Gaetha Mills, RN, CNRN
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4 bed monitoring unit (with 4 additional beds being constructed)
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5 epilepsy fellowship trained Epileptologists
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An epilepsy fellowship trained Neurosurgeon
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4 epilepsy trained neuropsychologists
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10 neuroradiologists and interventional neuroradiologists
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5 registered EEG Technologists
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2 biomedical scientists/engineers
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An RN Nurse Navigator and Epilepsy Trained floor Nurses
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Goal for our patients
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Hospitalization for seizure monitoring
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Technology used to create patient’s treatment plan
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Surgical options in Epilepsy
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Future technology/management of Epilepsy
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“No seizures, no side-effects”
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70% of patients’ seizures are controlled by medications
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Admission to Epilepsy Monitoring Unit for several days
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Continuous EEG with audio and video monitoring
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Seizure induction by discontinuing meds, sleep deprivation,
exercise, hyperventilation, and photic stimulation
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Curry computer system
Can superimpose multiple images for increased
accuracy (called co-registration)
Example: EEG and MRI co-registration used to better
localize seizure-onset zone/circuits
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WADA Testing- developed during World War II, used in North
America since the 1950’s
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Cerebral language and memory representation of each
hemisphere
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Barbiturate medication injected into Internal Carotid Artery to
test each brain hemisphere
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Meds put that side of brain “to sleep” to allow testing of
language and memory on opposite side of brain
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Functional MRI- “brain mapping” – newer technology, noninvasive, rapidly becoming more advanced, may eventually
replace Wada testing
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SPECT and PET
Both used to help with seizure foci localization
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SPECT (Single Photon Emission Computed Tomography) scan
◦ Examines blood flow
◦ Injection of radioisotope given during seizure to view increased
blood flow at seizure site
PET (Positron Emission Tomography) scan of Brain
◦ Examines glucose metabolism
◦ Performed “inter-ictally” or between seizures to view areas of
hypometabolism
Accepted treatment for medically refractory epilepsy since
the late 19th century
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Numerous studies report seizure freedom at 53-84%
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Usually need to continue AEDs for 1 year then taper
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Promising new device created by Neuropace
Responsive NeuroStimulation (RNS) – effective in reducing
seizures by 50% in >50% of patients
Only effective in focal onset epilepsies, but can be effective
if 2 foci in a given patient
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Vagus Nerve Stimulator – effective in reducing
seizures by 50% in >50% of patients
Good for both focal onset and primary generalized
epilepsies
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Invasive procedure yielding high resolution information
Provides the most localized area of seizure activity
Allows mapping of language areas
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Temporal lobectomy-most often removal of the anterior portion of temporal
lobe
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Lesionectomy-removal of a seizure causing lesion in any part of the brain
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Partial corpus callosotomy- corpus callosum severed to prevent seizure
spread through intrahemispheric pathways
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Multiple subpial transections- small incisions to “interrupt” seizures
performed when seizures originate in brain areas that cannot be removed
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Genomics-Personalized Medicine: Finding the right drug for
each patient through gene testing
◦ Only need saliva or blood to perform test
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Deep Brain Stimulation-implanting electrodes into specific areas of
the brain, and then stimulating these areas with small regular
electrical impulses
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Emfit Tonic-Clonic Seizure Monitor
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SAMi Sleep Monitor
◦ Sounds alarm when an unusual movement is detected
during the night
◦ Audio video information from a remote infrared video
camera is sent to an app which can run on a smart phone
◦ Totally portable
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Smart Watch and Embrace Seizure Watch
◦ Measures electrodermal activity and motions