Michael Sather, M.D., surgical director, Penn State Hershey Comprehensive Epilepsy Center, performing open surgery to place subdural electrodes directly on the surface of the brain with the ROSA™ system, which allows for precise placement of the relevant electrodes.
Technological improvements to both testing and treatment have revolutionized the field of epilepsy care in recent years. Clinicians seek to pinpoint the location of seizures to administer more targeted treatment. “There is a growing interest in identifying the seizure focus more precisely and noninvasively,” says Jayant Acharya, M.D., medical director, Penn State Hershey Comprehensive Epilepsy Center of Penn State Hershey Neuroscience Institute.
One example of this breakthrough technology is dense-array EEG, a noninvasive diagnostic technique that records electroencephalography with up to 256 electrodes versus standard techniques that typically employ 19-21 scalp electrodes.1 Past research has shown that information is lost unless EEG sampling provides an intersensor distance of no more than 2 cm, which would require 500 EEG channels distributed evenly over the head.2 This 256-channel sampling technology can approximate adequate spatial sampling and identify the precise area of neurological dysfunction.2 Acharya concludes, “In our setting, the most important feature is that it’s much more sensitive and specific in terms of localizing the seizure focus.” Continue reading
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.