Adult Epilepsy

Overview

• The UCLA Adult Epilepsy Program has offered surgical treatment of epilepsy for more than 30 years.
• The success of epilepsy surgery depends on a detailed and accurate evaluation prior to surgery, an evaluation that can only be carried out at an established epilepsy surgery center, such as Ronald Reagan UCLA Medical Center.
• Surgery is a well-established approach to treating epilepsy; nevertheless, it remains an underutilized treatment in this country.
• Of the 2.5 million patients in the United States with epilepsy, 250,000 are potential candidates for surgery, and each year there are 5,000 new potential surgical candidates. Yet the number of epilepsy patients choofsing surgical treatment totaled just 500 in 1986 and 1,500 in 1991.
• Despite the potential benefits of surgery, many candidates who could benefit from surgery are not referred because patients and doctors are unaware of the option for those whose seizures are not controlled by medications.
• At UCLA the success rate for temporal lobe surgery is more than 70 percent seizure-free. For those with tumors the success rate is 80 percent, and for other locations the rate is somewhat lower.

Features

• At UCLA the Adult Epilepsy Surgery Program is affiliated with the Seizure Disorder Center, and the combined program is recognized as a leader worldwide, having pioneered many of the innovations in epilepsy evaluation and surgical treatment.
• Our multi disciplinary team of doctors and other professionals, specializing in epilepsy, focuses on evaluating and treating people with seizures using the most modern techniques available.
• Each patient undergoes a multi-step diagnostic regimen designed to determine the location of the seizure focus and the most beneficial surgical plan.

Diagnostic Services

The advent of modern instrumentation and techniques together with the mushrooming of research on the brain and how it functions in health and disease combine to create a world-class diagnostic program at UCLA. The pre-surgical evaluation is a multi-step process:

• Initial consultation: A neurologist from the epilepsy surgical team conducts an initial assessment at our outpatient clinic. The doctor may prescribe additional medications or recommend tests to evaluate for possible surgery.
• Phase I evaluation: Patients are admitted to a special telemetry unit on the neurosurgery ward, where the medical team monitors seizure activity 24 hours a day with video recording and non-invasive scalp electroencephalograph (EEG) electrodes until enough seizures are documented to characterize them fully. Phase I also includes magnetic resonance imaging (MRI) and positron emission tomography (PET) brain imaging tests, as well as tests of memory, perception and other cognitive functions. These tests help pinpoint the seizure focus by providing additional information about any brain abnormalities.
• Case presentation: All findings are presented to the epilepsy surgery team, a panel consisting of neurologists, neurosurgeons, electrophysiologists, radiologists, psychologists and our coordinating clinical nurse specialist. The team determines whether the patient is a candidate for surgery and whether further testing is required.
• Further outpatient tests: In cases where the data fails to clearly pinpoint the seizure focus, the team recommends further outpatient tests, some in collaboration with other hospitals. These imaging tests include magneto-encephalography (MEG), performed at the Scripps Clinic in San Diego, Calif., or UC San Diego; single photon emission computed tomography (SPECT), performed at Cedars Sinai Medical Center in Los Angeles; functional magnetic resonance imaging (MRI), performed at the UCLA Brain Mapping Center; and various MRI protocols including T1- and T2-wieghted inversion recovery, FLAIR, 3-D reconstruction, diffusion tensor imaging (DTI), and positron emission tomography (PET)-MRI fusion, all performed at UCLA.
• Phase II evaluation: Occasionally the medical team needs additional information to pinpoint the seizure focus. Phase II evaluation involves surgery to place electrodes on the surface of the brain below the scalp (grid electrodes) or in deep structures in the brain (depth electrodes). The patient then remains on the telemetry ward for a second round of seizure monitoring. Stimulation brain mapping is performed if the suspected seizure focus is near a functional area of the brain, such as language or movement centers.
• Phase III: Phase III is the final phase at UCLA, where surgery is performed to control seizures. The results of the Phase I testing, the subsequent outpatient tests and/or the Phase II evaluation determines the recommended surgical plan. Additional tests may be performed in the operating room, including functional brain mapping of language or motor function, electrocorticography (ECoG), and intra operative image guidance.

A nurse is on duty 24 hours a day watching the patients on the UCLA telemetry ward to alert when the patients have seizures that are recorded by videotape and EEG.