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Epilepsy in Adults

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Epilepsy in Adults

Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time.

Seizures are episodes of abnormal brain activity that cause changes in attention or behavior. The epilepsy research institute CURE reports that 1 in 26 Americans develop epilepsy in their lifetime. If you or your loved one is searching for advanced Seizure Treatments in Rutherford NJ, our specialists are here to help.

Epilepsy may be due to a medical condition or an injury that affects the brain, or the cause could be idiopathic (of unknown origin). In this Q&A, Dr. Fried answers some of your most common questions about epilepsy.

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At Advanced Neurosurgery Associates (ANA), we are acutely aware that epilepsy represents a complicated combination of physical as well as psychological and emotional consequences. That’s why we emphasize our team approach to complete family care for our many pediatric epilepsy patients. Families seeking compassionate and expert Epilepsy Treatment Rutherford NJ can trust our decades of experience.

Research explains the impact of pediatric epilepsy on such areas as learning disabilities, behavioral disorders, anxiety and depression. But perhaps most instructive of all are the testimonials of past ANA patients, Stephanie Conklin and Victoria Vega, who speak on the emotional and psychological impact of their epilepsy history. Both have resumed productive and seizure-free lives following successful surgery at ANA.

With almost 60 years of combined experience, the Advanced Neurosurgery Associates (ANA) medical team diagnoses and treats individuals suffering from seizures and ensures an unmatched level of expertise and knowledge in the field of epilepsy surgery.

Common causes of epilepsy

There are many causes of epilepsy, and each individual should be extensively tested to determine the proper diagnosis.

  • Some common reasons why epilepsy occurs in adults include:
  • Stroke or transient ischemic attack (TIA)
  • Dementia
  • Traumatic brain injury
  • Infections, including brain abscess, meningitis, and encephalitis
  • Brain problems that are present at birth (congenital brain defect)
  • Brain injury that occurs during or near birth
  • Brain tumor
  • Abnormal blood vessels in the brain

Talk to one of our experts about your symptoms today.

Identifying Symptoms and Outcomes
Researchers have improved ways for epilepsy patients to receive crucial advance understanding of their chances to improve their symptoms through surgery. This is due to a far more accurate method of determining precisely what portions of the brain suffer from the disease. It can provide patients and physicians with better evidence of whether temporal lobe surgery will provide the results they seek. By analyzing the neuronal activity in the temporal lobe, doctors can determine whether it is diseased, and therefore, whether removing it with surgery will be beneficial.

Surgery is one treatment option that has seen patients living seizure-free lives, even long-term. Take a look Stephanie’s story below, who has celebrated five years seizure free.

Epilepsy Diagnosis

An epilepsy diagnosis requires evaluating the cause of epilepsy and to determine whether the seizure disorder falls within a recognized syndrome. An epilepsy diagnosis is a multi-step process, usually involving:
  • patient history
  • neurological exams
  • laboratory tests
  • other clinical studies.
Initially, the patient’s own testimony will be elicited for a medical history. However, depending on age, and also because the patient is often unaware during a seizure, a witness(s) can adequately describe the seizure characteristics and patterns. Thus, in keeping with our family-centered and sensitive approach, we engage family and caretakers as an important part of the diagnosis and evaluation process. An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy will often have abnormal electrical activity seen on this test. In some cases, the test may show the area in the brain where the seizures start.
Epilepsy Surgical Evaluation

Certain diagnostic tests may be performed to determine if surgery would be an effective treatment. This surgical evaluation can involve a number of tests to develop the diagnosis of the cause and location of the epileptic seizures.

Evaluation prior to surgery for epilepsy has changed radically in the past few decades, most notably since the advent of long-term video-electroencephalography (EEG) monitoring in the late 1970s, and advanced neuroimaging, specifically with the additional use of MRI.

To develop the epilepsy diagnosis before surgery, patients partake in extensive testing, such as:

  • Electroencephalogram (EEG), which helps identify the seizure focus
  • Magnetic Resonance Imaging (MRI), the “gold standard” for locating and evaluating brain lesions
  • Functional MRI (fMRI), which creates a “road map” of brain functions
  • Single-photon Emission Computer Tomography (SPECT) to explore where the seizure starts and its spread patterns
  • Intracarotid Memory and Speech Evaluation (Wada test), a test of language and memory functions.
  • Both before and during surgery, tests may be performed to map motor, sensory, language and memory functions; such as functional brain mapping and awake craniotomy.

It is also important to consider the emotional effects. Neuropsychology and psychiatry are a vital part of ANA’s epilepsy team’s evaluation.

Electroencephalography (EEG) is the fundamental measure of identifying seizure focus. The epileptologists on our team are adept at reading the spikes and sharp waves that constitute a spectrum of shifting seizure focus. Most patients undergoing evaluation for surgery will require EEG with video telemetry to document the seizure pattern.

However, an appropriate focus goes beyond single readings. Our experts evaluate EEG monitoring over a period of time. This is a critical measure to determine a clear onset and location of seizure activity.

