Pediatric Epilepsy Monitoring Unit. More than 100 children with severe conditions undergo epilepsy surgery annually, making Cleveland Clinic's Surgical Epilepsy program one of the foremost programs of its kind in the world.

Technologically Advanced Diagnosis & Treatment

A self-contained, eight-bed Pediatric Epilepsy Monitoring Unit is located at Cleveland Clinic Children’s, featuring state-of-the-art, all-digital, video-EEG equipment.

We monitor more than 550 children in these dedicated units that pinpoint the focus of seizures. Our newly expanded monitoring units feature state-of-the art, all digital video-EEG monitoring equipment and are fully staffed 24 hours a day, seven days a week. Staffed by experienced nurses and EEG technologists specializing in pediatric epilepsy, the unit is overseen by our dedicated team of pediatric epileptologists.

Our clinicians use a variety of medical and surgical treatment options for the control and prevention of seizures. Treatments are based on an individualized assessment of the nature, type and severity of the patient’s disorder.

In March 2009, Cleveland Clinic launched the first SEEG (stereoelectroencephalography) program in North America, for patients with uncontrollable epileptic seizures. Since 2008, Cleveland Clinic Epilepsy Center has been among a select number of institutions in the world with MEG (magnetoencephalography), a technique used to better identify epileptic sources in patients in whom the area of the brain causing the seizure would otherwise be difficult to identify. More than 700 studies have been performed in our MEG laboratory since its inception.

Special services for children with epilepsy include:

In addition, novel seizure treatment with the use of investigational antiepileptic drugs and devices are available through numerous ongoing clinical trials.

Cleveland Clinic was one of the first medical centers in the country to perform intracranial brain mapping for pediatric epilepsy.

Advancements of this technique, using three-dimensional computer images of the brain, help physicians determine the precise location of seizure activity. This technology, along with such procedures as vagus nerve stimulation, offers hope for our young patients struggling with pediatric epilepsy.

Experience in Pediatric Surgery & High Success Rates

We perform more than 100 pediatric epilepsy surgeries each year. Our epilepsy surgeons have performed more than 3,800 surgeries since 1996. One year after temporal lobe resection, 80 percent of Cleveland Clinic patients continue to be seizure-free; at the 10-year mark, 68 percent continue to be seizure free.

Only a few medical centers in the country provide the range of care for pediatric epilepsy that is available at Cleveland Clinic. We believe that providing the best medical and surgical care for children goes beyond state-of-the-art equipment and latest techniques. It also means providing care with compassion. We understand your concerns, and we are here to help.

Adult Epilepsy Team

  • Adult Neurologist/Epileptologist
    Within the Adult Section of our Epilepsy Center we have an experienced and dedicated team of specialists who are committed to meeting the unique needs of adults with epilepsy. Our epileptologists are neurologists who have received specialized training in the diagnosis, treatment, and management of epilepsy and who will work with you and your family to find the best treatment plan.
  • Epilepsy Neurosurgeons
    Within our Epilepsy Center we have an experienced and dedicated team of neurosurgeons are committed to meeting the unique needs of adults and children with epilepsy. Our epilepsy neurosurgeons received specialized training in surgical treatment of epilepsy, and have successfully operated on thousands of patients of all ages with difficult-to-control epilepsies. The success of epilepsy surgery is measured both in terms of its impact on seizure control and quality of life.
  • Adult Psychiatrist
    An adult psychiatrist is a physician who specializes in diagnosis and treatment of anxiety, mood disorders, and other mental health issues in adults. Within the Adult Section of our Epilepsy Center, we have dedicated psychiatrists who focus on the treatment of persons experiencing epilepsy.
  • Clinical Psychologist
    A clinical psychologist offers counseling and behavioral therapy in the treatment of mental health disorders. Within our Epilepsy Center, we have dedicated clinical psychologists who focus on the treatment of patients experiencing mental health challenges and epilepsy, and of persons with non-epileptic seizures.
  • Adult Neuropsychologist
    An adult neuropsychologist performs and interprets tests in regards to memory, language, problem-solving and mood to assist with the treatment recommendations. In the Adult Section of our Epilepsy Center, we have dedicated neuropsychologists who specialize in testing for adults with epilepsy.
  • Neurophysiology specialists
    These specialists are physicians and researchers who specialize in clinical neurophysiology and the continuous computerized neurophysiological assessment of seizures using specialized diagnostic technology, including MEG (magnetoencephalography) and invasive monitoring The results of these specialized tests are important in the planning for epilepsy surgery.
  • Neuroradiologists
    Our highly trained and experienced neuroradiologists interpret imaging studies of patients with epilepsy, using the latest in MRI and other scanning technologies (such as fMRI, PET, and SPECT) to evaluate the patient’s brain structure and function.
  • Bioethicists
    Bioethics is the study of ethical concerns surrounding medicine and technology. Our Epilepsy Center has dedicated bioethicists who specialize in assisting families facing complex decisions about epilepsy surgery.

