Comprehensive Approach, Individualized Treatment
At University of Chicago Medicine, we put our patients first when developing treatment plans. Our ultimate goal of treatment is to completely control or even cure your epilepsy. Even with the most difficult cases, we will work with you to design a tailored treatment plan that will optimize your quality of life. When you come to us, you can expect treatment that is customized to you and the way you experience seizures.
Our multidisciplinary team will work together to treat you as a whole person — not just your epilepsy. Whether your seizures are straightforward and easy to control or you have a difficult or rare case, you can count on the quality of care that can only be provided by a top hospital with two Level 4 Epilepsy Centers, one for adults and one for children. That is the highest possible classification granted by the National Association of Epilepsy Centers.
You are an important part of your medical team, so we will seek your input whenever possible and keep you informed about your care plan. We engage you in your care and make sure you are informed and comfortable with your treatment decisions.
At our epilepsy centers, we fully understand the impact epilepsy can have on patients and their families. We know that you never "get used to" seizures. Every seizure is difficult. We want to help you and your family through the challenges you face.
General Treatment Options for Epilepsy
Your treatment plan will depend upon a number of factors, including:
- Type of seizures you have
- How the seizures affect you
- Your age
- Your lifestyle
If we agree that a medical approach to treatment is best for you, we will start with medication. The medication we use falls into a class of drugs called anti-epileptic drugs (AEDs). Significant progress has been made in medical management of epilepsy in the last several decades.
The number of available AEDs has increased from a handful in the early 1980s to more than 20 today. The new generation of AEDs is not necessarily more effective than the old medications, but they are a lot more tolerable in terms of side effects. With new choices, patients have more opportunities to find the right medication that provides satisfying seizure control and minimizes the side effects.
AEDs only control the symptoms of epilepsy but do not cure it. In approximately 30 percent of patients, seizures cannot be adequately controlled with medication. For these patients, non-medical treatment such as laser ablation, open surgery, responsive neurostimulation, vagus nerve stimulation, deep brain stimulation and ketogenic diet can be effective options.
There are also some reports suggesting that medical marijuana may help control seizures. Medical marijuana for epilepsy has been approved in Illinois. If you have questions about whether this might be an option for your type of epilepsy, contact your doctor.
Changes in diet can be effective for some people who have seizures. There is a specific diet we sometimes recommend called a ketogenic diet, but most often, we reserve it for children. This diet is high in fat and low in carbohydrates, so it forces the body to burn fat for energy rather than carbohydrates. When the body burns fat, it produces ketones, and higher ketones may lead to improved seizure control.
Not all people with seizures will require treatment. If you’ve only had one seizure, or your seizures don’t put you in danger, we may take a watch and wait approach rather than starting medication right away.
Epilepsy Surgery & Device Therapies
If your seizures cannot be controlled with medications, surgery may offer the best opportunity for you to achieve seizure freedom. At UChicago Medicine, we offer advanced surgical and epilepsy device treatments that are not widely available, including new options for patients not previously considered candidates for surgery due to the location of their seizure source (such as near brain regions that control speech, movement or vision).
If we can pinpoint the origin of your seizures within the brain, what we call the "seizure focus," epilepsy surgery may work for you. We perform sophisticated, non-invasive source localization, which reduces the need for open surgical procedures during pre-surgical evaluation. This comprehensive testing helps our experts determine if surgery is an option and which procedure may have the best chance for success.
At UChicago Medicine, we perform several different types of surgeries to treat epilepsy.
DBS of the anterior thalamic nucleii employs the targeted implantation of two small electrodes deep in the brain and connection with a battery below the collarbone. High frequency stimulation undetectable by the patient stops developing seizures from manifesting and spreading. The treatment leads to a significant reduction in seizures and this reduction is progressive, meaning that even after five years of DBS, there is still ongoing improvement.
This procedure involves removing the portion of the brain where your seizures originate. For example, neurosurgeons remove a portion of the temporal lobe in patients with temporal lobe epilepsy. At UChicago Medicine, we use comprehensive, non-invasive technologies to help localize the seizure origination site and determine if there is more than one origination site. This is important because focal resection is only effective if seizures consistently originate from one location in the brain.
Hemispherectomy is a treatment we don’t often recommend. It involves removing almost all of one hemisphere, or side, of the brain. It can be a very successful procedure, but it is never a first option for treatment. We usually only perform it in newborns and children whose brains are capable of compensating for the removal of so much tissue.
