Advanced Surgical Options for Epilepsy and Seizures

Edgar Allan Poe, Vincent Van Gogh, Lewis Carroll and Theodore Roosevelt all had epilepsy. Epilepsy is a neurological disorder of the central nervous system characterized by abnormal brain activity that causes seizures or periods of unusual behavior, sensations and, sometimes, loss of awareness. About 3.4 million people in the United States live with epilepsy, and approximately 150,000 new cases are diagnosed in the United States each year, according to the Epilepsy Foundation. Moreover, one-third of people diagnosed with epilepsy live with uncontrollable seizures. Neurosurgeon Nitin Tandon, MD, a UTHealth Neurosciences physician affiliated with Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center, is successfully restoring quality of life to people with epilepsy, thanks to advanced surgical options now offered to treat the disease.

Q: What are some misconceptions about epilepsy and seizures?

Dr. Tandon: Just because you suffer from a seizure, doesn't mean you have epilepsy. The diagnosis of epilepsy can't be made based on the occurrence of seizures alone. Three to 5 percent of people will have a seizure in their lifetime, resulting from trauma to the brain or some other outside stimulus. Epilepsy is different because seizures recur and are unprovoked, or otherwise, unexplained.

Also, not all seizures are the grand mal type, most often depicted in the media. Flailing and convulsive movements of the entire body, foaming at the mouth and loss of bodily function occur only in a small percentage of seizures. Seizures may also cause loss of awareness, disorientation, partial movement of one part of the body or brief episodes of olfactory or auditory hallucinations.

There is a perception that something is "off" with people who suffer seizures, and because their independence may be limited, people think of them as not fully functional individuals. I remind people that epilepsy should be viewed as an intermittent disorder, no different than having asthma and suffering an asthma attack. People with epilepsy can live normal, productive lives if they're able to manage their epilepsy.

Q: How is epilepsy diagnosed?

Dr. Tandon: To be definitively diagnosed with epilepsy, a person's seizures must be witnessed within a medical setting and their brain activity recorded. We use different types of electroencephalography - best known as EEG - to diagnose epilepsy in a clinical environment. EEGs involve electrodes placed on the scalp or directly on the brain through tiny incisions made in the scalp, as in stereo EEG (SEEG) and robotic SEEG. These electrodes measure brain activity and show when a disruption of normal activity occurs, indicating a seizure.

Q: What are Epilepsy Monitoring Units (EMUs)?

Dr. Tandon: We admit patients to EMUs, which are specialized hospital units, to help us diagnose epilepsy. EMUs are equipped with EEG technology, which allows us to capture what occurs during a patient's seizure and can also help us see where in a patient's brain the seizure is occurring. Monitoring in an EMU also allows us to determine who may be a candidate for epilepsy surgery. Patients stay in EMUs long enough that we can observe two to three seizures.

Q: What advanced surgical treatment options for epilepsy are available?

Dr. Tandon: The goal of epilepsy surgery is to identify where seizures are originating in the brain and disrupt their pathway to control or eliminate them. Traditional epilepsy surgery involved first accessing the brain through the skull, placing electrodes directly on the brain and monitoring brain activity for several days in an EMU. Once the area of the brain producing the seizures was identified, we would remove that part of the brain and the seizures would stop.

With technological advances, first available in this region at Memorial Hermann-TMC, we can accomplish this same localization of seizures using robotic stereo electroencephalography (SEEG), where we place tiny probes into the brain through minimal incisions in the scalp. Patients then spend time in the EMU for ongoing monitoring. Once the seizures' origination is mapped, we determine if we should remove that portion of the brain, use laser ablation to destroy misfiring signals or implant a neuromodulation device, which is like a pacemaker for the brain, to redirect electrical signals of the brain on the correct path.

Q: What impact are these innovative surgical treatments having on patients' lives?

Dr. Tandon: Epilepsy surgery can drastically improve patients' seizure control and their quality of life. Once seizures are reduced or eliminated, most patients become independent. They can drive, hold a vocational position and live independently. Most patients are able to reduce the dose and number of medications they use to control their seizures. About one-third of patients can eliminate seizure medications altogether. Many people report improved cognition and brain function once the seizures are gone and the medications are reduced.

Q: What effect did the COVID-19 pandemic have on patients with epilepsy?

Dr. Tandon: Like with other chronic conditions, patients diagnosed with epilepsy or who were suffering with seizures, were unable in the first months of the pandemic to have their seizures managed. When telemedicine became available - fortunately, early in the pandemic at Memorial Hermann - neurologists were able to once again manage their patients or send them to epilepsy centers for evaluations and surgery. That was helpful in minimizing the negative impact that delayed care had on these individuals.

Dr. Tandon will be offering a free webinar about epilepsy treatment options. To register, visit memorialhermann.org/epilepsy-webinar. Need an appointment with an epileptologist? Call (713) 704-7100. For more information, visit memorialhermann.org/epilepsy.