Epilepsy Care

Epilepsy is a condition of the brain that is usually referred to as a seizure disorder. Epilepsy is a common brain condition, affecting nearly 3 million American children and adults.

Some factors, such as brain injury or illness, may lead to epilepsy, but for most patients the cause is unknown. There is no cure for epilepsy, but there are a number of mostly non-invasive treatment options that can help you manage your condition and lead an active, healthy life. If you need surgery or other advanced treatments, our team can provide them.

The board-certified specialists and trained providers at the Comprehensive Epilepsy Center of Dayton are committed to caring for you and helping you find methods to manage your condition. We specialize in epilepsy diagnosis, treatment, and are dedicated to working with our patients toward their goal of living their healthiest, fullest life.

Diagnosing Epilepsy

Epilepsy is a condition affecting the brain that is characterized by having multiple seizures. A person may have a seizure without having epilepsy. There are different types of seizures a person with epilepsy may experience. Many people have more than one type of seizure. 

Epilepsy affects the electrical activity in the brain. This abnormal activity causes physical responses in movement, function, or consciousness. A patient may lose awareness, have muscle spasms, convulse, or may be locked in a fixed gaze or stare.

The cause of epilepsy is often unknown, but can be linked to brain injury or brain illnesses such as bacterial or viral infections. Stroke, lack of oxygen at birth, Down Syndrome or Alzheimer's disease can also be related to epilepsy. Having a healthy pregnancy, lowering your chances of developing heart disease or stroke, preventing brain injury, and having vaccinations are ways to decrease the risk of epilepsy.

To be diagnosed with epilepsy, you must experience two or more seizures. A person can experience more than one type of seizure. Types of seizures are:

Generalized seizures 

These seizures affect the whole brain. Some types of generalized seizures include:

Focal (partial) seizures 

These seizures are concentrated to one part of the brain. Types of focal seizures include:

• Focal without impaired awareness (simple partial) seizures. These seizures occur while the patient is fully aware and may include twitching or a change in sensation like taste or smell.
• Focal with impaired awareness (complex partial) seizures. These seizures involve experiencing confusion and low responsiveness and may also include abnormal movements or twitching
• Secondary generalized seizures. These seizures start in one area of the brain and move to the whole; the patient may have a focal seizure which progresses to a generalized seizure. 

There are different types of epilepsy. The type of epilepsy is determined by evaluating the types of seizures that the individual patient has and using testing to determine the cause, the response to treatment, and other factors.

Diagnosing epilepsy will involve a physical examination and a discussion with your doctor about the seizure or seizures you’ve experienced. A definitive diagnosis will come after observation and testing. The diagnostic methods are non-invasive and painless; they include:

  • EEG (electroencephalogram). An EEG measures and records the brain's electrical activity. The test can show abnormalities that suggest a specific type of epilepsy and can guide treatment recommendations. An EEG takes about 40 minutes and involves pasting small wires on the head. 
  • Video EEG monitoring. Performed at the epilepsy monitoring unit at Miami Valley Hospital, this specialized test monitors your brain activity and takes video recordings for several days. The information helps your doctor analyze your seizures and understand what happens before, during and after a seizure. The information can also help determine where the seizures begin in the brain.
  • title=MRI (magnetic resonance imaging):healthinfo=Magnetic Resonance Imaging (MRI). Magnets and radio waves create detailed images of the brain that may show structural problems that can give rise to seizures. The images may also help define treatment options.
  • Functional MRI (fMRI). MRI images show which parts of the brain are involved in specific activities, such as motor, language, visual or even memory functions.
  • CT (computed tomography). X-rays and computer technology combine to form a picture of the brain.
  • PET/CT (positron emission tomography). Images are created using a radioactive agent to show changes in brain tissue.
  • SPECT (single photon emission computerized tomography). This imaging test shows blood flow in the brain and can help find where seizures begin.
  • Neuropsychological testing. This is performed at the specialized Premier Health Brain Mapping Center. A neuropsychologist will ask you questions and have you perform certain activities and testing to determine which areas of the brain are involved in cognitive, language, memory and motor skills, and to pinpoint changes from seizures in focal brain areas. This testing can also show which brain areas might be at risk from surgery.

Your epilepsy team will use all of your test results to create a personalized treatment plan.

How We Treat Epilepsy

There are several non-invasive treatment methods for epilepsy that we use at the Comprehensive Epilepsy Center of Dayton. Our goal is to exhaust each of these options before any other method is considered. Treatment options include medication, dietary therapies, and surgery. When surgery is indicated, our qualified and trained surgeons take care to inform patients of the procedures available, and partner with them in their treatment and rehabilitation. We strive to provide comprehensive care and assessment to find the treatment that is best for you.

Treatments may include:

  • Medicines. There are many medicines used to reduce seizures from epilepsy, and most people can control their seizures with medicine alone. It takes time to find the medicine or combination of medications that works best for you. In some cases, your doctor may try more than one medication to determine your best option. Once you find medicines that work, your doctor will monitor you on a regular basis to make sure your medicines do not damage liver or bone marrow function and to check how your body breaks down the medicine.

  • EMU (epilepsy monitoring unit). If you do not respond to anti-seizure medicines or your seizures are difficult to control, your doctor may recommend inpatient video EEG monitoring in the EMU at Miami Valley Hospital. Information from the EMU helps your doctor understand your seizures. Monitors digitally track the brain’s electrical activity, heart rate, and blood-oxygen saturation levels around the clock. Using infrared video cameras, EEG recordings, and other equipment, information is collected before, during and after seizures.
  • Diet therapies. Eating a diet high in fats and lower in carbohydrates if your seizures don’t respond to medication may help you control your seizures. You may be encouraged to work with a dietitian to find a diet therapy that works for you.  Frequently used dietary therapies in the treatment of epilepsy include: ketogenic diet, MCT (medium-chain triglyceride) diet, modified Atkins diet, and low glycemic index treatment. 

  • Epilepsy surgery. Before any epilepsy procedure, you undergo a thorough evaluation for epilepsy surgery. This helps your doctor decide which surgery is best for you. We perform a range of epilepsy surgeries to help reduce or stop seizures. Surgery is used when medicines and diet do not help. These procedures involve removing or ablating (damaging) the area of the brain where seizures begin to block the seizure’s electrical spread. They include:

    • Laser ablation. This procedure damages the area where seizures were found to begin to try to prevent the seizure or the spread of the discharges.
    • Focal resection. The part of the brain where seizures begin is removed.
    • Temporal lobectomy. This is the most common focal resection surgery. When seizures begin in the temporal lobe, removal of all or part of the temporal lobe can reduce or stop the seizures.
    • Hemispherectomy. A rare procedure where one hemisphere or half of the brain’s cerebrum is removed or disconnected.
    • Corpus callosotomy. This is a rare procedure generally performed only in children. The corpus callosum, which connects the two hemispheres of the brain, is cut to prevent the spread of seizures.
  • Vagus nerve stimulator (VNS). This implanted device helps to control and reduce seizures. Similar to a pacemaker, the device is placed under the collarbone. A wire from the device is attached to the vagus nerve in the neck. The VNS delivers regulated electrical signals to the brain through the vagus nerve, reducing the number and intensity of seizures.

Clinical Trials and Research

Our forward-thinking epilepsy specialists are committed to finding new and better ways to diagnose, treat, and manage epilepsy. Our physicians participate in research and clinical trials in a continued effort to make advancements in the care of epilepsy and other seizure disorders.