When Seizures Don't Stop: Advanced Epilepsy Care Offers New Options

For people living with epilepsy, the hardest part is often not knowing what comes next. A seizure can interrupt a workday, take away the ability to drive, create safety concerns at home and leave patients and families living with constant uncertainty.

Medication can help control seizures for many people. But for others, seizures continue despite medications. That is when a more advanced evaluation can make all the difference.

At Baptist Health Miami Neuroscience Institute, physicians are expanding the options available to patients with drug-resistant epilepsy, using advanced monitoring, robotic-assisted procedures, responsive neurostimulation and a multidisciplinary approach to help move patients from diagnosis to effective treatment more efficiently.

Seeing Where Seizures Start

Aviva Abosch, M.D., Ph.D., is deputy director of Baptist Health Miami Neuroscience Institute, where she serves as director of epilepsy surgery, co-director of functional neurosurgery and Esernia Endowed Chair in Surgical Treatment of Adult Epilepsy & Movement Disorders. Neurologist, Luis Felipe Tornes, M.D., is director of the Institute’s epilepsy program.

According to Dr. Abosch, stereo-electroencephalography, or sEEG, is one of the most important recent advances in epilepsy surgery. Unlike traditional scalp EEG monitoring, which records brain electrical activity from detectors on the surface of the head, sEEG uses thin electrodes placed into carefully selected areas of the brain to gather much more precise information.

That precision helps physicians identify the seizure onset zone—the area in which seizures begin—and determine whether a patient may benefit from surgical removal, laser ablation or device-based therapy. Each procedure targets the seizure onset zone in different ways.

“The closer you can get to the seizure onset zone, the more likely you are to figure out where those seizures are originating,” Dr. Abosch says. “sEEG has been a game-changing technology that allows the neurosurgeon to safely navigate to potential seizure onset zones and confirm whether these areas are both responsible for a patient’s epilepsy and can be removed without causing neurological problems.”

Because epilepsy is not a one-size-fits-all disorder, the level of detail matters. Seizures can spread through the brain in ways that make them difficult to localize using surface testing alone. By getting closer to where seizures start, the care team can make better informed decisions about the next step.

How Robotics Benefits Patients

At Miami Neuroscience Institute, robotic assistance is helping streamline the placement of depth electrodes used in sEEG. Dr. Abosch says the procedure once required repeated manual adjustments to place all the sEEG electrodes, which could stretch a single case across most of the day.

“You take a case that used to be longer than 12 hours and make it three hours,” Dr. Abosch says. “That is beneficial for the patient for a number of reasons, including less time under anesthesia and a smoother experience for someone who is already facing the stress of complex testing in the hospital.”

Another Option: Responsive Neurostimulation

Miami Neuroscience Institute’s epilepsy program is also growing in the area of responsive neurostimulation, or RNS, including bitemporal and bithalamic implantation, according to Dr. Tornes.

RNS is sometimes described as a “pacemaker for the brain.” A small device is implanted to monitor brain activity and deliver brief electrical pulses when it detects patterns that may lead to a seizure. The therapy is designed for certain patients whose seizures are not controlled with medication and who may not be candidates for surgery to remove a seizure onset zone or seizure network.

“In bitemporal implantation, the RNS electrodes are placed in the temporal lobe on both sides of the brain, an area commonly involved in seizures,” Dr. Tornes explains. “This approach may be considered when seizures appear to come from both temporal lobes or when we need more information about which side is most responsible.”

In bithalamic implantation, the electrodes are placed in both sides of the thalamus, a deep brain structure that helps relay signals across brain networks.

“Because some seizures spread through these networks, stimulating the thalamus may help reduce seizure activity in certain patients whose epilepsy is harder to localize or control,” Dr. Tornes says.

Why Timely Evaluation Matters

Just as important as the technology used is timely access to evaluation and treatment, Dr. Tornes says. When seizures remain uncontrolled, they can affect driving, employment, cognition, safety and overall quality of life.

Women of childbearing potential also warrant timely consideration because of the implications of prolonged exposure to potentially teratogenic anti-seizure medications.

Dr. Tornes says that patients referred to Miami Neuroscience Institute undergo multidisciplinary review, advanced imaging and epilepsy monitoring. Treatment planning is then tailored to the suspected seizure network and the patient’s clinical profile.

“Our goal is to determine whether the patient may benefit from surgery, laser ablation, neuromodulation or continued medical management—and to do so without unnecessary delays that can leave patients waiting too long for answers,” says Dr. Tornes. “By the time some patients complete a surgical workup elsewhere, it can take two years. We do it in a fraction of that time.”

A More Precise, Accessible Path Forward

For patients with drug-resistant epilepsy, access to advanced options such as sEEG and RNS can open a new path forward after years of uncontrolled seizures, Dr. Abosch says.

“It also means having access to a team that can look more closely, plan more precisely and offer treatment options that may reduce seizures and improve quality of life,” she says. “For people who have spent years living with seizures, that can change everything,” Dr. Abosch says.

Click here for more information about epilepsy and seizure treatments and specialists at Baptist Health Miami Neuroscience Institute.