The goal of corpus callosotomy surgery is to interrupt the pathway by which seizures spread. If the pathway is interrupted, the seizure cannot spread to other parts of the brain. This surgery does not remove parts of the brain. Instead, the surgeon will cut the large bundle of fibers that connect the two brain hemispheres. This fiber bundle is called the corpus callosum. There are two types of corpus callosotomy procedures. One cuts only part of the fiber bundle (a partial callosotomy), and the other severs the entire bundle (a complete callosotomy).
The NeuroPace Responsive Neurostimulation System (RNS) is a breakthrough device designed to prevent seizures before they start. The small, battery-powered system is implanted in the skull, just under the scalp. Wires, called leads, are connected to the NeuroPace device and placed in or on one to two brain regions where seizures originate. When the device detects abnormal brain activity, it responds in real time to deliver short bursts of electrical stimulation to stop the seizure. Patients typically do not feel the device working.
RNS treatment is available to people who cannot have resective surgery or laser ablation. RNS may be an option for many people previously not considered candidates for epilepsy surgery, such as those with a seizure focus in a critical part of the brain (near speech, vision or movement centers) or those with more than one seizure focus. This is because RNS therapy does not remove brain tissue, and the leads can be placed in or on more than one brain region.
Because the neurostimulator records brain electrical activity over time, our physicians use this information to get a better understanding of your seizures and to program the device to be more effective.
Within one year of being treated with RNS, patients report up to a 44 percent reduction in seizures and a 60 percent reduction in seizures by year three. Patients typically continue to take epilepsy medications, although in some cases, dosages are reduced or a specific medication is no longer necessary.
RNS is not associated with a higher risk for voice changes, hoarseness or shortness of breath.
Other similar techniques, such as multiple subpial transections, can also be considered if a seizure focus overlaps with areas of important brain functions such as language, motor skills and sensory ability. Multiple subpial transections is a surgical procedure we sometimes use for patients who have well-localized epileptogenic areas that can’t be resected because they are too important to overall brain function. The goal of the procedure is to sever fibers that are likely responsible for spreading seizure activity while preserving the fibers that control the necessary brain functions. This technique allows a small area of the brain to seize, but does not allow the seizure to spread and cause overt symptoms.
Stereotactic Epilepsy Surgery
Stereotactic epilepsy surgery is minimally invasive and uses a three-dimensional coordinate system applied to the brain by attaching a frame to the head. With the help of sophisticated MRI, CT or PET imaging and ultra-fast computers, any point in the brain can be safely reached with sub-millimeter precision. In combination with different technologies, the following approaches are used at UChicago Medicine, offering minimally invasive ways to provide long-term seizure control and avoid the risks associated with open brain surgery.
Visualase MRI-Guided Laser Thermal Ablation
Visualase laser thermal ablation is a minimally invasive treatment that uses lasers to destroy seizure-causing lesions with pinpoint accuracy. After making a tiny hole in the skull about the size of a pencil, surgeons guide the Visualase laser applicator into the brain and to the seizure focus. Laser energy is used to heat and eliminate the abnormal tissue. During treatment, physicians continuously view an MR image of the brain to monitor the laser's temperature, ensuring precise treatment while sparing healthy brain tissue. Only a single stitch is required to close the skin at the treatment area.
Visualase can be used safely and effectively in some patients with a single, well-defined seizure source, including those with medial temporal lobe epilepsy, focal dysplasias, cavernomas and hypothalamic hamartomas.
Because Visualase treatment does not require large incisions, patients typically spend less time in the hospital compared to open epilepsy surgical treatments.
- Radiosurgery, which can aim radiation in a single treatment session to destroy an epileptic focus using a linear accelerator (radiation therapy machine)
- Radiofrequency lesioning, which can be applied to thermally destroy an epileptic focus via a small probe
Some patients find relief from seizures with vagus nerve stimulation (VNS), an effective alternative to traditional surgery. In this minimally invasive procedure, your surgeon will implant a small device in your chest wall that sends electrical pulses to the vagus nerve in the neck. The goal is to block the faulty brain messages that cause seizures. The device is programmed to give stimulation at regular intervals, alternating between periods of stimulation and no stimulation. New versions of the VNS can also detect seizures when they start and stimulate the vagus nerve during the seizure.
Research shows that about 30 percent of people treated with VNS experience major improvement in seizure control. Another 30 percent experience some improvement. Most patients who undergo VNS must continue on epilepsy drugs, but some can reduce their dosage.
VNS is an attractive option when a seizure focus cannot be identified or when there are more than two seizure foci.