Pediatric Epilepsy Team

  • Pediatric Neurologist/Epileptologist
    Within the Pediatric Section of our Epilepsy Center we have an experienced and dedicated team of specialists who are committed to meeting the unique needs of children with epilepsy. Our pediatric epileptologists are pediatric neurologists who have received specialized training in the diagnosis, treatment, and management of epilepsy in children and who will work with you and your family to find the best treatment plan for your child.
  • Epilepsy Neurosurgeons
    Within our Epilepsy Center we have an experienced and dedicated team of neurosurgeons are committed to meeting the unique needs of adults and children with epilepsy. Our epilepsy neurosurgeons received specialized training in surgical treatment of epilepsy, and have successfully operated on thousands of patients of all ages with difficult-to-control epilepsies. The success of epilepsy surgery is measured both in terms of its impact on seizure control and quality of life.
  • Pediatric Psychiatrist
    A pediatric psychiatrist is a physician who specializes in diagnosis and treatment of anxiety, mood disorders, and other mental health issues. Within the Pediatric Section of our Epilepsy Center, we have dedicated psychiatrists who focus on the treatment of children experiencing epilepsy.
  • Pediatric Neuropsychologist
    An adult neuropsychologist performs and interprets tests in regards to memory, language, problem-solving and mood to assist with the treatment recommendations. In the Adult Section of our Epilepsy Center, we have dedicated neuropsychologists who specialize in testing for adults with epilepsy.
  • Neurophysiology specialists
    These specialists are physicians and researchers who specialize in clinical neurophysiology and the continuous computerized neurophysiological assessment of seizures using specialized diagnostic technology, including MEG (magnetoencephalography) and invasive monitoring The results of these specialized tests are important in the planning for epilepsy surgery.
  • Neuroradiologists
    Our highly trained and experienced neuroradiologists interpret imaging studies of patients with epilepsy, using the latest in MRI and other scanning technologies (such as fMRI, PET, and SPECT) to evaluate the patient’s brain structure and function.
  • Bioethicists
    Bioethics is the study of ethical concerns surrounding medicine and technology. Our Epilepsy Center has dedicated bioethicists who specialize in assisting families facing complex decisions about epilepsy surgery.

Epilepsy Neurosurgery Team

  • Epilepsy Neurosurgeons
    Within our Epilepsy Center we have an experienced and dedicated team of neurosurgeons are committed to meeting the unique needs of adults and children with epilepsy. Our epilepsy neurosurgeons received specialized training in surgical treatment of epilepsy, and have successfully operated on thousands of patients of all ages with difficult-to-control epilepsies. The success of epilepsy surgery is measured both in terms of its impact on seizure control and quality of life.

Other Teams

  • Epilepsy Nurses
  • Epilepsy Clinical Nurse Practitioners
  • Physical Therapists
    Physical therapy may be needed for those with issues of mobility. Our therapists are highly educated in helping people regain function and improve balance, while also educating our patients on how to make the home, school or work environment safer.
  • Occupational Therapists
    These specialists analyze how epilepsy affects the ways in which you perform your daily activities and help you learn new, more satisfying approaches.
  • Speech Therapists
    Our speech therapists will help in evaluating and treating patients that may be experiencing language barriers due to complications from the seizures.
  • Dietitians
    Having the right foods as well as balance of nutrition can be an important part of epilepsy treatment. Our dietitians help patients plan out meals and educate on proper nutrition to help the management of seizures and its effects. Together with our pediatric epileptologists, they also guide families in the use of the ketogenic diet for treatment of epilepsy.
  • Neurophysiology specialists
    These specialists are physicians and researchers who specialize in clinical neurophysiology and the continuous computerized neurophysiological assessment of seizures using specialized diagnostic technology, including MEG (magnetoencephalography) and invasive monitoring The results of these specialized tests are important in the planning for epilepsy surgery.
  • Bioethicists
    Bioethics is the study of ethical concerns surrounding medicine and technology. Our Epilepsy Center has a dedicated bioethicist who specializes in assisting families facing complex decisions about epilepsy surgery.

Patient & Medical Professional Resources

For Patients

For Physicians

Patient Resources

Becoming a Patient

Adult and pediatric patients come to Cleveland Clinic from all over the world for medical and surgical treatment of epilepsy. Learn how to become a patient.

Patient Downloads

For further information, select from our list of free epilepsy related educational brochures and fact sheets.

What We Treat Staff

Staff

Doctors & Surgeons

Care Providers

Adult Nurses

  • Deborah Jarrell, RN
  • Paula Klima, BSN, Clinical Coordinator
  • Michael Mackow, BSN, Clinical Coordinator
  • Joyce Soroka, BSN, RN

Adult Licensed Independent Practitioners

  • Kim Merner, MSN, APN
  • Susan Stanton, PA-C
  • Megan Konerth, PA-C
  • Jessica Hill, MSN, APN
  • Firdaws Laryea, PA-C
  • Thaddeus Nespeca, MSN, APN

Pediatric Nurses

  • Nancy Alexander, BSN, RN
  • Theresa  Andrich, BSN, RN
  • Demeshia Cunningham, BSN, Clinical Coordinator

Peds Licensed Independent Practitioners

  • Molly Delaney, MSN, APN
  • Cheryl Malek, MSN, APN

Surgery

  • Ann Warbel MSN, APN
  • Edie Landers, RN

Medical Assistant

  • Brittany Sandidge
Appointments

Appointments

Make an Appointment or Referral

Cleveland Clinic offers same-day or next-day epilepsy consultations at Cleveland Clinic Community Hospitals and Family Health Centers. In addition, comprehensive epilepsy services are provided on Cleveland Clinic main campus and at our Weston, Florida location.

