If you have been diagnosed with a seizure disorder or epilepsy, or if you have uncontrolled episodes of loss of consciousness, seeking a referral to an epilepsy specialty clinic will often give you access to treatment or information that may not be available from general neurologists. The University of Michigan Comprehensive Epilepsy Program is designated a Level 4 referral center by the National Association of Epilepsy Centers. This designation certifies that the Michigan Comprehensive Epilepsy Program provides the highest level of medical and surgical diagnostic and treatment options for epilepsy patients. Our team of highly skilled specialists evaluates, diagnoses and treats anyone who has suffered from seizures.
Epilepsy is a common condition that causes repeated seizures. The seizures are caused by bursts of electrical activity in the brain. Seizures may cause problems with thinking, muscle control, movement, speech, vision, or awareness. Seizures are usually brief, but can be frightening to the patient and anyone around them. The good news is that available treatment of epilepsy is usually very effective at controlling seizures. Roughly 70 percent of those with epileptic seizures can control them with the first medication they take. For the other 30 percent, epilepsy centers like ours can often find effective treatments for the more complex conditions.
We are a regional and national referral facility that offers the most complex forms of neurodiagnostic monitoring and surgical evaluations for epilepsy. We see approximately 3,000 patients each year.
We offer complete diagnostic testing, individualized to each patient. We may use:
- Single Positron Emission Computed Tomography (SPECT) with technologists at the bedside
- Positron emission tomography (PET)
- Magnetic resonance imaging (MRI) of the brain with special protocols for epilepsy patients
- Electroencephalography (EEG)
- In-patient EEG and video monitoring, including language, memory and behavioral testing during events
- Functional MRI to define areas of the brain that are involved in language and other tasks
- Electrocoticography (brain mapping) in the operative room or before surgery looking directly at the brain for function and electrical discharges
- Plus we have access to magnetoencephalography (MEG) if we feel this technique would help us develop a better understanding about where seizures are starting.
Some patients with epilepsy have unusual episodes or difficulty controlling their seizures with medications. When this happens, we may ask patients to stay in the hospital, often without medicine or on less medicine, so we can record episodes with video and EEG monitoring. In addition to nurses, physicians and skilled EEG technologists, our Epilepsy Unit has 24-hour monitoring attendants who have access to video of the patient's room at all times.
This monitoring allows us to see whether the episodes are epileptic and, if they are, where in the brain they seem to originate. This information can be extremely helpful for planning future therapy and helps us determine whether a patient is a candidate for surgery. Some patients are given a new diagnosis and do not need epilepsy medicine or are changed to more effective medicines.
Some patients being considered for surgery also benefit from SPECT. For this procedure, the patient sits in the room with a technician who injects a special tracer as soon as the seizure starts. This helps us pinpoint the most active part of the brain at seizure onset.
Through these techniques, our team can establish the location and cause of a patient's seizures. We are able to identify the most correct epilepsy syndrome diagnosis and therefore provide the treatment that is most likely to be helpful.
Surgical Treatment of Epilepsy
Sometimes, when the seizures are frequent and disabling, we can pinpoint scarred areas of the brain that seem to be causing the seizures and safely remove them surgically. Our neurosurgeons perform many types of surgery to accomplish this goal, each specifically tailored only for that individual patient, including anterior temporal lobectomy, resections in any lobe of the brain, and other specialized procedures that may be needed to stop seizures. The epilepsy surgery program has a national reputation for excellence in both patient care and research. We do 70-100 epilepsy surgeries per year. We also offer vagus nerve stimulation, which involves implantation of a pacemaker-like device that provides a type of electrical countersignal that can be very helpful for some patients.
Each week, our Comprehensive Epilepsy Team, made up of our board certified epilepsy faculty, neurosurgeons, speech pathologists, neuropsychologists, neuroradiologists and social workers, meet to discuss patients being evaluated for surgery and make the best decision for each patient. We work to bring together all the parts of the puzzle in planning optimal treatment.
Research in prediction and treatment of seizures
The epilepsy faculty also participates in diverse research efforts ranging from individual clinical projects to nationally-funded multicenter clinical trials and basic science studies. The University of Michigan is a site for the multicenter Epilepsy Phenome-Genome Project, a National Institutes of Health funded research study to identify genes that influence the development of certain types of epilepsy. Current areas of research at U-M also include vagal nerve stimulation, finding ways to better predict seizure onsets, and transforming patient-derived skin cells to nerve cells for studying mechanisms of genetic epilepsies. We also conduct experimental anti-epileptic drug trials.
In addition, our epilepsy program works hard to identify any medical, psychological and social complications that arise because of the seizure disorder, such as depression, other medical problems, inability to drive, pregnancy issues or modification of safety procedures for your job. We have many resources available, including counseling, assistance deciphering the law and educational information.