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Epilepsy Program

The Epilepsy Program at Baptist Hospital

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Epilepsy is a chronic neurological condition characterized by recurrent unprovoked seizures. It is the fourth-most common neurological problem, affecting some 3 million Americans. About 20 percent of these people haven’t been able to control their seizures with medication. They often feel hopeless and assume they must accept their situation. But there is hope.


If you have epilepsy that has not improved with two or more medications, the Epilepsy Program at Baptist Health’s Neuroscience Center can help. Accredited by the National Association of Epilepsy Centers as a Level 4 epilepsy center, the program provides the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.

 

Our epileptologists – Board-certified neurologists with fellowship training in the diagnosis and treatment of epilepsy – collaborate with renowned neurosurgeons, neuropsychologists, neuroradiologists and neurophysiology technicians to tailor a treatment strategy for each patient, with the goal of achieving seizure freedom and improving quality of life. Our program is one of the few in the nation using integrated technology to evaluate and manage drug-resistant epilepsy. Ask your physician for a referral to the Baptist Health Neuroscience Center Epilepsy Program.

 

Phase 1: Diagnosis and Evaluation

When patients enter the first phase of our program, an epileptologist and the neurophysiology medical team will evaluate them to see if they will benefit from surgical treatment. A variety of procedures may be used to diagnose and evaluate patients:

 
  • Video EEG
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  • PET CT
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  • CT Scan
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  • Ictal SPECT
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  • Interictal SPECT
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  • SISCOM
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  • Magnetic Resonance Imaging (MRI)
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  • Functional MRI (fMRI)
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  • 3D Source Localization
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  • 3D Image Fusion
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  • Magneticelectoencephalogram (MEG)
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  • Wada Testing
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  • Multidisciplinary Meeting
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    Electroencephalogram (EEG): The most common test used to diagnose epilepsy, this study records the electrical activity of the brain by means of electrodes attached to the scalp. Long-term video EEG monitoring consists of a simultaneous recording of brain electrical activity and patient behavior. The patient stays in a comfortable, private room from one to five days, or even more, in order to capture typical epileptic events for diagnosis and treatment purposes.

     

    PET CT: Positron emission computerized tomography identifies the parts of the brain that may cause seizures.

     

    CT Scan: Computerized tomography (CT) uses X-rays and computers to create three-dimensional views or images of the internal structure of the brain. CT scans are used to detect abnormalities.

     

    SPECT: Single-photon emission computed tomography (SPECT) is an imaging technique used to measure the blood flow in the brain. It can detect the region of seizure onset to assist doctors in planning epilepsy surgery.

     

    Interictal SPECT: Interictal is the interval between convulsions or seizures; an interictal single photo emission computerized tomography (SPECT) is used to detect these intervals.

     

    SISCOM: SISCOM stands for Subtraction Ictal Single-Photon Emission Computed Tomography (SPECT). This procedure uses specialized software that subtracts the Ictal SPECT Scan from the Inter-Ictal SPECT scan. The difference between the two studies represents the seizure focus and is co-registered to the MRI for a more specific anatomical localization of the epileptology region. SISCOM is used to assist in determining whether a patient is a candidate for surgery.

     

    Magnetic Resonance Imaging (MRI): An MRI scan uses a large magnet, radio waves, and a computer to give three-dimensional view or images of the internal structure of the brain. It is a very useful tool for an in-depth neurological workup to evaluate brain structural abnormalities. A functional MRI (fMRI) measures the changes in the blood flow that occur when specific parts of the brain are working, enabling doctors to identify the exact locations of critical functions, such speech and movement.

     

    Functional MRI (fMRI): Functional magnetic resonance imaging (MRI) produces images of the brain in order to record blood flow to functioning areas of the brain.

     

    3D Source Localization: This process analyes seizure activity from EEG electrodes attached to the patient's scalp to pinpoint the location of a seizure focus. This assists physicians in placing intracranial electrodes to further define the source of the seizure.

     

    3D Image Fusion: This technology combines several images from MRI and CT to create highly defined images of the patient's brain. These images allow surgeons to analyze and visualize the best approach to treatment.

     

    Magneticelectoencephalogram (MEG): Records magnetic activity generated by the brain's electrical activity. The MEG helps identify the parts of the brain where seizures originate.

     

    Wada Testing: This test is used to assess language and memory functions in patients preparing to undergo epilepsy surgery. It helps to identify the dominant speech hemisphere and memory dysfunction.

     

    Neuropsychological Evaluation: A comprehensive assessment of cognition – such as language, memory, attention, and problem solving – to help determine if a patient’s thinking skills have been affected by epilepsy, medications or other factors. This evaluation will help determine the patient’s risk for cognitive changes following surgery.

     

    Phase 2: Surgical Options

    After a thorough evaluation in Phase 1, a patient who is considered a candidate for epilepsy surgery will enter Phase 2 of our program. The surgical method used is based on careful analysis of the patient’s condition and recommendations by the treating epileptologist and the multidisciplinary team. Surgical treatment options include:

     
  • Resective Surgery
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  • Single Stage Surgery
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  • 2 Stage Surgery
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  • Vagus Nerve Stimulation (VNS)
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  • Cortical Stimulation/Functional Mapping
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  • Electrocorticography
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    Resective Surgery:
    An operation in which the area of the brain responsible for epilepsy seizures is surgically removed.Baptist Health Neuroscience Center is the first and only facility in Miami-Dade to acquire intraoperative magnetic resonance imaging, or iMRI, for use during brain surgery. Using iMRI minimizes the risk of complications, such as neurological damage, and maximizes the effectiveness of the procedure.

     

    Single Stage Surgery: A single stage surgery is performed when the surgeon is certain there is only one seizure focus and the patient does not require implanted electrodes to further locate the seizure focus. The patient has resective surgery to remove the seizure focus.

     

    Two Stage Surgery: When there is a possibility that the patient has multiple seizure foci or doctors believe that one seizure focus activated a second focus, the patient may be a candidate for a two stage surgery. During this surgery, the patient receives an electrode implant and their brain activity is recorded with a video EEG for three or more days to study the origin of their seizure. Once a definite focus is identified, the patient returns to the operating room for resective surgery to remove the seizure focus.

     

    Vagus Nerve Stimulation (VNS): A treatment where short bursts of electrical energy are sent to the brain by way of the vagus nerve, a large nerve in the neck. The energy comes from a small battery surgically implanted under the skin.

     

    Responsive Neurostimulation (RNS or Neuropace): The RNS system constantly monitors an epilepsy patient’s brainwaves, looking for unusual activities that may lead to a seizure. It works all the time, even during sleep. Within milliseconds of detecting unusual activity, the device sends brief pulses to instantly disrupt this activity and normalize the brainwaves, often before the patient can feel seizure symptoms.

     

    Cortical Stimulation/Functional Mapping: This method is designed for patients who require a two stage surgery. With this technique, the doctor stimulates the implanted electrodes to determine what brain functions, if any, would be affected by resective surgery.

     

    Electrocorticography: Also known as electrical brain mapping, it may be required if the seizure area cannot be found through diagnostic testing. Brain mapping is a diagnostic surgical test that uses electrodes placed directly on or in the brain through a hole in the skull (craniotomy).

     
    Non-surgical Options
    Ketogenic Diet: A strict high-fat, low-carbohydrate and protein diet used in certain childhood epilepsies. It has some short-term benefits of seizure response or control; however, most patients have difficulty with compliance.
     

    Medication Optimization: The patient undergoes different medication trials to achieve seizure control without surgery.

     

    To learn more about the Baptist Health Neuroscience Center Epilepsy Program, please call 786-596-7065.​​