For an appointment, call us locally at 216.636.5860 or toll-free at 866.588.2264.
For Cleveland Clinic Florida, please call 954.659.5671.

Virtual Visits

Select patients now can see our providers online from their home or office by using the Cleveland Clinic Express Care® Online tool. This service allows patients a fast, secure and easy way to receive care from their healthcare team in a live virtual visit using a smartphone (iPhone or Android), tablet or computer. The benefits of choosing a virtual visit include no travel or parking, less waiting, significant time savings, no facility fee and the convenience of seeing your physician from wherever you choose.

If you would like to use Express Care Online for your next visit, please call your provider’s office. If you are eligible, our team will schedule your virtual visit and provide details on the cost of your appointment and setup instructions.

Refer a Patient

To refer a patient to the Epilepsy Center in Cleveland, Ohio please call us locally at 216.445.0601, toll-free at 866.588.2264, or email us:

To refer a patient to our Epilepsy Center in Weston, Florida or for an appointment:

DrConnect: Online Tool for Referring Physicians
DrConnect is a complimentary online tool for referring physicians that offers secure access to their patients' treatment progress at Cleveland Clinic.


What to Expect at the Epilepsy Center

What can I expect during my first appointment?
Your preliminary evaluation is performed by a board-certified neurologist with subspecialty training in epilepsy. It includes:

  1. A detailed history of your seizure activity and anticonvulsant drug regimens to help define the type of epilepsy you have and to determine whether it is resistant to medical treatment
  2. Outpatient testing to screen for abnormalities within the brain
  3. Inpatient EEG recordings to identify where, within the brain, the seizures begin

Your doctor will also need to know about a family history of seizures or other similar conditions and medications prescribed.

What questions is my doctor seeking to answer?
If you are evaluated for suspected seizures or epilepsy, your doctor will work to answer these questions:

  • Have you had an epileptic seizure or something else?
  • What is the cause? If a cause is identified, can it be treated?
  • What is the seizure type?
  • What is the outlook?

For Our Adult Patients
During your first appointment you will meet with members of our Epilepsy Team. They will take your medical history, perform a physical examination and complete a series of neurological and blood tests. Although your tests will be performed as quickly as possible, you should expect some waiting; you may want to bring some reading material to help pass the time.

For Our Pediatric Patients
If you are the parent or the caretaker of a child or adolescent, the first appointment will take place in the outpatient department of the Cleveland Clinic Children’s Hospital, located on the 7th floor of the S building (desk S-71).

A physician who specializes in epilepsy will meet with you to gather information about your child’s medical history and perform a physical examination. Towards the end of this visit, the physician will discuss with you the initial diagnostic impression and suggest the tests that will be pertinent for your child’s epilepsy type, as well as discuss some possible treatment options. This type of visit will typically take one to two hours.

What do I need to bring to my first appointment?

For Our Adult Patients
Your past medical record is very helpful to us. On the day of your appointment, please bring your actual films, CD/DVD and test results of any X-ray, angiography, MRI, CAT or CT and/or your EEG records that relate to your medical condition. Also, if you have recently been in the hospital (other than Cleveland Clinic), please bring a copy of your hospital discharge summary sheet, as well as other relevant hospital information. Your local physician can help you obtain these items.

For Our Pediatric Patients
A family member or a caregiver who has witnessed some of the child’s seizures should accompany the child during the clinic visit. This is essential in obtaining details of the seizures. You should closely work with your child’s regular medical care provider and obtain records of all previous testing that has been performed.

Previous EEG reports, summaries of video/EEG evaluations, CT, MRI films and other laboratory tests form an important part of the medical history of a child with epilepsy. It is best to bring these records physically with you to your first appointment; sending them via mail adds unnecessary delays to the procurement of the records. You may prepare (ahead of time) a list of all the previous and current antiepileptic medications, including information about the dose used and the duration for which they were given. You may also bring the bottles of the current medications that your child is prescribed.

What questions should I be prepared to answer at my first appointment?

Important questions that you should prepare for include:

  • At what age did the seizures begin?
  • What circumstances surrounded your first seizure?
  • What factors seem to bring on the seizures?
  • What do you feel before, during and after the seizures?
  • How long do the seizures last?
  • Have you been treated for epilepsy before?
  • Which medications were prescribed and at what dosages?
  • Was the treatment effective?

If other individuals have seen you during a seizure, such as family members or close friends, they should be present to provide details because you may not have been aware of what was happening.

What testing will occur?

