Epilepsy

The evaluation and treatment of epilepsy has a long tradition at the University of Washington, with initial surgical activity by Arthur A. Ward, Jr. (1917-1997) in 1948. Many of the fundamental principles of surgical treatment of epilepsy were developed at the UW. The Regional Epilepsy Center at Harborview Medical Center and Children’s Hospital and Regional Medical Center comprise the epilepsy service of the UW. Facilities include inpatient monitoring suites, outpatient clinics and vocational and rehabilitation counseling and services. Numerous ongoing clinical trials are investigating anti-epileptic agents. This multi-disciplinary team of neurologists, neurosurgeons, speech pathologists, therapists and social workers, under the direction of Dr. John Miller (Neurology), provide comprehensive evaluation and treatment for patients suffering from epilepsy. Within the Department of Neurological Surgery, Drs. Daniel Silbergeld, George Ojemann, Jeff Ojemann and Richard Ellenbogen specialize in the surgical treatment of epilepsy. Dr. Silbergeld holds the Arthur A. Ward, Jr. Professorship, and Dr. Ellenbogen serves as the Chaiman of UW Neurosurgery and Chief of Neurosurgery at Children’s Hospital.

Regional Epilepsy Center at Harborview Medical Center:
http://pcs.hmc.washington.edu/Epilepsy/

Childrens Hospital and Regional Medical Center in Seattle, epilepsy information:
http://www.seattlechildrens.org/our_services/stories/0412.asp

For more information on epilepsy and its management, please read the following primer:

Epilepsy is a common neurological disorder caused by abnormal, unpredictable electrical and chemical activity of neurons. In normal brain function, electrical and chemical information is passed from nerve cells in the brain to other parts of the body in a coordinated, orderly fashion. In patients with epilepsy, this pattern is interrupted by sudden and synchronized bursts of electrical energy, which, if intense enough, may briefly affect a person's consciousness, bodily movements or sensations. These physical changes are called epileptic seizures.

There are two categories of seizures: "partial" seizures occur in one area of the brain, and "generalized" seizures affect nerve cells throughout the brain. Normal brain function does not return until the electrical activity returns to normal. A feeling of unease or discomfort, called an aura, may precede an epileptic attack, thereby serving as a sign of the onset of a seizure. Another sign of an impending epileptic seizure may include visual phenomena, such as flickering lights or sunbursts. Individuals predisposed to seizures may have an increased risk for having a seizure following stress, sleep deprivation, fatigue, insufficient food intake, flashing lights or failure to take prescribed anti-convulsant or anti-epileptic medications.

Epilepsy is estimated to affect one percent of the U.S. population -- approximately 2.8 million people. In more than half of all epileptic patients, no cause can be found. In the other group of patients, head injuries, brain tumors, exposure to toxic agents, structural abnormalities in the brain and certain genetic, vascular, and infectious illnesses can be the underlying cause.

Epilepsy may be treated with drug therapy, surgery, biofeedback or a ketogenic diet, depending on the underlying cause. Of these, anti-convulsant drugs, which prevent or control seizures, remain the cornerstone of epileptic treatment. If anti-epileptic drug therapy fails, surgery may be a viable alternative. Improved technology has made it possible to identify more accurately where seizures originate in the brain (epileptogenic regions), and advances in surgery have made operative management safer. Surgery may involve removing these epileptogenic areas, or implanting a vagal nerve stimulator. Whether patients would benefit from surgery depends on the type of epilepsy they have and requires a comprehensive evaluation by experts.

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