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E PI L E P S Y Specialized Center Offers Best Hope for Patients with Intractable Epilepsy For patients with epilepsy whose seizures cannot be controlled with medication, a specialized center that offers multiple options can be the best hope for treatment. Leading epilepsy centers such as UCLA’s now offer multiple treatment options that include nonsurgical approaches as well as traditional surgery and newer minimally invasive procedures. “People with uncontrolled seizures have a five-to-10 times greater risk of dying than the general population, as well as a higher incidence of depression and suicide,” says Jerome Engel, Jr., MD, PhD, director of the UCLA Seizure Disorder Center. “It is a serious condition that doesn’t get as much attention as it should, and only a small percentage of people are referred to appropriate centers that can help them.” A primary reason many patients aren’t referred, Dr. Engel says, is the misconception that epilepsy centers only perform surgery. He says that many physicians assume that their patient won’t want surgery or isn’t a candidate. In fact, a complete evaluation by a multidisciplinary team of experts using state-of-the-art technology often leads to other conclusions. In about one-third of the cases seen at the center, the patient is found not to have epilepsy at all, pointing to a different type of treatment that can be successful. In some cases, the wrong medication was prescribed for the type of epilepsy the patient has, and another one can be tried. Still other patients are candidates for experimental drug trials conducted at epilepsy centers. When surgery is an appropriate option, the UCLA Seizure Disorder Center is able to stop the disabling seizures in a high percentage of cases with minimal or no side effects. If the intervention is performed early enough, it can allow patients to lead normal lives, Dr. Engel notes. He explains that because of the significant advances that have been made in surgical approaches in recent years, many more patients are candidates for surgery than in the past. Beyond the traditional epilepsy surgery, two new approaches are both expanding the number of candidates and providing less-invasive options for patients who qualify. In responsive neurostimulation, a device analogous to a heart defibrillator is implanted into the brain area where the seizures originate. While it doesn’t completely eliminate the seizures in most patients, it greatly reduces their frequency. “This device is able to detect the changes that occur when a seizure is about to begin and trigger electrical pulses that can stop the seizure from occurring,” explains Dawn Eliashiv, MD, co-director of the UCLA Seizure Disorder Center. “It allows us to successfully treat patients who have seizures coming from both sides of their brain, or patients who have seizures that are close to critical areas of motor and language that we would not want to surgically remove.” For patients in whom the area of the brain generating the seizures is small but difficult to reach through traditional surgery, laser thermal ablation is a new minimally invasive technique. “If we don’t need to remove the tissue, we can eliminate the electrical abnormality simply by heating it to the point that it’s no longer capable of producing the seizures,” says John Stern, MD, co-director of the UCLA Seizure Disorder Center. “In addition to being less invasive, this has allowed patients to benefit from surgery who never would have been candidates in the past.” To view a video about epilepsy treatment, go to: epilepsytreatment UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631)