Most of the patients who come to Cleveland Clinic for a comprehensive epilepsy evaluation will be prescheduled for an outpatient EEG prior to their initial clinic visit.

The EEG is an especially important part of the evaluation because seizures are defined by abnormal electrical activity in the brain. This test is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.

However, it is not uncommon for routine outpatient EEGs to show normal results in patients with epilepsy. Repeat EEGs after sleep deprivation can increase the chance of finding an abnormality.

When routine outpatient EEG studies fail to provide the needed information, prolonged EEG monitoring may be necessary. Particularly, if the diagnosis is not clear, or the patient may be a potential candidate for epilepsy surgery, they will need to undergo an Epilepsy Monitoring Unit evaluation.

The family is contacted by our epilepsy nursing staff for scheduling a return visit to the Epilepsy Monitoring Unit with the next available opening. Further tests (as may be indicated) are scheduled around this visit to coordinate a streamlined efficient visit for the convenience of the patient and their families. Such tests may include: MRI, PET, SPECT, WADA test, neuropsychology evaluation etc. As part of the evaluation, your doctor will need to perform additional tests, including:

  • A complete physical and neurological examination of muscle strength, reflexes, eyesight, hearing and ability to detect various sensations.
  • Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI).
  • Blood tests to measure red and white blood cell counts, blood sugar, and blood calcium and electrolyte levels, and to evaluate liver and kidney function. Blood tests help rule out the presence of other illnesses.
  • An electroencephalogram (EEG), which measures electrical impulses in the brain.

If video-EEG monitoring is needed, how long will the stay be?

The expected length of stay is three to five days. The duration of stay largely depends upon the frequency and complexity of seizures and the necessity of doing additional testing (e.g. SPECT scan).

In the case of a diagnostic evaluation where surgery is not being considered, the expected length of stay is three to five days. However, for a presurgical evaluation where additional testing (e.g. SPECT) and consultations (e.g. neuropsychological evaluation) might be indicated, the length of stay is five to seven days.

Most of the time, you will stay in bed or in a reclining chair next to your bed. You will be disconnected from the equipment to get up and move about twice a day. You also will be disconnected to use the restroom and to shower. Having a family member or staff person accompany you on all walks is required for your safety as your medication will be reduced or discontinued. For your safety, we also limit your walking within the unit itself.

Children are encouraged to bring along their favorite blankets, toys, books, pacifiers or other comfort items. Feel free to bring any photographs, pictures or small items that will make your child’s room seem more like home.

Parents are encouraged to stay around-the-clock with their child, though only one person may stay overnight. After monitoring is completed, young patients are welcome to use the playroom and playdeck. The playroom and playdeck are located in Cleveland Clinic Children’s Hospital, where the Pediatric Monitoring Unit is located.

What will I take home with me after the evaluation?

At the end of the evaluation, the physician will provide you with a summary impression from the information gathered from the testing and provide further recommendations for a treatment plan. Within the following few days, your referring physician (unless otherwise specified) can expect to receive a copy of the complete evaluation and further recommendations.

Epilepsy is a disorder that needs very close follow-up care on an ongoing basis. We like to work very closely with your referring physicians in providing them with feedback and future recommendations whenever needed. In many cases, medication levels and prescriptions are best handled by a follow-up closer to home with the regular physician. However, we would like to stay available for further consultation and follow-up visits at any time in the future.

Research & Clinical Trials

Research & Clinical Trials

Clinical Trials

Here are some questions to ask your doctor to help you decide if you want to take part in a research study:

  • What is the study trying to find out and how long will it last?
  • What kinds of tests and exams will I have to take while I'm in the study? How much time do these take? What is involved in each test?
  • How often does the study require me to go to the doctor or clinic?
  • Will I be hospitalized? If so, how often and for how long?
  • What are the costs to me? Will my health insurance pay for it?
  • What follow-up will there be? What will happen at the end of the study?
  • What are my other treatment choices? How do they compare with the treatment being studied?
  • What side effects can I expect from the treatment being tested? How do they compare with side effects of standard treatment?

Below, find clinical trials that are currently recruiting:

The Spectrum of Familial Epilepsy

This study is a data collection, non-treatment study to locate and study the genes that cause epilepsy.

Eligible subjects will have a diagnosis of epilepsy and a positive family history of epilepsy.

Identified subjects will have one single blood sample and questionnaires to complete.

If you would like more information on this study please contact:

Jocelyn Bautista, MD, Adult Epilepsy, or
Cindy Rose, Clinical Research Coordinator
216.444.7485

Cleveland Clinic's Epilepsy Genetics Registry

The purpose of this registry is to serve as a confidential database of medical and genetic information, family history and banked blood samples from persons with epilepsy.

Eligible subjects will have a diagnosis of epilepsy and a positive family history of epilepsy. Control subjects without a history of epilepsy will also be recruited.

Identified subjects and family members will have one single blood sample and questionnaires to complete.

