05 November 2004
Approximately 1.5 million individuals are afflicted with active epilepsy in the United States; 100,000 new cases are reported each year. With the introduction of anticonvulsant medication, many persons with epilepsy have achieved better seizure control. Compared to the seizure remission rate of less than 30 percent at the turn of the century, it is now estimated that today, 50-80 percent of epileptics are seizure-free with medical therapy.
Despite aggressive medical management, however, there remains a large group of patients who have poorly controlled epilepsy. It is estimated that 20 percent of patients with complex partial epilepsy have medically refractory epilepsy. The recent development of surgical techniques and sophisticated preoperative evaluations have offered an alternative therapy to an additional 10-25 percent of epileptics. Eighty percent of these individuals achieve a seizure-free state following surgery.
The Epilepsy Center is a comprehensive unit with emphasis on both medical and surgical therapies. We evaluate and manage patients of all ages and with all forms of epilepsy, ranging from the idiopathic epilepsies to the symptomatic partial and generalized epilepsies. We have taken an active interest in studying the quality of life of epileptics. The objective of any form of therapy is to optimize seizure control, while preserving quality of life with minimal or no side effects.
Since we are a major medical and referral center, we have opportunities to participate in experimental drug studies at a national level. This enables us to offer additional medical therapy to a selected group of patients who otherwise would be medically refractory. We are also studying how a complete evaluation in the sleep disorders medicine clinic will help in the design of new medical therapies.
We offer a multidisciplinary approach with specialists in neurology, neuropsychology, neurosurgery, and neuroradiology.
Potential surgical candidates undergo a detailed and involved pre-operative evaluation with long-term EEG telemetry, neuropsychological testing, neuroimaging studies, and angiogram-WADA study. The objective of these studies is to localize the seizure focus to a resectable area in the brain. The data collected are presented and discussed by a panel of epileptologists, neuropsychologists, neurosurgeons and neuroradiologists. Questions include:
· Are all the seizures similar to one another?
· Is the seizure focus localized to one particular area in the brain only?
· If so, is it in a quiet area of the brain where an operation is safe, and will not cause an important loss of function such as paralysis or loss of speech?
· Is the focus in an area that is surgically approachable?
We offer surgery only to those individuals for whom we can answer "yes" to the above questions.