A seizure is a sudden wave of abnormal electrical activity in the brain. It may start in one location and then spread throughout the whole brain - similar to a wildfire. Seizures can cause a variety of symptoms depending on the part of the brain affected. Patients may experience tingling, weakness, confusion or a blank stare, jerking of the arms or legs, or even a convulsion of the entire body.

Epilepsy is a neurologic disorder in which a person suffers recurrent seizures. A person can develop epilepsy at any age, and epilepsy is relatively common: 1 in 26 people will develop epilepsy at some point in life.

Epilepsy is usually diagnosed by a neurologist, who will review your symptoms and medical history and performed a physical examination. Most patients will have additional testing, often including an EEG. The EEG is used to study your electrical brain rhythms, which are often abnormal in epilepsy - sometimes even between seizures. An MRI may be performed, but an MRI or other imaging test such as a CT scan does not establish the diagnosis of epilepsy - it is used to look for a cause of the seizures.

Treatment for epilepsy begins with medications. For some patients, strict adherence to a ketogenic diet can also provide relief from seizures. Unfortunately, 30-40% of patients with epilepsy will continue to have seizures despite two, three, or more anti-seizure medications. In these cases of “medically refractory” or “drug-resistant” epilepsy, surgery should be considered. Surgical options are described in more detail below.

Uncontrolled seizures can have a variety of effects on a person’s life over time, from difficulty maintaining employment or a driver’s license to disruptive changes in thinking and memory. Patients with uncontrolled seizures are also at a high risk of sudden death, a catastrophic outcome of epilepsy referred to as SUDEP.

with time. Others can be controlled but may require lifelong anti-seizure medication. When epilepsy is associated with a growth in the brain such as a brain tumor or cavernous malformation, removing the growth can sometimes cure a patient’s epilepsy. Even when there is no growth in the brain, certain forms of epilepsy can be cured with surgery.

Any patient who continues to experience frequent or disruptive seizures despite trials of two or three anti-seizure medications should have a surgical evaluation.

There are probably close to 1 million epilepsy patients in the United States that meet criteria to be considered for surgery. And yet, there are only 2 or 3 thousand surgeries per year in the US (only 0.2-0.3% of eligible patients)! Why is this number so low?

The main reason for this discrepancy is that most patients with drug-resistant epilepsy are never referred to an epilepsy neurosurgeon. My message to patients and affected family members who are struggling with epilepsy is to be your own advocate. If you are suffering from seizures and haven’t seen enough benefit from medications, ask your neurologist whether an evaluation for surgery would be right for you.

The landscape of epilepsy surgery has changed dramatically in just the past five years. We now have a variety of minimally invasive techniques for treating seizures - many of which do not involve cutting out part of the brain! There are options for nearly every patient with drug-resistant seizures. Ask your neurologist to learn more, and find out about referring to my clinic here.

My first goal in treating an epilepsy patient is understanding where in the brain the seizures are arising. We use several pieces of information to help “localize” seizures:

* Seizure symptoms

* Video EEG study

* Brain MRI

* PET scan of the brain

* Neuropsychological testing

Each of these gives us a clue as to where the seizures are coming from. Patients should generally have had most or all of these tests before proceeding with surgery. If they have not been completed when you see me in the office, I will arrange for the tests that you need.

Our first goal is understanding where the seizures begin in the brain. If the tests listed above do not give us enough confidence about the seizure onset zone, I may recommend an additional test called SEEG.

SEEG is a diagnostic surgery where I introduce millimeter-thin electrodes directly into the brain. I use a surgical robot to help place the electrodes in a precise and minimally invasive manner. We use these electrodes in a similar way to a scalp EEG to study where a patient's seizures are arising. SEEG electrodes provide much more precision than a scalp EEG, because the electrodes are inside the brain and much closer to where the seizures begin.

After an SEEG procedure, the patient stays in the hospital and we monitor his or her brain rhythms during several seizures, which allows us to understand where they are starting.

Once we understand where the seizures start, the next question is whether the epileptic brain tissue is essential for normal neurologic functions like speaking, movement, vision, and memory. If the epileptic tissue is not essential for these functions, I may recommend a procedure to remove or damage the epileptic tissue, often with a craniotomy or a newer, minimally invasive technique called [laser interstitial thermal therapy (LITT; sometimes called “laser ablation”).

Removing or burning epileptic tissue carries the highest seizure cure rates. For example, patients with mesial temporal lobe epilepsy can be cured 70-75% of the time with a procedure called a temporal lobectomy.

What happens if the epileptic tissue is important for normal functions like speaking or movement? Or what if we discover that there is more than one spot in the brain where seizures begin?

In these cases, I may recommend one of three forms of neuromodulation: deep brain stimulation, responsive neurostimulation (NeuroPace), and vagus nerve stimulation. These therapies all involve applying electrical stimulation to part of the nervous system. They are seldom a cure for epilepsy, but most patients experience significantly fewer seizures along with improved quality of life and a reduced risk of sudden death from epilepsy. Please visit the individual pages linked above to learn more about these therapies.

First, please request a referral from your neurologist. I prefer a neurology referral over a self-referral because a referral from your neurologist will include medical records of your epilepsy care.

Second, please review the following questions about your epilepsy. Keeping a seizure diary can help you remember some of these details. It can also be very helpful to bring a family member to your appointment who has witnessed one or more of your seizures.

* At what age did your seizures begin?

* Do you have just one type of seizure, or are there several?

* For each type of seizure that you have:

* Is there an aura beforehand?

* How often do these seizures happen?

* Describe step-by-step what you experience during a seizure.

* (For your family member): Describe what you see during a seizure.

* Do you ever have generalized tonic-clonic seizures? If so, how often?

* Which anti-seizure medications have you tried, and which are you on now?

* Have you ever had surgery for seizures? If so, when, where, and by whom? How effective (or not) was the surgery?

* Epilepsy Foundation of Colorado

* The Epilepsy Foundation