If you would like more information on this study please contact:

Jocelyn Bautista, MD, Adult Epilepsy, or
Cindy Rose, Clinical Research Coordinator
216.444.7485

Searching for "Sleep Friendly" Therapies for a sleep population: A Double-Blind, Placebo-Controlled randomized trial to assess the effects of Lacosamide on sleep and wake in adults with Focal Epilepsy

Sleepiness and fatigue are the most common complaints of people with epilepsy and can have a negative impact on quality of life. Though unproven, these problems are often blamed on anti-seizure medications. Cleveland Clinic investigators are studying the impact of the newest anti-seizure medication Lacosamide (Vimpat®) on sleep and wakefulness in adults with focal (partial onset) seizures.

Focal epilepsy, also called partial epilepsy, is a disorder in which seizures are preceded by an isolated disturbance such as a twitching of a part of the body, a particular sensation or feeling, or some other disturbance in consciousness. The study is open to adults 18 and older with focal seizures.

Participation involves a physical exam, sleep testing at the Sleep Center, blood tests, completion of study questionnaires/diaries, and a random assignment to either take the study drug or placebo (often called a “look alike” or “sugar pill”) for 5 to 8 weeks. There are 5 study visits and participants will receive compensation for time spent in the study.

If you would like more information on this study please contact:

Nancy Foldvary-Schaefer, DO, Cleveland Clinic Sleep Disorders Center at 216.445.2990, or
Monica Bruton, Study Coordinator at 216.444.6718


Epilepsy Research

In the Epilepsy Center, research is fundamental and supported with technology and experience necessary to map the brain’s electrical activity, localize the seizure source and, if appropriate, remove the source for patients with adult epilepsy.

The Epilepsy Center’s staff is involved in research programs investigating the causes of epilepsy including:

  • Molecular, genetic and cellular mechanisms of epilepsy
  • Novel imaging techniques for the identification and localization of various types of epilepsies
  • Development of new treatment techniques for adult epilepsy

Dedicated research efforts target specific areas such as women’s health and specific issues directly related to adult epilepsy in women.

The epilepsy research program has been continuously funded from national public and private institutions, including the National Institutes of Health and the Epilepsy Foundation of America, American Academy of Neurology, and the American Epilepsy Society since 1995.

Innovations That Have Made a Difference for Epilepsy Patients

Innovations pioneered by Cleveland Clinic physicians include:

  • Instrumental epilepsy research that has helped neurosurgeons distinguish normal brain tissue from tissue that causes seizures. Because the difference is not apparent to the eye, they developed a brain mapping technique that allows them to identify and remove the desired tissue, thereby increasing the likelihood of eliminating seizures for adult epilepsy patients without damaging vital functions.
  • Pioneering of a microsurgical technique used in anterior temporal lobe surgery that protects the lobe and adjacent tissue.
  • Development method of sorting and analyzing electroencephalogram (EEG) imaging data on a computer to make pertinent information more readily accessible.

Current Epilepsy Research

Today, the Epilepsy Center continues to be involved in basic and clinical research designed to better understand the cause of adult epilepsy and find more effective ways of treating it. These involve methods of:

  • Improving presurgical monitoring
  • Modifying surgical techniques
  • Ensuring the protection of vital brain functions
  • Testing the effectiveness of new medication combinations

In addition, we are working with advanced techniques used at Cleveland Clinic for other brain disorders, including Gamma Knife surgery and deep brain stimulation, to see how they may be applied to adult epilepsy patients with equal success.

Mechanisms of Epilepsy

Through active funding from the National Institutes of Health and the National Institutes of Neurological Disorders and Stroke, the research team at the Section of Adult Epilepsy was able to identify specific proteins that may constitute the molecular basis for the generation of seizures in patients with brain malformations and epilepsy. These findings are of paramount importance, as they may constitute the basis for the design of specific medications that are effective in seizure control but are devoid of the side effects that are most commonly seen after the administration of most standard antiepileptic medications. These results have been presented in National and International meetings and published in peer-reviewed National and International Journals.

Recent work at the Adult Epilepsy research program has led to the discovery of a novel gene that may be implicated in a type of generalized epilepsy associated with a common movement disorder.

Neuronal cells in epileptic tissue

Neuronal cells in epileptic tissue (arrows in C and D) harbor specific proteins (in red, C) that enhance the activity of one of the main excitatory glutamate receptors (NMDA) and therefore, contribute to the expression of seizures in patients with cortical dysplasias. These proteins are absent from nonepileptic tissue (A). The identification of this differentially expressed protein may lead to the development of specific therapeutic options and enhance our ability for imaging areas that are able to generate seizures. These pictures were taken using a confocal special microscope that is available at the Cleveland Clinic Lerner Research Institute Core facility.


Imaging Techniques for the Investigation of Patients with Epilepsy

The Cleveland Clinic Epilepsy Research group has been actively involved in the testing of novel imaging modalities such as Magnetic Resonance Spectroscopy (MRS) for the diagnosis and localization of various types of epilepsies. The testing of this technique was performed in animals and later applied to patients with epilepsy. This technique is now commonly used in the presurgical evaluation of some patients with epilepsy.

