Epilepsy and Seizures

At your first appointment, your epileptologist will spend time getting to know you and discussing your medical history. They’ll ask you to describe your seizures and what you experience when you have one. It’s helpful if a family member who has seen you have a seizure comes with you. Family members who have videos of your seizures can describe them to your care team.

We’ll do a neurological exam to help understand what might be causing your seizures. They may also order one or more of these tests:

• Electroencephalogram (EEG).
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET).

Often, the neurological exam and these tests are enough to confirm a diagnosis. But if we need more information, your provider may order additional specialty testing in our epilepsy monitoring unit.

Adult epilepsy monitoring units

Cleveland Clinic has epilepsy monitoring units for adults at our main campus in Cleveland, Cleveland Clinic Abu Dhabi, Cleveland Clinic Akron General and Cleveland Clinic Florida. Our epilepsy monitoring units are staffed 24/7. They feature all digital video EEG monitoring equipment that records information to help us best treat you. Using EEG equipment to monitor brain activity and high resolution video cameras to record your body movements gives us a greater understanding of your seizures than either technique alone.

We will watch you closely in the epilepsy monitoring unit for about three to seven days, depending on the test your provider orders. This extended stay gives your provider and care team a much greater understanding of your seizures. It allows us to not only make a diagnosis, but also to keep an eye on your overall health and design the best possible treatment plan.

Specialty epilepsy testing

Because of our size and expertise, Cleveland Clinic also offers additional epilepsy testing that’s not available at most centers elsewhere.

• Magnetoencephalography (MEG): A noninvasive and painless test that uses sensitive magnetic sensors attached to a helmet (similar to a hair dryer hood) to detect abnormal brain activity in a specific part of your brain.
• Stereoelectroencephalography (SEEG): Cleveland Clinic was the first institution in the United States to use SEEG to guide epilepsy surgery. Since 2009, we’ve used this minimally invasive surgical technique to map the areas of the brain where your seizures begin.
• Single-photon emission computerized tomography (SPECT): A nuclear imaging scan that uses a CT (computed tomography) scan and a radioactive tracer to detect how blood flow changes in your brain during a seizure.
• Voxel-based morphometry: A unique type of MRI that uses computer algorithms to detect hard-to-find areas of the brain which might be contributing to epilepsy. This is especially useful when an MRI provides unclear results.
• 7-Tesla (7T) MRI: Cleveland Clinic is one of only a limited number of healthcare institutions in the country offering this advanced imaging technology. A 7T MRI displays brain tissue more precisely than more widely used 3-Tesla MRIs.

After your first visit and testing, your care team will carefully explain the results. We’ll also answer any questions you may have. It might be helpful to have a loved one come with you to make sure you get all the answers you need. Your provider will then give you additional treatment plan recommendations. We’ll also share this plan with your primary care provider or referring provider (if you have one). Your treatment plan might include:

Medications

Your provider may first try anti-seizure medications to stop your seizures. The type of medication will depend on:

• The type of seizures or epilepsy you have.
• Your age.
• If you are or can become pregnant.
• Any other medical conditions you might have (including depression, anxiety and headaches).

Epilepsy surgery

If you’ve tried at least two anti-seizure medications without success (you’re drug-resistant) or your seizures are disabling and are a serious risk to your physical or mental health, your provider might recommend surgery. We know that surgery might sound scary, but it’s been shown that epilepsy surgery is safer than continuing medical therapy in those with drug resistant epilepsy. We’ll do our best to answer all of your questions and make you feel as comfortable as possible during the entire process.

Depending on what type of epilepsy you have, and which areas of your brain are affected, your provider may recommend one of these epilepsy surgeries:

• Disconnected surgeries: These surgeries involve separating the area of seizure from the rest of the brain, and are most commonly done in children. They include functional hemispherectomy, anatomic hemispherectomy, peri-insular hemispherectomy and corpus callosotomy.
• Focal laser ablation: During this minimally invasive surgery, lasers are used to pinpoint the exact area of the brain where the seizures are happening and eliminate the focus (where the seizures begin).
• Focal resection: This is the most common type of epilepsy surgery and involves removing the area of the brain that’s causing the seizures.
• Lobectomy (temporal lobe epilepsy surgery): This surgery involves removing a piece of the brain’s temporal lobe that has been tested thoroughly and is determined to be causing your seizures.
• Lesionectomy: This option is a surgery to remove a lesion (damaged area or abnormality) in the brain that’s causing focal seizures.

Neuromodulation therapy

If your seizures don’t respond well to medication, and you don’t qualify for surgery, neuromodulation implant devices may be an option. In these procedures, devices are implanted that send electrical pulses to disrupt the abnormal activity happening in your brain:

• Responsive neurostimulation (RNS): RNS involves a device that’s implanted in your brain near where the epileptic focus is and continuously monitors brain waves. The device sends electrical stimulation to the epileptic focus when abnormal epileptic brain waves are detected.
• Deep brain stimulation (DBS): A device is implanted deep in your brain that sends electrical pulses episodically (in a series) to disrupt abnormal epileptic brain waves that might happen far away from the DBS electrode.
• Vagus Nerve (VNS): A device is implanted in your chest and electrodes are placed in your neck around the left vagus nerve. The device sends electrical pulses to the vagus nerve, which then sends signals to the brain to help reduce seizures.

Our goal at Cleveland Clinic is to help you become — and stay — seizure free. This usually requires regular visits with your epileptologist. How often you’ll need follow-up visits depends on your needs. It may also change if you have any new symptoms. From time to time, your provider may order more testing, like blood work or EEGs, that may help guide treatment. If you need special care, we offer:

Psychogenic nonepileptic seizure care

Sometimes seizures can look like epilepsy, but they aren’t caused by epilepsy. Psychogenic nonepileptic seizures (PNES), for example, are seizures caused by psychological stress.

Typically people will learn that they have PNES after medication fails to stop seizures and they’re referred to the epilepsy monitoring unit for more testing. If you have PNES, you’ll work with a clinical psychologist and your epileptologist. Treatment usually includes cognitive behavioral therapy, which helps you manage stressors, problems and emotions.

Pregnancy and epilepsy

If you are or can become pregnant, seizure disorders require individualized care. Some commonly-used medications to treat epilepsy and seizures can affect your birth control, pregnancy, hormone levels and reproductive cycle. Our epileptologists work with you to keep an eye on your health if you are pregnant or want to become pregnant in the future.

People with epilepsy or seizures can go on to have healthy pregnancies and healthy babies with some extra planning. It’s important to receive the right prenatal care by working closely with your epileptologist and Ob/Gyn.

Adults 65+ with epilepsy

Epilepsy and seizures can affect anyone at any time. Symptoms of epilepsy or seizures in adults 65+ are sometimes more difficult to recognize because they might not look like what we consider typical seizure-like behavior.

Because many adults 65+ who are diagnosed with epilepsy may have additional health conditions, it’s important to get care from providers who specialize in this field for treatment that will lead to the best outcomes.

Taking the Next Step

Chances are, if you’re here, you’re coping with epilepsy and seizures or know someone who is. Finding the best care as soon as possible is so important when managing this often lifelong condition. You’ll find the best care at Cleveland Clinic. You’ll also find compassionate specialists who understand what you’re facing and are ready to help you find the calm within the storm.