Neurology

Seizures and Epilepsy

Penn Neurology provides comprehensive evaluation and treatment for patients with epilepsy, seizure disorder and all seizure-associated symptoms including memory and mood problems. Our program is led by experienced Penn neurologists who are recognized leaders in the research, diagnosis, and medical and surgical treatments for epilepsy.

The Penn Epilepsy Center is recognized by the National Association of Epilepsy Centers (NAEC) as a Level 4 epilepsy center. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.

What is a Seizure Disorder?

Seizure disorder is a general term used to describe any condition where seizures are a symptom. Seizures are characterized by abnormal electrical activity in the brain that affects physical and mental functioning.

There are two main types of seizures: generalized and partial. Generalized seizures involve the entire brain, while partial or focal seizures begin in one area of the brain.

What is Epilepsy?

Epilepsy is defined as a group of related disorders characterized by a tendency to suffer recurrent seizures. Seizures can occur at any time, and often without warning. In most people, seizures can be controlled with treatment and may go away entirely, in others, seizures continue despite treatment and may last a lifetime

The Penn Epilepsy Center

The Penn Epilepsy Center offers a comprehensive, individualized evaluation and a wide variety of surgical treatments particularly for patients whose epilepsy is difficult to manage. As a Level 4 epilepsy center, we have the expertise and facilities to provide the highest-level of medical and surgical evaluation and treatment for patients with epilepsy.

The center offers comprehensive evaluation for people who have experienced:

  • Long-standing seizures that are not adequately controlled
  • One or more seizures
  • Unacceptable side effects from epilepsy treatments
  • Unusual events that a physician believes may have been seizures

Diagnosing Epilepsy

Patients benefit from the most advanced, leading-edge diagnostic services and technology available, including:

Ambulatory EEG

Patients take this device home for 24 to 48 hours to measure and record electrical activity in the brain

Electroencephalography (EEG)

A non-invasive test that measures and records electrical activity in the brain. Our center is fully equipped with the most advanced digital EEG machines that can record up to 32 channels of data

Epilepsy Monitoring Unit with Video electroencephalography (Video EEG)

The Epilepsy Monitoring Unit features a modern eight-bed unit with video EEG for the evaluation of individuals who are candidates for surgery and for differential diagnosis of "spells." Epilepsy patients are admitted for long-term monitoring (LTM) anywhere from 3 to 7 days and are typically weaned off of medications to see what the cause of the seizures are and where they originate. Some patients undergoing this treatment require intracranial electrode monitoring. A number of other diagnostic tools may be used including MRI, MEG, EEG, SPECT and PET to locate the origin of the seizures.

Functional magnetic resonance imaging (fMRI)

An imaging technique used to identify the parts of the brain that are essential for normal functioning

ICU monitoring

The use of EEG to test for seizures in comatose patients

Magnetoencephalography (MEG)

An imaging technique used to identify the areas of brain that are most likely to cause seizures. It is also used to identify parts of the brain that are necessary for normal functioning

Magnetic resonance imaging (MRI)

An advanced imaging technique to see structural changes in the brain.

Positron emission tomography (PET)

A nuclear imaging test that creates 3-D images of organs in the body

Single photon emission computed tomography (SPECT)

A nuclear imaging test to show how blood flows to organs and tissues

Treating Epilepsy

We offer patients individualized treatment plans and comprehensive care from a team dedicated to this subspecialty. In addition we collaborate closely with specialists across multiple disciplines throughout Penn Medicine, including:

Treatment options for epilepsy and seizure disorder include:

Antiepileptic medications

Twenty medications that are categorized into two types:

  • Augment inhibition — Gaebergic anticonvulsants
  • Medicines that reduce excitation — Anti-glutamatergic anticonvulsants
Neuromodulation therapy

Advanced medical devices that work to elevate or suppress activity of the nervous system for the treatment of various diseases:

  • Vagus nerve stimulator device
  • Responsive neurostimulation device
Neuropsychology

Neuropsychologists assess patients to identify and monitor mental, behavioral and emotional symptoms to plan the best treatment. They also provide referral to behavioral therapies to help patients and families better understand and cope with the psychological changes associated with epilepsy.

Surgery

When performed by a qualified neurosurgeon on appropriately selected patients, epilepsy surgery often can eliminate seizures. Surgical treatment involves identifying and removing the tissue that is causing seizures without damaging normal function.

Types of epilepsy surgery include:

  • Corpus callosotomy — A procedure that separates two halves of the brain down the middle. This is done to treat severe epilepsy causing tonic or atonic seizures.
  • Implantation of neuromodulation device such as vagas nerve stimulator or responsive neurostimulator
  • Intracranial monitoring — Electrodes are placed under the skull (called subdural electrodes). This is done when the origin of the seizure cannot be pinpointed just using electrodes on the scalp.
  • Resective surgery
  • Transorbital mesial temoral resection — A type of minimally invasive resective surgery unique to Penn.
  • Visualase — MRI-guided stereotactic laser induced thermotherapy (done with a smaller incision and intraoperative MRI guided laser).

Research and Clinical Trials for Epilepsy

The Penn Epilepsy Center is known for its premier clinical research. Penn is developing biomarkers and new diagnostic tests — including neuromodulation development, surgeries, and devices for the treatment of epilepsy. We are proud to be one of the most innovative centers in the world that leads in basic science and novel therapies.

We offer patients the opportunity to participate in a range of clinical trials including:

  • Advanced imaging
  • Medications specifically for the treatment of seizure clusters
  • New seizure notification devices
  • New techniques for EEG monitoring and surgery
  • New medications