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Advanced Options for Epilepsy Treatment

December 16, 2018

Imagine that you could create a 3D map of your brain. With this map, your doctor could track your brain activity, pinpoint problems, and offer the most advanced treatment. Thanks to the Brainlab technology and an expert functional neurosurgeon at Kettering Health Network, all of this is possible. Unlike other fields of neurosurgery that concentrate on brain lesions such as tumors, functional neurosurgery deals with the circuitry of the brain and spinal cord itself. This can be particularly beneficial for people with epilepsy.

Epilepsy is a disorder that is marked by recurrent seizures. It can affect people of all ages and may be caused by an injury or by a genetic component, though sometimes the cause is unknown. For many people, epilepsy can be effectively managed with medication. Some others, however, will need to explore more options.

Comprehensive evaluation

About one-third of patients with epilepsy will not experience seizure freedom with medication alone. “If a patient is still having seizures after trying two appropriately chosen, accurately dosed medications, it is time for an epilepsy surgery evaluation,” says Rajinder Singh, DO, epileptologist with Kettering Health Network. “The chance of success with a third anti-seizure medication is less than 5%.”

The goal of a surgical evaluation is to identify the origin of the seizure, then perform tests to find out if the tissue can be removed safely. Dr. Singh offers comprehensive assessments, working with a multidisciplinary team that includes an epilepsy nurse and specialists from nuclear radiology, neuroradiology, neurosurgery, and neuropsychology.

The first phase of testing involves MRI and CT scans. At Kettering Health Network, patients also have access to 3TMRI technology, which can detect lesions that are not visible on standard MRIs. Many patients also undergo video electroencephalography (EEG), which takes place in an epilepsy monitoring unit over the course of a multi-day hospital stay. It records the patient’s brain activity while capturing corresponding behaviors on video, providing valuable information about the patient’s seizure activity.

Creating a 3D brain map

In some cases, Mark Hoeprich, MD, functional neurosurgeon with Kettering Health Network, can use new Brainlab technology to create a more pinpointed map of where the seizures are coming from. “Using Brainlab’s robotic arm, I can safely implant depth electrodes in the brain,” Dr. Hoeprich says. “The electrodes remain in place for several days and record seizure activity while the patient stays in the epilepsy monitoring unit. We can then combine the Brainlab software with the MRI images to create a highly detailed, three-dimensional map of the brain to help us pinpoint the seizure focus.”

In some cases, the next step will be surgery to remove or repair diseased tissue. Complication rates for these surgeries are low—in fact, Dr. Hoeprich says that the risk of uncontrolled seizures is far greater than the risk of surgery. “Most surgical epilepsy cases involve seizures originating in the temporal lobe, and when these patients are treated with surgery the seizure freedom rate approaches 80%,” Dr. Hoeprich explains. “Surgery has the potential to restore function and improve a person’s quality of life significantly. Epilepsy is a major growth field within neurosurgery—we are at just the tip of the iceberg.”

To learn more about the services of Kettering Health Network Brain & Spine, visit ketteringhealth.org/neuro or call 1-844-211-5482.