Our neurosurgeons use the latest technologies for surgical treatment of epilepsy; including stereo electroencephalography, laser interstitial thermotherapy, responsive neural stimulation, and deep brain stimulation. Our experienced board-certified epilepsy neurologists (Epileptologists) and Neurosurgeons are internationally renowned leaders in the field. Patients of all ages come to NCEP from across the nation for innovative care and quality outcomes.

Causes of Epilepsy

Epilepsy has many possible causes and includes several types of seizures. Anything that disturbs the normal pattern of brain neuron activity – illness, brain damage, or abnormal brain development – can cause seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve-signaling chemicals called neurotransmitters, changes in important features of brain cells called channels, or a combination of these and other factors.

Diagnosing Epilepsy

Patients who are suspected of having seizures, who have seizures of unknown type or cause, who have not responded to treatment, or who are being evaluated for possible surgery are admitted to NCEP’s state-of-the-art Epilepsy Monitoring Unit. During their three- to seven-day stay, our team monitors them 24/7 using continuous electroencephalography (EEG) and high-definition video recordings. If the origins of the epilepsy are precisely located, it opens the door to surgery as a potential cure.

Your epilepsy team will order specialized tests that may include:

• Video EEG
• High-resolution 3-Tesla MRI
• Functional MRI (fMRI)
• Diffusion tensor imaging (DTI)
• Position emission tomography (PET)
• Single-photo emission computer tomography (SPECT) scans
• Wada test
• Neuropsychological testing
• Magnetoencephalography (MEG)

For some epilepsy patients, the team uses intracranial electrodes that are temporarily implanted on the surface of the brain via craniotomy, or by the placement of small depth electrodes through stereo electroencephalography (SEEG).

Stereo electroencephalography (SEEG) allows for simultaneous exploration of electrical activity on the surface of the brain and deep within it. SEEG helps the neurosurgeon find the precise location of the epileptogenic focus without craniotomy and for longer monitoring periods than conventional subdural electrodes – for up to four weeks, which has been shown to improve accuracy.

Some patients’ tests will show that there is no single epileptic focus, that there may be more than one focus or that the seizures may be generalized. Uncontrolled seizures that have more than one focus or are generalized may be treated with other surgeries:

Laser interstitial thermal therapy (LITT) uses real-time MRI-guided thermal imagery, which allows surgeons to target and destroy brain lesions that cause epilepsy and other seizures, with minimal destruction to surrounding tissue. Patients who undergo LITT have minimal pain or discomfort, and most are in the hospital only one day.

Responsive neural stimulation (NeuroPace™) allows patients to stop some seizures with electrical stimulation using an implanted device. The device is implanted in the skull and connected to two electrodes that target the region of the brain called the hippocampus. The implant detects abnormal brain activity and responds with stimulation to interrupt the signal and help control seizures.

Deep brain stimulation (DBS) is the implantation of electrodes into the thalamus to modulate seizures, particularly those that are hard to localize or originate in multiple brain regions. 

Vagus nerve stimulation (VNS) may be considered for patients who are not candidates for removal of the epileptic focus. VNS involves implanting a small device similar to a pacemaker to electrically stimulate the left vagus nerve in the neck to help prevent seizures. The device operates automatically, but patients can also activate it themselves when they feel a seizure coming on.