While computerized tomography (CT) scan can provide some useful information about lesions which may be causing seizures, the “gold standard” for locating and evaluating brain lesions is magnetic resonance imaging (MRI). The greatest advance of MRI technology for epilepsy is the incredible clarity of both the normal and pathological anatomy of the brain. Since the mid-1980s, this technology has allowed us to routinely identify lesions that were previously undetectable.

FMRI scans use the same basic technological principles as MRI scans, but whereas MRI scans image anatomical structure, FMRI images chart metabolic function. Thus, functional MRI (fMRI) provides a non-invasive means of obtaining a ‘road map’ for the function of the brain. It is used to localize sensory, motor or cognitive function in the brain via changes in blood flow and hemoglobin oxygenation. Important information is obtained by integrating the results of fMRI with EEG.
Magneto-encephalography (MEG) is performed using a machine that consists of a variety of highly sensitive magnetic sensors. These magnets are positioned around the scalp in a helmet-shaped container called a Dewar. They are attached to the scalp to detect small magnetic changes that arise from normal and abnormal electrical brain activity. This technology is a valuable tool because it can be used to localize the source of epileptic activity and normal functional areas of the brain for surgical planning in patients with epilepsy.

Nuclear medicine, which deals with imaging the body for both diagnostic and treatment purposes, plays an important role in the pre-surgical assessment of patients with refractory epilepsy. This is evident in the case of single-photon emission computed tomography (SPECT) which is used to determine the seizure onset zone.

SPECT (single proton emission computed tomography) has an important role in the investigation of surgical candidates. Ictal (meaning taking place during a seizure) SPECT has also been useful to study seizure-spread patterns. Blood flow increases in the brain area in which the seizure originates and the blood flow can become less than normal in that same area during non-seizure states. By injecting a small and safe amount of a radioactive substance into a patient’s blood stream via IV we can evaluate the blood flow in the brain at a given time. Changes in blood flow during and after a seizure can be helpful in localizing seizure focus and spread patterns.

Neuropsychology testing is an important part of evaluation for epilepsy surgery. Conducted by an expert neuropsychologist, it is a formal assessment of cognition such as language, memory, attention and problem-solving. The neuropsychologist is able to determine how various parts of the brain are related to each of these tasks. This testing should be able to distinguish frontal from temporal brain dysfunction. This evaluation is also compared pre- and post-surgery to asses the effects of the surgery.

Epilepsy Treatment

Epilepsy treatment varies depending on the severity of a patient’s seizures, the cause of epilepsy, age and a number of other factors.

Surgery is an alternative for patients whose seizures cannot be controlled by medications. In pediatric epilepsy, surgery may be required to avoid destruction to cognitive development, mental and psychological health.

Prior to surgery, a prospective patient undergoes a thorough evaluation consisting of complete physical and neurological examination and an assemblage of studies to assess if a patient will ultimately benefit from epilepsy surgery. At ANA, our team collaborates on cases to define the best epilepsy treatment path for each patient.

Medication

At least half of those newly diagnosed with epilepsy will become seizure-free with their first medication—if they take it regularly and as prescribed. The efficacy of these medications of course depends on the type and severity of the epilepsy. In some cases, medication may diminish but not completely control all seizure activity.

Many various types of anticonvulsant (also called antiepileptic) drugs are available. Some patients respond to one drug and some may need more than one. It may take several months before the best drug and dosage are determined. Patients are monitored throughout the medication process via blood tests.

A ketogenic diet, one which supplies the majority of calories from fat as opposed to glucose, mimics the body’s response to starvation by burning fat for energy. Scientists are not precisely sure why this diet prevents seizures, although it is being studied. Estimates vary from 10-30% of children who try it become seizure free, or almost seizure free. And over half who try it gain a 50% reduction in seizures. The remainder do not respond or are unable to tolerate the diet because of side effects.

Epilepsy Surgery for Children

Epilepsy surgery can be especially beneficial to patients who have seizures associated with structural brain abnormalities, such as:
  • benign brain tumors,
  • malformations of blood vessels (e.g. arteriovenous malformations, venous angiomas, and cavernous angiomas)
  • strokes.
How Does Surgery Treat Epilepsy?
Epilepsy surgery is particularly effective when seizures always originate in the same part of the brains. Surgery may also help patients who experience frequent seizures that cannot be controlled with anti-epileptic drugs (AED). Epilepsy surgery can greatly reduce the number of seizures. Epilepsy surgery focuses on the area of the brain where the seizures originate. Dr. Arno Fried explains more in his Q&A article on epilepsy. The operations generally involve either:
  • the removal of epileptogenic tissue from the zone where seizures arise,
  • an alteration in the brain, by interrupting the nerve pathways along which seizure impulses spread.
Surgery is considered only if the area of the brain, called the seizure focus, can be clearly identified, and its removal does not jeopardize any critical functions, such as movement or language. Extensive testing is conducted prior to any consideration of surgery in order to determine if that surgery is appropriate. One consideration for epilepsy surgery is that the patient must have unsuccessfully tried at least a combination of two or more AEDs. These medically resistant patients – up 30 percent of epilepsy cases – are candidates for surgical evaluation. Studies show that outcomes improve the earlier surgery is performed, meaning surgery is being considered sooner as a treatment option.
Lobectomy and Cortical Resection

The most common form of epilepsy surgery is a lobectomy or cortical resection. It is estimated that approximately 30% of patients with partial epilepsy have seizures that are not well controlled with medications and could benefit from this surgery.

