Epilepsy

The Los Angeles
Neurosurgical Institute

Epilepsy is a disorder of the electrical impulses in the brain , which causes seizures – discharges
of electrical energy from brain cells. For about three out of every four people who have epilepsy,
the seizures can be controlled with drugs.

But for those whose condition doesn’t respond to drugs or medical treatment, may be candidates
for epilepsy surgery. Children in particular may avoid the progressive brain damage that occurs
from frequent, uncontrollable seizures. (More than half of all patients with epilepsy are younger
than 14.) Research has shown that patients are more likely to live normal, productive lives if they
receive surgery early in their disorder.

What the LANSI Epilepsy Surgery Program Does

The Epilepsy Surgery Program at the Los Angeles Neurosurgical Institute is designed to:

Confirm the diagnosis and classification of seizures
Determine the impact of the seizure disorder on each patient's life
See whether surgery is necessary
Optimize surgery to reduce or get rid of seizures
Provide follow-up services, including rehabilitation, after surgery
Improve the patient's lifestyle

During an initial visit, doctors do an in-depth evaluation of each patient, exploring nonsurgical
options for treating seizures. This is followed by:

1. Telemetry monitoring
2. Intracranial telemetry monitoring
3. Surgery
4. F ollow-up and Outcome Data

1. Telemetry Monitoring
This process, which requires a 2 to10-day stay in the Medical Center, is designed to record typical
seizures (ictal recordings) on an electroencephalogram (EEG) and videotape. Locating where the
seizure begins identifies the focal source of most patients’ seizures.

This evaluation is done using the latest technology, including two state-of-the-art video EEG
monitoring units. The unit has six adult and four pediatric beds. It is staffed by dedicated
technical and nursing teams specially trained to deal with all types of seizure and neurological
disorders in a sophisticated and compassionate way.

During this time, electrodes are attached to the scalp and wires inserted into the cheeks
(sphenoidal electrodes) to transmit the patient's EEG to a small amplifier he or she wears. If
seizures do not occur, doctors make them happen by stopping medication and depriving the
patient of sleep.

If doctors get enough data with telemetry monitoring to pinpoint the source(s) of the seizures,
confirmed by imaging tests, the patient then may have surgery, without more monitoring.

2. Intracranial Telemetry Monitoring
When more information is needed, intracranial telemetry monitoring is used. This is done when
doctors need to evaluate deeper areas of the brain. Grids are placed over the seizure areas of the
brain or depth electrodes are surgically put into the brain, near the area that is likely producing
seizures. The patient stays in the hospital for two to three weeks.

Intracranial telemetry monitoring is similar to basic telemetry monitoring except that the patient's
movements are more restricted. There also may be some discomfort associated with the deeper
placement of the electrodes. The doctors continuously monitor the patient. Most patients who
have intracranial telemetry monitoring can proceed to surgery. Patients with depth electrodes
require about a month for their scalp to heal before surgery. Patients with grids undergo a second
surgery, where the grid is removed.

3 Surgery
During surgery, neurosurgeons remove or disconnect small portions of damaged brain that cause
the seizures. Based on the monitoring results, doctors decide which of several possible procedures
will be most successful.

A number of approaches are available, depending on the patient’s condition. These newer
procedures use advanced stereotactic microsurgery techniques. They are much less invasive and
have faster recovery times than older procedures.

The most common procedure is selective hippocampectomy. This is the source of seizures in
most epilepsy patients evaluated for surgery. About 90% of patients undergoing this procedure
eventually become free of seizures. All surgical procedures require close medical follow-up and
may involve risks and complications. Patients generally return to normal activities in three to four
weeks.

4. Follow-up and Outcome Data

The Epilepsy Surgery Program at the Los Angeles Neurosurgical Institute has a strong
commitment to patients after surgery. Their progress is followed closely for one year and once
annually throughout their lifetime. Psychosocial counseling and cognitive (memory) and
vocational rehabilitation help patients in their transition to a more active life.

THE EPILEPSY SURGERY PROGRAM at the
LOS ANGELES NEUROSURGICAL INSTITUTE