EMORY EPILEPSY CENTER Department of Neurology Emory University School of Medicine

August 15, 1997

Media Contacts: Sarah Goodwin, 404/727-3366 - sgoodwi@emory.edu
Kathi Ovnic, 404/727-9371 - covnic@emory.edu
http://www.emory.edu/WHSC/

Epilepsy services at the Emory University School of Medicine were consolidated and enhanced by the establishment of the comprehensive Emory Epilepsy Center in July 1995.

Epileptologist Thomas R. Henry, M.D., was recruited from the University of Michigan, Ann Arbor, to direct the center; he is also associate professor of neurology. He has increased collaboration among other Emory neurologists, neurosurgeons, neuropsychologists, radiologists, researchers and nurses to offer adults and children with epilepsy advanced diagnostic, medication and surgical options.

DIAGNOSIS

Several Emory resources are helping epilepsy experts diagnose more precisely than ever before, the types of seizures patients experience. This information is essential for individualizing therapy. Access to one of the best-equipped PET (positron emission tomography) centers in the country, to MR (magnetic resonance) imaging augmented by spectroscopy, and to technicians trained in video-assisted EEG (electroencephalography) help doctors pinpoint affected regions of the brain.

According to Emory neurosurgeon Roy A.E. Bakay, M.D., Emory doctors are using PET glucose metabolism studies to help localize an epileptic focus in patients who are candidates for surgery. He says that patients with certain types of seizures have below normal levels of glucose between seizure episodes.

Cardiac and psychiatric evaluations, detailed patient histories and blood tests also provide valuable diagnostic data.

"Epilepsy is expressed so differently among patients, that it is imperative we paint as accurate a picture as possible of where abnormal electrical discharges arise in a particular patient's brain," Dr. Henry says. "Only with this information can we help patients make decisions about the best treatments for their seizure disorder."

MEDICATION

With about 20 anticonvulsant drugs now on the market, physicians must be especially careful about choosing the most appropriate medication(s) for specific cases. About two-thirds of persons with epilepsy experience a reduction or even elimination of seizures once drug therapy begins.

The U.S. Food and Drug Administration (FDA) approved in 1993 the first new antiepileptic drugs to enter the market in 15 years. The new drugs, Gabapentin and Lamotrigine are used for seizures that begin in focal areas of cortex (the more advanced or "higher" areas of the brain). With FDA approval, the Emory Epilepsy Center is carrying out clinical trials of other promising, new antiepileptic drugs.

SURGERY

Emory was one of the sites involved in testing the vagus nerve stimulator approved by the FDA in July 1997 and was the only site in the world to characterize the device's mechanism of action. Confirmation was made using PET.

Many patients diagnosed with partial seizures may be helped by a type of epilepsy surgery called temporal lobectomy. The theory behind the surgery is to simply remove small portions of the brain in which seizure discharges begin. Only patients with seizures localized to distinct parts of the temporal lobe (one of the brain's four main lobes, or sections) may qualify. For patients whose temporal lobe seizures cannot be controlled with medications, temporal lobectomy can in many instances, offer complete seizure control. According to Dr. Bakay, other areas of the brain less often originate seizures than does the temporal lobe, but these areas can also be treated surgically.

Dr. Bakay works closely with Dr. Henry and the other seizure specialists to plan surgical strategy before operations. Great care is taken to identify and avoid brain areas necessary for memory and language functions, so these areas will not be injured. PET scanning is helping brain surgeons make presurgical mapping even more accurate. Emory is one of the few centers in the country applying PET technology to epilepsy surgery.

Another surgical approach being evaluated is electrical stimulation of the vagus nerve. In vagus nerve stimulation, an implanted device, similar to a cardiac pacemaker, stimulates the vagus nerve in the neck, which sends signals to the brain at regular intervals. These signals may help to reduce seizure occurrence in some individuals, Dr. Henry says.

CHILDREN

Unfortunately, many children are affected by epileptic seizures. Fortunately, many children who have certain genetic causes of epilepsy will grow out of the condition by adulthood. And some children with epilepsy are spared the generalized, grand mal seizures often experienced by adults. Teachers may mistake symptoms of absence (petit mal) seizures for inattentiveness, since affected children may appear to be daydreaming or in a trance-like state.

Children whose seizures are uncontrolled by medication, may be amenable to surgical treatment. Egleston Children's Hospital at Emory University recently became the first children's hospital in the United States to acquire an ISG Viewing Wand Ò a three-dimensional imaging system that guides surgeons through operations in real time. When the pencil-like wand is passed over soft tissue, a real-time map of cerebral structures is illuminated on a screen.

For the first time, pediatric neurosurgeons like Emory's Joseph Petronio can do navigational imaging during surgery without having to rely on presurgical scans for guidance. The wand-generated pictures can be redissected, rotated, placed in stop action, and magnified or altered to show any trajectory. Dr. Petronio already is using the wand during procedures to treat children with epilepsy, brain tumors and craniofacial anomalies.

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