Caring for Patients with Uncontrolled Epilepsy
Most patients’ seizures come under control with the use of medications. Unfortunately, however, for about one-third of all individuals with epilepsy, medications either do not work or lead to intolerable side effects.
Our center offers the advanced diagnostic tests that can be critical to the care of patients with drug-resistant epilepsy, including continuous video-EEG recording on an epilepsy monitoring unit (EMU); brain imaging tests such as high-resolution MRI, PET, and SPECT scans; high-density (HD) EEG with up to 256 scalp electrodes; and intracranial electrode recordings when needed. For some patients, a consultation with our epilepsy neurosurgeon may be appropriate. If medications are not successful, surgical treatment options include resective brain surgery, vagus nerve stimulation, deep brain stimulation, responsive neurostimulation, laser ablation, and stereotactic radiosurgery.
When a patient is evaluated for possible drug-resistant epilepsy, the epileptologist will first want to make sure that epilepsy is the correct diagnosis, since sometimes other medical and psychiatric conditions can mimic a seizure disorder but require different kinds of treatments. Then, we will ensure that the right types of medications have been tried, and we may continue adjusting medicines to see if seizures can be brought under control. Once it is established that the disorder is drug-resistant, surgical treatment will be considered. Patients with drug-resistant epilepsy at BIDMC can rest assured that their treatment is not just in the hands of a single doctor, but rather an entire team: Regular multidisciplinary conferences are held at which cases are presented in detail to multiple specialists so that the best possible ideas for successful treatment can be discussed.