A team from the Epilepsy Center and the Department of Neurosurgery recently developed a computer program that is designed to three-dimensionally visualize the brain and to detect epileptic lesions and to localize the areas of potential epileptic activities.

Research on the Development and Introduction of Novel Treatment Techniques

Our physicians and researchers have been actively involved in the development of novel techniques for the treatment of epilepsy.

map of the MRS metabolic changes

This figure shows a “map” of the MRS metabolic changes (increase in lactate that typically reflects a significant focal increase in the activity of the brain) seen in the brain of a patient with right temporal lobe epilepsy after one of his seizures. This technique allows the localization of the seizure in a non-invasive way.

Electrical stimulation of the brain as a treatment modality in epilepsy (“Brain pacemakers”)

Over the last 5 years, the research team at the Epilepsy Center has been testing various means that use electrical stimulation of various brain targets for the treatment of epilepsy in animal models of seizures using our state of the art neurophysiology facility. We are currently testing novel brain targets and methodologies that benefit from computer technologies that enable us to detect seizure activity and to automatically stimulate and control the area of seizure onset.

Cartoon  electrical stimulation

This cartoon shows the principals behind the various modes of electrical stimulation of the epileptic areas in the brain. The “overdrive method” (illustrated in the purple fibers) is the one that was introduced at the Cleveland Clinic Epilepsy Center and is currently being tested.

Function mapping

This image shows the three dimensional reconstruction of the brain from MRI images. Computer enabled co registration (in blue color) of the area of the lesion that caused the patient’s seizures is seen together with the location of the electrodes (green circles) that were surgically placed on the brain to map the motor and speech regions.

For Medical Professionals

For Medical Professionals

Training

We offer best-in-class clinical neurophysiology training to adult neurology residents and pediatric neurology fellows.

Cleveland Clinic Epilepsy Center has gained national and international prominence for the management and investigation of epilepsy and offers excellent training for medical professionals. Our high-volume clinical practice attracts adult and pediatric patients from all over the world.

Our coordinated, multidisciplinary team contributes a comprehensive range of skills and knowledge of adult and pediatric epilepsy. Excellence in diagnostics, medical and surgical clinical treatment programs, and research have yielded important basic and clinical science contributions.

We invite both adult neurology residents and pediatric neurology fellows considering clinical neurophysiology training to consider Cleveland Clinic for your further training.

Download the application for an epilepsy residency or fellowship at Cleveland Clinic:

Fellowships

Learn more about the Epilepsy Fellowship

Observership Three-Month Course

The clinical neurophysiology/epilepsy course is an intensive three-month course designed to introduce core clinical competency in clinical neurophysiology and epilepsy training. The course consists of a nine-week lecture series and three one-week workshops.

The course consists of the following:

  • Hands-on learning in the form of case discussion on various topics pertaining to clinical neurophysiology and epilepsy
  • Introduction to clinical and basic science research opportunities, including timeliness of research expectations and requirements
  • Lectures about formulating research questions/hypotheses, aims, and studies

Participants will be asked to think of a research question and select a mentor. At the end of the course, each clinical participant will present his or her research idea in research meetings.

Resources

Resources

Pediatric Epilepsy Support

The mission of our Pediatric Epilepsy Support Group is to meet and address the needs of families who are caring for children afflicted with difficult-to-control epilepsy.

The Pediatric Epilepsy Support Group was established in fall 2003. It is intended as an avenue for families to interact with the members of the support group, as well as with each other.

Caring for a child with refractory epilepsy is not easy and families often find their emotional resources spread thin. It is even more daunting to come to the hospital for evaluation with new and sophisticated diagnostic tests, participate in discussions involving epilepsy surgery as a possible treatment option and undergo procedures such as invasive monitoring of seizures for accurate surgical planning.

The acute void of support beyond the immediate pediatric medical-care-related interactions during their stay in the hospital has been bridged with the help of the Pediatric Epilepsy Support Group. The weekly meetings of the pediatric support group have been a source of strength and comfort for the family members.

The Pediatric Epilepsy Support Group then continues to be a platform for networking interactions beyond the hospital stay and following epilepsy surgery.

This group is a 'work in progress.' Getting our pediatric patients and families through difficult times is our main focus.

Adding a different dimension to complement its role, PESG is pleased to present a biennial venue for pediatric post epilepsy surgery patients. The essential role of these family reunions is to offer a platform to interact with others with whom they share a common thread: epilepsy surgery. Invited speakers offer valuable information pertaining to life after surgery. Alongside nurses and physicians who had been a vital part of their journey, these families celebrate life, hope, strength and determination.

Deepak Lachhwani, MD
Director, Pediatric Epilepsy Support Group
216.445.9818

These meetings occur every week at Cleveland Clinic's main campus at Cleveland Clinic Children’s. The meetings are designed to accommodate the parents of our hospitalized patients by providing an opportunity for interactions, exchange of ideas, as well as an environment to express each others' concerns and draw comfort as their child goes through various evaluations, procedures or epilepsy surgery. For several years, scores of families have benefited from the weekly meetings of this support group.

