An epilepsy center is a special unit in a clinic or hospital that provides comprehensive care for people with epilepsy and seizures. Epilepsy center specialists are experts in the diagnosis, evaluation and treatment of epilepsy. Epilepsy centers are classified as Level 3 and Level 4. Level 4 centers offer epilepsy surgery.
Epilepsy centers provide the following comprehensive care:
- Multidisciplinary care (care by many specialists) for people with seizures and epilepsy.
- Expertise in pediatric and adult epilepsy
- Comprehensive care including assessment of psychosocial issues
- Education for each person and their caregivers regarding seizure management
- Diagnostic studies including EEG (electroencephalogram), MRI (magnetic resonance imaging or brain scan), and video-EEG (epilepsy) monitoring.
- Testing before epilepsy surgery (Pre-Surgical Evaluation).
- Medical and surgical treatment options
Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. A person is diagnosed with epilepsy if they have two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that were not caused by some known and reversible medical condition like alcohol withdrawal or extremely low blood sugar.
The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. The word “epilepsy” does not indicate anything about the cause of the person’s seizures or their severity. Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well.
Although the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, how it spreads, how much of the brain is affected, and how long it lasts all have profound effects. These factors determine the character of a seizure and its impact on the individual.
Having seizures and epilepsy can affect one’s safety, relationships, work, driving, and so much more. Public perception and treatment of people with epilepsy are often bigger problems than actual seizures.
American Hospital Tbilisi Epilepsy and Sleep Disorders Department is headed by Nino Gzirishvili, MD, PhD, a young neurologist full of enthusiasm and positive energy.
Overview
The Epilepsy Center at AHT is a level 4 epilepsy center. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.
We know every patient and family member copes with epilepsy differently. The AHT Epilepsy Center is home to an experienced, world-renowned multidisciplinary team that brings you the experience you need to treat your epilepsy.
Our neurologists, neuropsychologists, psychiatrists, neurosurgeons, neuroradiologists, nurses and physician assistants work together to make an accurate diagnosis and identify the best treatment plan for you. With appropriate treatment, most of our patients are able to fully engage in occupational, academic and recreational pursuits.
Epilepsy Monitoring Unit
As part of your evaluation, your physician may want you to be admitted to AHT’s Epilepsy Monitoring Unit. Monitoring allows us to see precisely how many seizures you are having. A video EEG (electroencephalograph) records what you are doing or experiencing on video tape while an EEG test records your brainwaves. The purpose is to be able to see what is happening when you have a seizure or event and compare the picture to what the EEG records at the same time. Sounds that occur during the testing are also recorded – this can pick up if a person talks or makes sounds during an event. By doing this, doctors reading the EEG can tell if the seizure or event was related to the electrical activity in the brain. If so, we’d call this an epilepsy seizure.
- Video EEG is most helpful to determine if seizures with unusual features are actually epilepsy, to identify the type of seizures, and to pinpoint the region of the brain where seizures begin. Locating the region precisely is essential if epilepsy surgery is being considered.
Video EEG tests are usually done in a hospital setting where seizures can be monitored in a safe way.
- Since seizures are unpredictable, they may not occur right when you want them to during EEG monitoring. When a person is hospitalized for the testing, seizure medications can be lowered to help provoke seizures so they can be recorded.
- The length of testing varies depending on how often a person usually has seizures, the type of seizures, and why the monitoring is being done. Testing may take a few days to a week or more
Epilepsy Surgery
About one-third of people living with epilepsy experience “drug resistant epilepsy,” or epilepsy that cannot be fully treated using medications alone. For some of these people, undergoing surgery may be the best way to stop or reduce their seizures.
Different surgeries are available for different types of epilepsy. These include
- Focal Resection
- Temporal Lobe Resection
- Extratemporal Resection (frontal, parietal, and occipital)
- Lesionectomy
- Multiple Subpial Transections
- Laser Interstitial Thermal Therapy
- Anatomical or Functional Hemispherectomy and Hemispherotomy
- Corpus Callosotomy
- Stereotactic Radiosurgery
- Neurostimulation Device Implantations, including
- Vagus Nerve Stimulation (VNS)
- Responsive Neurostimulation (RNS)
- Deep Brain Stimulation (DBS)
Epilepsy Pre-surgical Evaluation – Testing for epilepsy surgery
Testing for epilepsy surgery is aimed at finding out if a person can benefit from surgery to treat their seizures. A number of tests in the outpatient setting. For other tests, a hospital stay will be required.
Outpatient testing helps to:
- Assess a person’s baseline neurologic status
- Make an accurate diagnosis of seizure type
- Assess seizure frequency and impact on a person’s life
- Review past treatment trials
- Determine if routine EEGs (electroencephalographs) are able to show where seizures begin
- Determine if a structural abnormality (lesion) is present on brain imaging (MRI) and if it is the cause of seizures
- Determine if there are problems with memory and thinking
- Evaluate if a person has difficulty with depression or anxiety
Inpatient testing:
In almost all cases, inpatient EEG monitoring and videotaping (called a video EEG) is done to record a person’s typical seizures and compare them with the changes seen on EEG.
- During this testing, usually seizure medication is lowered or stopped so seizures can be recorded and the location where they arise can be found.
- Length of hospital stay can vary from 3 to 10 days and in some cases longer.
- Neuropsychology testing assesses language, memory, and cognition.
- A psychiatrist evaluates any mood problems, how this may be related to your epilepsy, and how to treat it.
Our Training and Education
What Is Epilepsy?
Epilepsy is a neurological condition that affects the nervous system. Epilepsy is also known as a seizure disorder. It is usually diagnosed after a person has had at least two seizures (or after one seizure with a high risk for more) that were not caused by some known medical condition.
What Are Seizures?
Seizures seen in epilepsy are caused by disturbances in the electrical activity of the brain. The seizures in epilepsy may be related to a brain injury, genetics, immune, brain structure or metabolic cause, but most of the time the cause is unknown.
What Are Some Commonly Reported Triggers?
- Specific time of day or night
- Sleep deprivation – overtired, not sleeping well, not getting enough sleep, disrupted sleep
- Illness (both with and without fever)
- Flashing bright lights or patterns
- Alcohol – including heavy alcohol use or alcohol withdrawl
- Drug use – Use of cocaine and other recreational drugs such as Ecstasy
- Stress
- Menstrual cycle or other hormonal changes
- Not eating well, long times without eating, dehydration, not enough fluids, low blood sugar, vitamins and mineral deficiencies
- Specific foods, excess caffeine or other products that may aggravate seizures
- Use of certain medications
- missed medications
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