If you’re one of the 3.4 million Americans diagnosed with epilepsy, you’re probably all too familiar with its debilitating symptoms. Seizures – caused by abnormal electrical activity in the brain – recur with or without warning (an aura). They may be accompanied by loss of consciousness and convulsions.
Fortunately, epilepsy diagnosis and treatment have evolved rapidly, and patients today benefit from major breakthroughs in technology, medication and surgical intervention – all of which are available at Overlook Medical Center’s Atlantic Neuroscience Institute (ANI). The National Association of Epilepsy Centers ranks the Epilepsy Center as a Level IV – the highest ranking – for its ability to provide complex forms of intensive neurodiagnostic monitoring, as well as more extensive medical, neuropsychological, psychosocial and neurosurgical treatment. It is also the only epilepsy center in New Jersey to offer magnetoencephalography (MEG) for advanced diagnostics and surgical planning, and a minimally invasive neurosurgical robot, called ROSA®.
Overlook’s Comprehensive Epilepsy Program
“We’ve developed one of the largest, most comprehensive programs in the country for the diagnosis and treatment of adult and pediatric epilepsy,” says Marcello E. Lancman, MD, co-director with Jeffrey M. Politsky, MD, FRCP(C) of Overlook’s Epilepsy Center, a collaborative commitment between Atlantic Neuroscience Institute and the Northeast Regional Epilepsy Group (NEREG). “Our well-established team of epilepsy fellowship-trained and board-certified neurologists, epilepsy neurosurgeons, neuropsychologists, epilepsy nurses, nurse practitioners and registered EEG technologists come from the nation’s top academic institutions. The only difference between our center and a major teaching hospital is our personalized approach to care in a community-based setting.”
“We offer every patient a complete evaluation to ensure we thoroughly understand the underlying basis for their presenting symptoms, whether they are epilepsy-related or something else,” states Dr. Politsky. “This approach allows us to provide the best treatment options to achieve the ideal goal of ‘no seizures, no side effects’ with every patient.”
Pinpointing Seizure Activity
Preliminary diagnostic studies include electroencephalograms (EEG) and CT, MRI, PET and SPECT scans. State-of-the-art inpatient video EEG monitoring, which records the brain’s electrical activity over the course of several days, can also be a major factor in helping to determine the appropriate treatment.
Other advanced diagnostic tools used to evaluate epilepsy patients include New Jersey’s first magnetoencephalogram (MEG), which records the magnetic fields associated with electrical activity in the brain; a 3 Tesla (T) MRI, the most powerful clinical scanner available for producing exceptionally detailed diagnostic images; electrocorticography, which records electrical activity in the brain by placing electrodes in direct contact with the cerebral cortex; and a Wada test to identify which hemisphere of the brain is dominant for language and memory function.
When testing is complete, the center’s team recommends treatment options and provides a comprehensive report to the referring physician. In the meantime, patients and their families have the added assurance of 24-hour, on-call service to handle epilepsy-related emergencies.
“Our patients have access to the most recently approved medications as well as others being tested in clinical trials,” says Dr. Lancman. “We also emphasize the important role of a ketogenic diet – one that is high in fat and protein and low in carbohydrates – which helps some patients to reduce seizures.”
“Our first course of action in treating epilepsy is medication,” explains Dr. Politsky, “but antiseizure medications do not result in a seizure-free state in over one-third of epilepsy patients and may produce chronic side effects that negatively impact a person’s quality of life. For those patients, we have minimally invasive, moderately invasive or traditional surgical options that can be utilized alone or in combination.”
“Traditional epilepsy surgery directly treats the source of seizures by removing some or all of the epilepsy focus, or even by disrupting the abnormal network,” comments Ronald P. Benitez, MD. “However, many epilepsy patients are not candidates for epilepsy surgery. If seizure activity is on two opposite sides of brain, it’s not possible to remove that much brain tissue without impacting cognitive or motor function.”
The least invasive surgical option is vagus nerve stimulation (VNS), during which a small pacemakerlike device is implanted under the skin beneath the collarbone to send an electrical impulse to the vagus nerve and disrupt seizures.
Responsive neurostimulation (RNS®), a moderately invasive surgical option, works by implanting a neurostimulator, the world’s first and only medical device that can monitor and respond to brain activity. The small neurostimulator is connected to up to two tiny wires (electrodes) that are placed in and around the area(s) of the brain where seizures originate. The electrodes record seizure activity and then deliver a pulse of stimulation back to the brain to interrupt the seizure, preventing it from spreading beyond its origin.
Now, combining the recently acquired ROSA robotic minimally invasive device (the first in New Jersey) with existing stereoelectroencephalography, the team can better map the placement of depth electrodes and position them more quickly, safely, and accurately through tiny drill holes in the skull along trajectories planned by the surgeon.
“Leading-edge technology like MEG, RNS and ROSA will increase the number of patients who can benefit from epilepsy surgery,” comments Dr. Lancman.
We are delivering on the National Association of Epilepsy Centers primary goal of no seizures, no side effects for our patients.