As many as 70 percent of epilepsy patients can be controlled with anti-seizure medications; however, the remaining 30 percent are thought to have drug-resistant epilepsy with poorly-controlled seizures. The addition or substitution of medications usually does not significantly improve outcomes in this population; in one study, as few as 1 percent of patients receiving a third medication for epilepsy were seizure-free.1
Image of brain after the completion of Stereoelectroencephalography (SEEG).
The Comprehensive Epilepsy Center at Penn State Hershey Medical Center, designated as a level IV epilepsy center by the National Association of Epilepsy Centers (NAEC), specializes in the treatment of complicated epilepsy cases, and coordinates multi-disciplinary care for the diagnosis, evaluation, and treatment of both adult and pediatric epilepsy. Medical Director Jayant Acharya, M.D., points out that since the facility also participates in both surgical and medical research, eligible patients may have access to pre-approval medications through participation in clinical trials.
If results of both standard and ambulatory EEG prove inconclusive, more extensive monitoring takes place in the inpatient Epilepsy Monitoring Unit (EMU), where patients are monitored by a team of experts while various tests are performed, from noninvasive video-EEG monitoring up to invasive intracranial monitoring with subdural or intracerebral depth electrode placement.
Robert Harbaugh, M.D., professor and chair of Penn State Hershey Neurosurgery and director of Penn State Hershey Neuroscience Institute, has been chosen as president-elect of the Society of Neurological Surgeons (SNS). The SNS is the oldest neurological society in the world and includes leaders in neurosurgical residency education. Harbaugh also serves as president of the American Association of Neurological Surgeons and as vice-chair of the American Board of Neurological Surgery.
Penn State Center for Neural Engineering has combined its research mission with the clinical mission of Penn State Hershey Neuroscience Institute to develop a Smart ICU, using the data collection and synthesis method known as predictive modeling to deliver patient-specific care. Although its use in medicine is relatively new, predictive modeling has proven successful in areas as diverse and complex as weather forecasting and aviation.1
Currently, medical practitioners are presented with a multitude of variables relating to critically ill patients—as many as 200 during one session of rounds alone—and must make time-sensitive clinical decisions based on these data. This can contribute to ongoing information overload and even lead to preventable medical errors.2
J. Christopher Zacko, M.D., director of Penn State Hershey Neuroscience Critical Care Unit, states, “In addition to the standard measurement of intracranial pressure (ICP), factors such as microdialysis, cerebral blood flow, sodium levels, and cerebral oxygen pressure can all be important in the treatment of brain-injured patients.” Continues Steven Schiff, M.D., Ph.D., director of the Center for Neural Engineering, “When all this data is collected and analyzed in real time—we can better determine what’s going on with a patient. It’s too much data to keep in your head, but a predictive computer model can produce recommendations. Call it the ‘Big Data’ approach.” He cites a patient in whom intracranial pressure (ICP) is not yet elevated. Predictive modeling may suggest treatment methodologies that would prevent ICP from rising in the first place – which it almost surely would do otherwise.
L to R: Kevin Cockroft, M.D., Jennifer Humbert, R.N., and Ray Reichwein, M.D.
LionNet, Penn State Hershey’s regional stroke care network, offers real-time video consults with doctors in area emergency departments (EDs) and Penn State Hershey specialists, providing faster diagnosis and treatment of strokes for patients throughout central Pennsylvania.
“When patients come to an ED with suspected stroke, they need immediate evaluation by a specialist who can confirm the diagnosis and make treatment recommendations,” said Jennifer Humbert, R.N., Penn State Hershey LionNet coordinator. Continue reading
Penn State Milton S. Hershey Medical Center’s designation as the only comprehensive stroke center in central Pennsylvania means that patients who require treatment beyond administration of the clot-busting tPA drug can get the care they need.
Several hospitals in the central Pennsylvania region have now become certified or primary stroke centers [see graphic for explanation on the differences between certifications].
Many hospitals have increased their rates of diagnosis and tPA administration as a result of a telemedicine partnership with Penn State Hershey.
Still, about a quarter of stroke patients need advanced interventions that only an academic or comprehensive stroke center like Penn State Hershey can provide.