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Stanford offers hope to patients with intractable epilepsy

Epilepsy is a common condition, affecting one percent of the world’s population. And while the majority of these patients enjoy seizure control with antiepileptic medications, there remain about one third with intractable, or uncontrolled, epilepsy—patients with ongoing seizures despite taking medications. Many of these patients have seizures that disrupt their quality of life for years, even though advanced treatment is available.

When to refer for epilepsy

Patients with difficult to treat epilepsy should be referred to a comprehensive epilepsy center for advanced diagnostic and treatment options.
These patients include:

  1. Patients with intractable epilepsy—patients who continue to suffer from seizures that affect their quality of life despite trying at least two different antiepileptic medications
  2. Patients who have disabling side effects from their seizure medicines
  3. Pregnant women with epilepsy, or women with epilepsy who wish to become pregnant
  4. Patients with severe co-morbidities of epilepsy
  5. Patients who are difficult to diagnose, or who may have one of the many imitators of epilepsy
  6. Any patient who might be a candidate for resective surgery or neuro-implantation to treat their epilepsy

“Even one seizure every few months is an intolerable and potentially dangerous scenario,” says Robert Fisher, MD, PhD, Director of the Stanford Epilepsy Center. “There is often too much complacency about allowing seizures to continue. There are a number of treatments available that can help reduce seizures and in many cases make patients seizure free.”

Stanford offers a multidisciplinary approach to treating patients with uncontrolled seizures, says Josef Parvizi, MD, PhD, who leads the Stanford Program for Intractable Epilepsy. “Sometimes we see patients who have been suffering 20 years,” he says. “It’s heart-breaking because we could have helped them much sooner. Patients do not have to accept that this is their life forever. They need to be evaluated for new drugs, devices or surgical resection.”

Advanced technology offers hope
When a patient is referred to Stanford, a multidisciplinary team specializing in clinical epileptology, epilepsy nursing, neurosurgery, neuropsychology and neuroradiology conducts a comprehensive evaluation to determine a patient’s suitability for individualized medical or surgical treatment options. According to Parvizi, the Program strives to first localize the seizure focus in the brain using comprehensive video EEG monitoring; high-resolution structural imaging with 3 and 7-Tesla MRI; and functional brain mapping using fMRI,  electrocorticography and electrical brain stimulation. Then, the Stanford team can revise or stabilize the medication regimen, offer surgical resection of the source of epileptic seizures where appropriate, or provide surgical devices to mitigate the seizures.

Stanford is a Class IV epilepsy surgery center, the highest designation offered to any center. Parvizi and others have developed precise methods for localization and successful resection of seizure focus that allow patients to become seizure free or experience marked improvement without causing surgery-related cognitive decline in thinking, memory and perception.

“Beside conventional Vagus Nerve Stimulation (VNS) therapy, we also are testing the next generation of VNS stimulators, which stimulate with increased heart rate during a seizure,” explains Fisher. In addition, two forms of brain stimulation awaiting FDA approval were pioneered at Stanford, he adds. “Stanford is a place with great interest and expertise in treating patients with seizures that do not easily come under control.”

Expedited referral process Patients with intractable epilepsy will be seen within two weeks of referral. Referring doctors can sometimes arrange a direct admission for video EEG monitoring. To refer a patient, fax a referral to 650.725.0390.

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