Treatments and Services
The Emory Epilepsy Center offers comprehensive epilepsy treatment, including epilepsy surgery.
When patients with certain types of epilepsy cannot be cured with medications, epilepsy surgery is often the best chance of seizure control or potential cure. Surgery is generally only considered an option after you have tried at least two anti-seizure medications and have not been able to gain control of your seizures. At the Emory Epilepsy Center, a variety of highly specialized surgical techniques are available to patients. Our epilepsy neurosurgeons are highly skilled and experienced, with excellent patient outcomes. New, innovative techniques such as stereoelectroencephalography (SEEG) allow the epilepsy team to locate the origin of a patient’s seizures in the brain without a traditional open brain procedure. This technique is safer and less painful for patients. Additionally, minimally invasive laser ablation surgery can be performed to remove the seizure focus, with excellent outcomes. Traditional procedures such as open resections, corpus callosotomy and hemispherectomy are also performed at the Emory Epilepsy Center.
- Approximately 80 percent of patients with temporal lobe epilepsy (the single most common form of epilepsy) gain complete control of their seizures after surgery, while most of the remaining 20 percent report significant improvement
- Other types of epilepsy surgery, in addition to temporal lobe surgery, must be individually determined for the particular patient
Epilepsy surgery usually involves the removal of a small area of the brain cortex where electrical seizures begin. These carefully planned procedures are based on a comprehensive EEG, brain imaging and neuropsychological tests to avoid injury to areas of the brain that support motor, language, memory and other important functions of the brain cortex.
Anti-Epileptic Drug Therapies
Anti-epileptic drugs can completely control seizures in more than two-thirds of epilepsy patients. In many cases, an epilepsy specialist must make adjustments to standard drug regimens in order to achieve complete seizure control.
About 80% of epilepsy patients can achieve complete seizure control using anti-epileptic drugs. In many cases, an epilepsy specialist must make adjustments to standard drug regimens in order to achieve complete seizure control. Some patients may want to participate in clinical trials of investigational anti-epileptic drugs at the Emory Epilepsy Center. The Center also offers expertise with patient groups that typically experience special problems with these medications. These special cases include:
- Children who experience problems with learning or behavior in school
- Pregnant women and those considering pregnancy, who are concerned with the effects of medications on fetal development
- Elderly individuals, who often experience drug interactions and toxicities that are rare at younger ages
Every anti-epileptic medication can produce side effects. Your medication may make you feel tired, off-balance, clumsy, more or less hungry, or see double, depending on the medication you are taking. Adjusting your dosage or changing your medication can usually reduce these side effects. Our providers will work closely with you to develop a treatment plan that provides the greatest seizure control with the fewest side effects.
Discontinuing Your Medication
After several years of complete seizure control, some patients can discontinue their medication and remain seizure-free. Others will need to continue to take anti-epileptic medication throughout their lives to maintain complete seizure control. Never discontinue any anti-epileptic medication without consulting your epilepsy specialist.
Vagus Nerve Stimulation
This procedure is designed to block seizure-producing electrical activity in the brain via the vagus nerve. This nerve, which is located in the neck, is believed to contain fibers that are connected to areas of the brain. The Vagus Nerve Stimulator (VNS) is an excellent alternative for patients who have medically refractory seizures but are not surgical candidates.
VNS involves the use of a small generator, similar to a cardiac pacemaker, which is implanted into the left cervical region of the chest and attached to a lead that is inserted and connected up to the vagus nerve. The generator should automatically stimulate the nerve and block the abnormal messages to the brain that are causing seizures.
This was the first FDA-approved electrical stimulation treatment for epilepsy:
- VNS can improve seizure control in a wide variety of seizures.
- VNS does not cause systemic side effects like many antiepileptic medications do.
- Some patients experience improvements in memory, mood or interictal alertness after VNS*
*The same chemicals and paths that slow or stop seizure activity also lower levels of other brain activity. When seizures are controlled via medication or therapy, some patients experience short episodes of depression and anxiety called interictal disorders that seem to occur when they would have normally had a seizure.
NeuroPace/Responsive Neurostimulation (RNS)
The RNS Neurostimulator is a small, battery powered device surgically implanted in the skull. Electrodes placed within the seizure focus detect seizures and deliver a small pulse of stimulation to prevent the seizure before it happens. RNS is an excellent alternative for patients who have medically refractory seizures, but are not candidates for resective surgery (i.e., patients with more than one seizure focus, or patients whose seizure focus is an area of the brain that cannot be removed).
Rehabilitative (Neuropsychological) Services
Our center also offers psychological services to help manage decreased memory, attention, or problem solving associated with chronic epilepsy. Specific services include:
- Neuropsychological Assessment to help identify the parts of the brain that are involved in generating seizures and to detect decreases in memory, attention, problem solving, and other mental abilities associated with epilepsy or epilepsy surgery.
- Specialized Testing for patients who are candidates for surgery. This specialized testing includes the “Wada test,” a procedure that helps determine the risk to memory and language function after epilepsy surgery. Cortical mapping, another specialized procedure, is also performed by the neuropsychologist and the epilepsy doctor. This procedure helps map the function of brain areas prior to surgery, to ensure that no permanent neurologic damage is done.
- Cognitive Rehabilitation to assist patients in learning to compensate for problems in memory, attention and reasoning so patients may work and live up to their full potential.
- BRITS Program – this is a specialized treatment program for patients with psychogenic nonepileptic spells. Trained therapists perform cognitive behavioral therapy geared specifically toward these patients with the goal of identifying the cause and preventing future spells.
The Center also offers expertise with patient groups who’s needs may differ somewhat, such as pregnant women, those with learning or behavioral problems, and the elderly.
Pregnancy and Anti-Epileptic Medications
Women who have epilepsy should talk to an epilepsy specialist before becoming pregnant. For a woman who has seizures, pregnancy can pose special risks for her and her child. Because some drugs are more likely than others to cause birth defects, an epilepsy specialist will need to adjust a woman's medication and prescribe important vitamins before conception occurs. Though certain precautions must be taken, most women with epilepsy have successful pregnancies and deliver healthy babies.
Some patients may be eligible to take part in a clinical trial of investigational anti-epileptic drugs at Emory Epilepsy Center.
How Can We Help You Today?
Need help? We will be delighted to assist you today, so please call us at 404-778-7777. We look forward to hearing from you.