Seizures in the temporal, parietal, frontal or occipital lobes may be treated surgically if the seizure-producing area can be safely removed without damaging vital functions.

Corpus callosotomy is the sectioning, or separating of the corpus callosum—a nerve bridge which connects the two halves of the brain and integrates its functions. Separating the cerebral hemispheres reduces generalized seizures by confining the spread of an epileptic discharge to one cortex.

A corpus callosotomy may be performed when partial seizures secondarily generalize and it’s not possible to identify a single epileptic focus, or when resection of a localized focus would cause a pronounced neurological deficit. Uncontrolled generalized seizures may also be treated with this type of surgery.

The operation may be done in two steps. The first operation partially separates the two halves of the brain, but leaves some connections in place. If the generalized seizures stop, no further surgery is done. If they continue, a second operation to complete the separation may be performed.

This operation also seeks to control seizures by cutting nerve pathways. It is used when the seizure focus is located in a vital area of the brain that cannot be removed. Instead of taking out the affected tissue, the surgeon severs the parallel connections between cells in the affected area.

When a child has Rasmussen’s encephalitis, a rare, progressive disease affecting one whole hemisphere of the brain, a hemispherectomy may be performed.

A hemispherectomy is the removal of all or almost all of one side of the brain. Weakness on the side opposite the operation will continue, but the half that remains takes over many of the functions of the half that was removed.

Hemisperectomies may also be performed when children are born with conditions that cause excessive damage to one side of the brain, such as bleeding in the brain prior to birth.

A vagus nerve stimulator (VNS) is similar to a pacemaker. It is a small device implanted under the skin in the collarbone area. A wire (lead) connects the device to the vagus nerve, which is located in the neck. Our neurosurgical experts then create electrical signals that travel along the vagus nerve to the brain at regular intervals for the purpose of preventing the electrical brain activity that causes seizures. This device is indicated for children in whom no specific seizure area can be found in the brain. In a 2011 NIH study, Over 50% of patients experienced at least 50% reduction in seizure burden with this procedure.
Functional imaging techniques are used to map motor, sensory, language, and memory areas in neurosurgical patients with conditions as diverse as brain tumors, vascular lesions, as well as epilepsy. Functional brain mapping may be useful for both preoperative planning, as well as decision-making during the surgical procedure. The additional use of functional MRI and other non-invasive technologies adds to the menu of useful tools for pediatric epilepsy patients. Since about 1999, awake craniotomies have become more routine, even in young patients. This technique is useful for procedures necessitating brain mapping while avoiding any interference on the recording of important data from the use of anesthesia. Awake functional testing is the best method to direct navigation and test neurological functioning.

Epilepsy Surgery Recovery Time

Epilepsy surgery is a major neurosurgery. Some risk is associated with it and there is some mild discomfort afterward. The recovery period varies for each individual. The hospital stay also varies, depending on the specific procedure performed. Most people can resume normal activities 2 to 8 weeks after epilepsy surgery.
Can Surgery Cure Epileptic Seizures?

Epilepsy surgery is measured by the level of improvement in seizures and quality of life. Adult studies of epilepsy surgery have shown that seizures can be greatly reduced or totally controlled in some cases, and many can stop AEDs. Pediatric studies also report that the majority of infants and young children show favorable outcomes in seizure control, and can also stop AEDs after surgery.

It is critical for the patient and family to have realistic expectations of the results of the surgery. After surgery, some patients become completely seizure-free and some have no improvement at all. Many people fall between these extremes, having fewer seizures or seizures that are less intense, or they require less medication. Most people who do become seizure-free after surgery must continue to take seizure medicines to prevent breakthrough seizures. Although seizures may be greatly reduced or totally controlled following surgery, a number of patients report periods of depression during the adjustment period and it appears that the greatest benefit accrues to those whose seizures are completely controlled.
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WHAT WE OFFER SERVICES

Pediatric epilepsy, a condition that affects the nervous system, is the most common neurological problem in children.

Of the approximately 150,000 people in the U.S. who develop epilepsy each year, 20,000 to 45,000 of them are children and adolescents. But the highest risk group in the pediatric population for developing epilepsy are those ages 1 to 12 months.

Pediatric epilepsy is defined as two or more unprovoked seizures more than 24 hours apart in a child over one month old. Seizures are episodes of abnormal brain activity that cause changes in attention or behavior.

 
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