Overview of Epilepsy
Epilepsy is characterized by recurrent seizures—bursts of electrical activity in the brain that can cause convulsions—as well as less severe episodes of confusion, speech arrest, or motor or sensory symptoms. Most seizures are due to a scar, tumor, stroke or other abnormalities in the brain, although some can result from toxic or metabolic upset, or a genetic disorder.
Epilepsy is a common, chronic medical condition present in approximately 1 out of every 200 people. Epilepsy sufferers have (or are at risk of having) recurrent seizures. Some seizures are mild and result in a brief staring spell or slight body movements. Other seizures are more severe, such as convulsion.
For many people, the cause of epilepsy cannot be determined. In others, a brain lesion such as a scar, stroke or tumor may be the cause, or there may be a genetic predisposition to seizures.
Lahey Hospital & Medical Center’s Epilepsy Program
At Lahey Hospital & Medical Center, all of our neurologists treat epilepsy, but several members of the neurology staff have additional fellowship training and expertise in treating complicated epilepsy cases. Seizures produce abnormal electrical activity in the brain and can therefore often be diagnosed and localized by an EEG (electroencephalogram). MRI scans also help to find abnormalities in the brain that cause seizures, and SPECT and PET scans may provide additional diagnostic information, as well.
Our inpatient video-EEG monitoring unit is used to evaluate patients with epileptic or other spells. Patients are admitted to the hospital, medication doses are often reduced, and seizures are recorded by both video and EEG. Analysis of the episodes helps us to determine whether the seizures are indeed epileptic, and if so, what type they are and where in the brain they arise. Our epilepsy specialists use these tools to make appropriate diagnoses and provide our patients with the best possible treatment.
Once properly diagnosed, approximately two-thirds of epilepsy patients can be successfully treated with medication. Use of newer epileptic medications and knowledge of epilepsy-specific problems (related to age, gender and other complicating medical conditions) helps us to provide optimum care for each patient.
For the one-third of patients who do not respond adequately to medication, surgery may be helpful. Most seizures come from one small area of the brain. If that area can be located, and it can be demonstrated that this area is no longer serving any useful purpose, it can be removed surgically, and this could significantly improve a patient’s chance of becoming seizure-free. Using MRI scanning, MRI spectroscopy and, for some patients, insertion of electrodes on the surface of or within the brain, the seizures can often be located and the seizure focus removed.
When surgical resection is not possible, a patient may benefit from a vagus nerve stimulator, a pacemaker that stimulates the vagus nerve in the neck. This nerve connects with the brain and, when stimulated, can reduce the frequency and intensity of seizures.
Lahey Hospital & Medical Center offers a wide range of resources for patients with seizure disorders who might consider surgery as a treatment option. Along with in-house video EEG monitoring to help determine the focus of the seizures, we offer the comprehensive use of sodium-Amytal testing, MRI, functional MRI, neuropsychological testing and neuropsychiatric testing. In addition, surgical procedures that might be recommended after a full evaluation include:
- Placement of subdural strips and grids
- Depth electrodes
- Temporal lobectomy and other focal resections
- Corpus Callosotomy
- Vagus nerve stimulators
- Deep brain stimulation
Many patients are ideal candidates for surgical intervention, often benefiting from a complete resolution of their seizures. While a cure is not always possible, surgery is a safer and more reasonable option than ever before, due to technology advances. Collaboration with members of the Neurology and Behavioral Medicine Departments is key to the successful management of these complex cases.