In a collective effort, our team of Volunteer Ambassadors, Cleveland Clinic Child Life Support, Cleveland Clinic Social Work, and members of the medical and neurosurgical staff make themselves available for the parents. These meetings have been universally well-received, as is evident by glowing feedback from families who have attended, and the keen interest expressed by a number of them to become volunteer ambassadors themselves.

Support for Parents of Children or Teens With Epilepsy - You Are Not Alone

Has your epileptic teen ever struggled with, or have you as his or her parent been concerned that your teen may suffer from:

  • depression or anxiety
  • problems socializing with peers or low self-esteem
  • being bullied by classmates because of their epilepsy

Emotional and mental health is an important part of our overall wellness. Unfortunately, because of the fear and stigma our society harbors about mental illness, many of us are uncomfortable dealing with that part of our lives. So, we may overlook warning signs that we or our children are depressed or anxious, with sometimes disastrous consequences.

Additional Resources

These resources can help you and your child learn more about seizures and epilepsy.

FAQs for Parents

Question of the month:
"Our child has done well since surgery and our doctor offered to gradually stop the medication altogether. Is this risky?"

Answer:
The most likely outcome is that your child will have no further seizures. Your doctor will weigh the odds which would favor a successful medication withdrawal and share this information with you.

The following risks are rare, however they should be discussed:

Risk #1: Child may have one of the typical pre-operative seizures.
Plan: Restart medication; majority of children become seizure free again with just restarting medication.

Risk #2: Child may have a longer or harder seizure than pre-operative typical seizures.
Plan: Emergency care and restart medication.

Risk #3: Seizures may be difficult to stop again.
Plan: Your epileptologist will need to guide further management.

Teens with Epilepsy - Q&A

Being a teenager comes with its own set of challenges, but being a teenager with epilepsy, raises even more questions and anxiety, such as explaining seizure to their friends, concerns about playing sports and driving, or not knowing when the next seizure will occur.

Epilepsy and Driving
Should parents allow and encourage their teen son or daughter to obtain their driver’s license?
Ajay Gupta, MD, Pediatric Epilepsy Specialist: Driving means independence, and ability to have a better quality of academic, social and occupational life. Driving should not only be encouraged, but should always be a goal, whenever possible, after considering all aspects of every teenager's condition. Parents should discuss this with the physician as the child is approaching the drivable age in the state he or she lives to give the best opportunity to plan ahead.

Are there any restrictions or other concerns that should be raised about driving?
Ajay Gupta, MD, Pediatric Epilepsy Specialist: While seizure control is critical for teenager's ability to drive, it is not the only factor in evaluation for driving. Compliance, supervision, and tolerance to antiepileptic medications are important. Any physical, intellectual, behavioral and maturity issues must be taken into account. Laws of each state vary, and meeting the state guidelines and driving standards is another consideration. Value of ongoing follow up and close supervision under a physician is paramount to maintain one's ability to drive and proactively make medication adjustments. Most teenagers with well controlled epilepsy are likely to be able to drive if they can demonstrate compliance to medications.

Epilepsy and Dating
Should teens tell their dates that they have epilepsy?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: Yes, it is important to keep an open line of communication, in case the patient has a seizure during the date, and talk about the basics (A-B-C) on what to do when you have a seizure.

How should the first conversation (about having epilepsy) be carried?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: The first discussion should be very informative and it should include the facts of epilepsy. People are able to cope with situations better when they know what to expect, so it is easier to discuss all the epilepsy facts to help increase awareness and de-stigmatize this disorder.

Are there any special concerns for teenage girls with epilepsy?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: Teenage girls might experience changes in their seizure frequency around the time puberty starts, with some girls actually experiencing more seizures before, during or soon after their period.

Can teens with epilepsy have normal intimate relationships?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: Of course they can, just making sure their partner is aware about the epilepsy helps build encouragement and support in the relationship.

Epilepsy, Alcohol and Drugs
Are there any particular dangers of drugs and alcohol usage in teens with epilepsy?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: It is very dangerous for teenagers with epilepsy to experiment with drugs and alcohol, as these might decrease the seizure threshold and increase the number and duration of the seizures. Using drugs and alcohol also put teenagers in risky situations that could be very dangerous.

How do drugs and alcohol interfere with the antiepileptic medication?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: Drugs and Alcohol compete in the liver with the enzymes that metabolize the antiepileptic medication, therefore there is less amount of the necessary circulating antiepileptic medication which can cause an increase in the number of seizures.

Epilepsy, Work and College
Should teens with epilepsy work (part-time jobs)?
Ajay Gupta, MD, Pediatric Epilepsy Specialist: The goal is always to have a good quality of life in social, occupational, and academic spheres. Independence and employment are important issues that must be addressed considering all aspects of epilepsy that ‘specifically apply to each teenage child with epilepsy’. Teens are encouraged to work and drive whenever it is possible. Career choices, types of employment, compliance, follow up, driving, and drug side effects are some of the important factors one should consider while considering employment opportunities.

