Treating Epilepsy

Minimally Invasive, Stereotactic Surgical Localization Procedure Improves Diagnosis, Treatment

The University of Virginia Health System is one of the few hospitals in the region using a minimally invasive procedure that implants electrodes in the brain to diagnose and treat epilepsy.

The procedure begins by placing a stereotactic frame on the patient's head for guidance, says Jeff Elias, M.D., an assistant professor of neurosurgery. The patient then undergoes an MRI scan. Results from the scan are transferred to a computer workstation and used to map the patient's brain anatomy in three dimensions, creating a road map that helps plan the procedure.

The electrodes are inserted through a small hole in the skull with an accuracy of within a millimeter, Elias says. The minimally invasive stereotactic approach may provide treatment or a diagnosis to those who were previously thought to be untreatable.

Both subdural and depth electrodes can be implanted in patients, says Mark Quigg, M.D., an associate professor of neurology. The electrodes accomplish two main tasks - precisely targeting the epileptic area along with mapping which important brain functions are nearby and need to be protected. In some cases, physicians use cortical mapping, which sends a small electrical current through the electrodes to help determine the function of portions of the brain.

"This gives us an accurate grid to determine where the seizure is starting and where the lesion is," Quigg says. The procedure should only be considered for patients with focal epilepsy, Elias says.

Research is underway at the University of Virginia to determine if such electrodes can also be used for treatment purposes, Elias says. By connecting the electrodes to a pulse generator, stimulation to the brain or an identified epileptic area can be delivered like a pacemaker for the brain.

The stereotactic diagnosis and treatment option is among the full range of diagnosis and treatment options available through UVa's F.E. Dreifuss Comprehensive Epilepsy Program. UVa is considered a Level 4 medical and surgery program - the highest rating available - by the National Association of Epilepsy Centers, says Nathan Fountain, M.D., the program's director.

UVa's epilepsy program sees about 2,000 patients annually with a multidisciplinary team that includes seven full-time epileptologists, a dedicated epilepsy surgeon, nuclear radiologists, neuroradiologists, specially trained epilepsy nurses and EEG technicians. The Epilepsy Foundation of Virginia provides education and psychosocial services.

Patients benefit from the full range of diagnosis and treatment options for epilepsy patients, Fountain says, including diagnosis of cases with unknown causes, treatment of refractory epilepsy and clinical trials. Services include an epilepsy monitoring center with six full-time beds that merges EEG and video to provide comprehensive information about a patient's condition.

To refer a patient for epilepsy treatment, call UVa Physician Direct at 800-552-3723.