Connections: Expanding options for epilepsy | Summer 2018

Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.

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From the OHSU Brain Institute

David C. Spencer, M.D., headshot

David C. Spencer, M.D.

Dr. Spencer is a neurologist and director of the OHSU Comprehensive Epilepsy Center, the only Level 4 epilepsy center in Oregon.

Ahmed M.T. Raslan, M.D., headshot

Ahmed M.T. Raslan, M.D.

As a neurosurgeon, Dr. Raslan treats a spectrum of neurosurgical disorders. He focuses on brain mapping in addition to surgery for epilepsy, chronic neurologic pain and movement disorders.

With advances in new diagnostic and surgical techniques and 23 medications approved by the Food and Drug Administration, there have never been so many options for treating epilepsy.

Medication works for many, but not for all.

Approximately 1 percent of the population has epilepsy. About two-thirds of those patients will find seizure control through medication. However, even patients who do have good control may be due for an evaluation as newer generations of medications have better tolerability, with fewer side effects and medicine interactions. For patients who are not completely seizure-free after trials of two medications, a comprehensive evaluation by a multidisciplinary epilepsy team can determine if they have a more resistant form of epilepsy and offer additional options for treatment.

Minimally invasive diagnostic and surgical methods lower the threshold

Stereotactic surgical techniques are an increasingly important intervention for drug-resistant epilepsy. In the past, many procedures and diagnostic tools required a full craniotomy. Over the past two years, OHSU has added two minimally invasive surgical procedures (Responsive Neurostimulation System and laser thermal ablation) and one diagnostic method (stereotactic EEG) that substantially change the options for certain patients. The number of epilepsy procedures we’ve performed at OHSU has tripled since adding these methods that are less traumatic for the patient and make it more practical to maximally explore the brain for the seizure focus with greater effectiveness. For example, we performed laser ablation for epilepsy on a pediatric patient in May. The procedure required only a 3-millimeter incision that took one stitch to close. The patient went home 24 hours later.

Next tech: ROSA robot combined with SEEG

In June, OHSU began using a ROSA (Robotic Stereotactic Assistance) robot for all stereo-electroencephalography (SEEG) diagnostic epilepsy surgery in adults and children. The robot can provide precise GPS-like imagery of the brain and compute the extensive calculations necessary to place up to 20 fine wires used to map seizure focus. ROSA’s robotic arms also remove frame-based limitations for placing electrodes. Using the robot halves the operative time and allows for efficient and precise placement of the wires.

With SEEG and the ROSA robot, we have a minimally invasive method to implant diagnostic wires in significantly less time in the operating room and with reduced risk of error as all calculations are automated. We can target all areas of the brain without brain surgery. We can remove the wires at the patient’s bedside. These tools greatly enhance our ability to find answers for epilepsy while increasing patient safety and comfort.

When to refer

  • Patients who are not seizure-free after one or two trials of anti-seizure medicines.
  • Patients whose side effects to medication are lowering their quality of life.
  • Patients with lesional epilepsy.
  • If a diagnosis of epilepsy is uncertain.

Stereoelectroencephalography (SEEG)

SEEG is a presurgical evaluation procedure to identify seizure foci areas of the brain. At OHSU, we use SEEG when the patient’s seizure focus is potentially located in deep areas of the brain inaccessible to traditional subdural grid technology. We also use SEEG for some patients unable to tolerate a traditional craniotomy. In the procedure, the surgeon passes thin wires through tiny holes very precisely to place electrodes in multiple areas deeper in the brain than previously possible. SEEG eliminates the need for before-and-after craniotomies and reduces risk and recovery periods.

Epilepsy Monitoring Unit

For patients who need monitoring overnight or require in-depth testing, OHSU Comprehensive Epilepsy Center provides an epilepsy monitoring unit. The EMU has the latest in advanced technology and is staffed by epilepsy-trained nurses.

The EMU features:

  • Eight private inpatient beds monitored 24/7.
  • Dedicated nurse navigator to coordinate care and help patients and families understand resources and choices.
  • Video-EEG monitoring in all beds
  • Private outpatient examination and procedure rooms.

Contact us

Our experts are available for consultation and as a resource in the diagnosis and management of epilepsy patients as well as other conditions of the central nervous system.

If you have questions or would like to refer a patient for evaluation, please call the OHSU Physician Advice and Referral Service at 503-494-4567.