Are there any career limitations for teens with epilepsy? What opportunities exist for teenagers who have epilepsy as well as other developmental disabilities?
Ajay Gupta, MD, Pediatric Epilepsy Specialist: A teen with well controlled epilepsy, who is compliant with treatment is eligible for most jobs. Certain jobs may have specific limitations for some diseases even if the symptoms are under control, and eligible teens should clarify this before hand. One example is, perhaps, fighter pilots. There are good books and web resources that one can explore to learn more on taking control of one’s epilepsy.

Should teens with epilepsy work (part-time jobs)?
Ajay Gupta, MD, Pediatric Epilepsy Specialist: The goal is always to have a good quality of life in social, occupational, and academic spheres. Independence and employment are important issues that must be addressed considering all aspects of epilepsy that ‘specifically apply to each teenage child with epilepsy’. Teens are encouraged to work and drive whenever it is possible. Career choices, types of employment, compliance, follow up, driving, and drug side effects are some of the important factors one should consider while considering employment opportunities.

Epilepsy and Depression
How common is depression in teens with epilepsy?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: Depression is very frequent in teens with epilepsy, around 26%.

What are the symptoms of depression in teens with epilepsy?
Tatiana Falcone, MD, Pediatric Epilepsy Psychologist: The symptoms of depression are; decreased sleep, decreased energy, increased guilt, irritability, increased anger, isolation from social activities and hobbies, hopelessness, helplessness, and in the severe cases suicidal ideation. Studies have reported that teenagers are particularly at risk for increased suicidal ideation especially those with epilepsy.

How is depression treated in teens with epilepsy?
Tatiana Falcone, MD
, Pediatric Epilepsy Psychologist: There are two choices; if the depression is mild or moderate psychotherapeutic intervention such as Cognitive Behavioral Therapy (CBT) are very effective for the treatment of depression in teens, if the depression is moderate or severe the use of medications such as antidepressants are probably the treatment of choices. The most effective method to treat depression is the combination of the two, CBT and medication. Additionally, the parent’s role is very important, they have to recognize the pattern of behavior change and ask for help (consult to the child and adolescent psychiatrist or psychologist)

Epilepsy and Sleep
Is there any relationship between sleep deprivation and seizures? How much sleep should a teen with epilepsy get?
Ajay Gupta, MD, Pediatric Epilepsy Specialist: This relationship is commonly observed by families, however, is not universal. Generally, sleep deprivation is one of the triggers among multiple other triggers that set the teenager up for more seizures. Other common triggers are fasting, dehydration, flu or other febrile illnesses, unmonitored over the counter or prescription medications, sedation for procedures, stress or physical exhaustion. Sleep hygiene makes sense for all teenagers with or without epilepsy. If a consistent relationship is observed between sleep and seizures, consistent sleep times and duration could help in seizure control. A healthy teenager must sleep for at least 8 hours of uninterrupted sleep at night, and for sure, many may require 9-11 hours of sleep.

What is Project COPE?

Collaboration for Outreach and Prevention Education (COPE) for Children with Epilepsy.

The COPE program consists of four sessions geared toward either the parents of children/teens who have epilepsy or the children/teens (ages 12 to 18) themselves.

Participants will learn about the importance of emotional wellness/mental health and how to cope with everyday stressors they may face.

Improving Access to Mental Health Care for Youth with Epilepsy

Despite continued progress in the treatment of epilepsy, the psychosocial outcome in adults is reported as poor, even in patients who reach seizure freedom. Rates of psychopathology are high in patients with epilepsy, ranging from 37 percent to 77 percent in children and adolescents with epilepsy. An analysis of 29 cohorts of patients with epilepsy demonstrated increased risk of suicide compared with the general population.

Resources for Parents of Youth with Epilepsy

Webchats

Access our doctors' detailed, informative responses to patients' epilepsy-related questions in our transcripts. Topics include advice about treatments, surgery and mood disorders.

Invasive Testing & Epilepsy Surgery

Mood Disorders, Non-Medical Epilepsy Treatment & Ketogenic Diet Information

Upcoming Online Health Chats
Health chats are free, live chat events with Cleveland Clinic doctors and experts. They cover a range of medical topics, including epilepsy.

Patient Downloads & Guides

Related Links About Epilepsy

Learn about epilepsy from foundations, societies and other non-profit organizations.

Find support from organizations dedicated to helping you cope with pediatric epilepsy.

Email Us
The PESG e-mail is a designated account to offer interaction and networking opportunities. Emails are forwarded and processed by PESG (Pediatric Epilepsy Support Group) staff to Volunteer Parent Ambassadors.

Call Us
PESG voicemail is a dedicated phone line with a confidential voice mail box available for interested families. Messages left on this voice mail box are retrieved on a regular basis by the Volunteer Parent Ambassadors who then return the calls or forward them as appropriate.
216.445.9768 / 800.223.2273 x59768 (Toll Free)

Family Directory
Many of our patients' families expressed interest to work with other families of children who have had epilepsy surgery. If you are interested in additional information, please contact: Deepak Lachhwani, MD
Director, Pediatric Epilepsy Support Group
216.445.9818