Epilepsy is a spectrum of disorders that affects 1-2% of the population of the United States. These disorders involve abnormal synchronization of brain activity; that is, normal brain function is temporarily disrupted by a passing wave of abnormal activity, called a seizure, that can result in abnormal movement, behavior, loss of consciousness, or convulsions, that happen unpredictably and uncontrollably. Epilepsy affects many aspects of a person’s life and can range in severity from mild and easily treated to severe and and incapacitating. It can affect work, mobility, social and family life, and public misunderstanding of this disease unfortunately contributes to its impact on people’s lives.
Treatment and Surgery
Most forms of epilepsy can be successfully treated with medication. The medical treatment of each type of epilepsy is different, and requires the expertise of a neurologist and sometimes a subspecialist with experience in complex epilepsy. There are no medications that can cure epilepsy, and the goal of medication is to control the symptoms. In many cases medication alone is not able to control all the seizures, or may have side effects that are themselves disabling. Some patients affected in this way are candidates for surgery to help relieve their symptoms.
Depending on the cause of the epilepsy, many patients who are not adequately controlled with medication can be cured with surgery, while others may have their condition greatly improved. Surgery may involve removing the source of the seizures within the brain, or placing stimulating wires on or in the brain, or on nerves connected to the brain, to improve control of the seizures.
The SENTA Approach
At SENTA we treat the patient, and not the disease. For epilepsy, this requires an integrated team approach that involves neurologists, neuropsychologists, neurosurgeons, physical therapists and others. We specialize in diagnosing, evaluating, and treating patients for whom surgery is an option. This can be a complex and confusing process for many patients—we place a priority on guiding our patients through this process to help each person make the best decisions and, in the case of surgery, have the best outcomes and greatest possible improvement in quality of life.
Patients are usually referred to us by their neurologists, but in some cases may be referred by a family physician or even come to us directly. Because of our team approach, patients who have not yet done so are all evaluated by a specially trained neurologist with extensive experience in the medical treatment of epilepsy. This ensures that all medical options have been considered. More importantly, patients who undergo surgery need the expertise of such a neurologist in order to achieve the best outcomes and to choose which surgical procedure is likely to produce the best result. In most cases, this will involve a hospital stay in an “epilepsy monitoring unit” where the patient’s seizures are observed and recorded, as well as special imaging tests including MRI scans and PET scans of the brain. Testing by a neuropsychologist is also part of the evaluation process. Patients may then be referred for surgery. Following surgery, patients continue with their neurologist, who will gradually reduce their medications.
Epilepsy surgery may involve a craniotomy, a brain operation to remove abnormal tissue that is causing the seizures. In rare cases this may require a patient to be awake during part of the surgery in order to test speech and other functions, but with modern technology most epilepsy surgery is done with the patient asleep under anesthesia. In some cases, two procedures are needed; one to place tiny electrodes on the brain in order to more precisely locate the source of the seizures and identify surrounding structures, and a second to stop the seizures using this information. For some patients, a device known as a “vagus nerve stimulator” is a treatment option—this involves a stimulating wire and pacemaker attached to a nerve in the neck. Newer devices that directly stimulate the brain to help stop the spread of seizures are also now becoming available. The decision about which surgical procedure will achieve the best result is a complex one that involves the entire team, including most importantly, the patient.
Dr Jeffrey Schweitzer is a board certified neurosurgeon specializing in the treatment of movement disorders, epilepsy, and other diseases affecting the function of the nervous system. Trained at Harvard and UCLA, and Dr Schweitzer also received fellowship training in epilepsy surgery at Yale. He is among the most experienced epilepsy surgeons in California, having directed the program at Kaiser in Los Angeles before coming to San Diego.