What is epilepsy?

Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness.

Epilepsy has many possible causes, including illness, brain injury and abnormal brain development. In many cases, the cause is unknown.

Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help. Special diets can help some children with epilepsy.

Source: NIH: National Institute of Neurological Disorders and Stroke 

Why choose Ohio State for treatment of epilepsy?

Comprehensive Center: The Ohio State University Wexner Medical Center’s Comprehensive Epilepsy Center is designated a Level 4 epilepsy center, the highest rating given by the National Association of Epilepsy Centers (NAEC). This classification indicates our ability to provide all levels of care for epilepsy, including the most complicated surgeries to eliminate seizures.

Expertise: Our physicians are epileptologists, neurologists who focus solely on treating patients with epilepsy and who receive one to two extra years of medical training in epilepsy care. We also have a nurse practitioner certified in epilepsy care and a pharmacologist trained in epilepsy drug treatments.

Care of the Whole Person: We provide ongoing education to help you manage your disorder, and we address other health issues that often accompany epilepsy.

Epilepsy Monitoring Unit: To help us determine definitively if you have epilepsy, we have an eight-bed inpatient unit dedicated to the diagnosis of epilepsy. We assess patients during seizure events to discover the type of epilepsy you have and the area of the brain generating the seizures.

High-Risk Pregnancy Care: If you have epilepsy and become pregnant, we partner with our Maternal Fetal Medicine experts in our High-Risk Pregnancy Clinic to monitor you and your fetus. Our epilepsy experts are skilled in managing medications and dosages to control your disease while minimizing the effects of the medications on your baby.

Research: Ohio State initiates clinical trials and collaborates with other medical centers and pharmaceutical companies across the country to provide you access to the latest medications and treatments.

Epilepsy Diagnosis

Our epilepsy specialists’ advanced training makes us highly skilled at using diagnostic tools to differentiate epilepsy from other disorders with similar symptoms. With a correct diagnosis, we can provide the best possible treatment for your condition.

To help us best diagnose epilepsy, we have an eight-bed Epilepsy Monitoring Unit where we can monitor you overnight and record seizure events.

We offer these diagnostic tests:

• Electroencephalogram (EEG), a brief brain wave recording to look for activity that would indicate likelihood of epilepsy
• Magnetic resonance imaging (MRI), which produces images of the brain’s structure to allow our physicians to evaluate whether tumors may be causing your symptoms

Within the Epilepsy Monitoring Unit, we also offer:

• Continuous video-EEG monitoring (V-EEG), which observes brain waves for 24 hours, records seizures and pinpoints what areas of the brain they are coming from
• Injection of tracers that go into the brain, which helps us visually locate the source of seizures with a CT scan
• Implantation of EEG leads to record from the brain itself  

Epilepsy Treatment

Controlling epileptic seizures can have a dramatic effect on a person’s life, affecting memory declines and mood disorders and allowing normal activities such as driving.

Standard epilepsy medications control seizures effectively in up to 70 percent of people. However, for those who don’t respond to standard medications, we offer other options.

If epilepsy symptoms do not respond to medications, we can utilize these tests to pinpoint the area of the brain that is generating seizures and to help us decide if surgery may be beneficial:

• 3 Tesla MRI, with a stronger magnet to produce higher-definition pictures of your brain
• Neuropsychological testing, in which we ask you a series of detailed questions to determine your thinking and reasoning abilities
• Ictal single photon emission computed tomography (SPECT), in which we inject a radioactive tracer during the start of a seizure to see where the seizure is coming from

Surgery can be performed to remove nonfunctioning areas of the brain where seizures originate. Nonfunctioning areas may be due to injury, stroke, scarring or congenital (present at birth) abnormality. Our epileptologists perform precise electrical mapping of the brain before surgery to ensure that centers that control thinking and movement are not affected.

If you do not qualify for surgery, we offer these treatment options:

• Deep brain stimulation in the Center for Neuromodulation has been shown to alleviate seizures. It involves surgically implanting tiny electrodes into the brain and connecting them to a small pacemaker-like device that has been implanted into the chest wall. The electrodes deliver tiny electrical signals that calm abnormal brain signals.
• Vagus nerve stimulation can prevent seizures by sending regular, mild pulses of electrical energy to the brain via a wire around the vagus nerve, which travels up the neck to the brain. These pulses are supplied by a device like a pacemaker, which is implanted in the chest wall.
• RNS neurostimulator, a device implanted in the brain, detects abnormal electrical activity in the brain and responds by delivering electrical stimulation to normalize brain activity before you experience seizures.
• Clinical trials provide you with access to medications not yet available in the marketplace.

Epilepsy and pregnancy 

If you have epilepsy and become pregnant, we partner with our Maternal Fetal Medicine experts in our High-Risk Pregnancy Clinic to monitor you and your fetus. We carefully prescribe medications and dosages to protect your baby and minimize the effects of the medications.  

Research

If you have ongoing seizures and want to try another option before considering surgery, you can participate in one of many ongoing trials of newly designed medications.

Current medication studies include:

• Two studies on the medication brivaracetam for patients who don’t respond to other medications
• Trial on the medication ganaxolone for patients who don’t respond to other medications
• Trial of a drug called YKP3089 for people who don’t respond to current medications
• Inpatient study for people who have out-of-control seizures, comparing standard medications to intravenous brivaracetam
• Study of midazolam intranasal spray for inpatients who have clusters of seizures to test the spray’s safety and effectiveness in stopping the seizures