Clinical Specialties : Epilepsy

Epilepsy

The University of Miami School of Medicine’s International Center for Epilepsy (ICE) offers comprehensive evaluation and management to patients with seizure disorders.

Many patients with epilepsy do not achieve adequate seizure control with medications alone. These seizure disorders may be a result of brain injuries from trauma or related to other disorders such as malformations of areas of brain tissue. In some of these patients the onset of the seizures can be localized to limited areas of brain tissue that may be relatively safely removed. Localization of these seizure foci requires extensive evaluation by a multidisciplinary team involving neurologists, neurosurgeons, psychologists, and radiologists.

Symptoms

  • Seizures
  • Muscle twitches

Treatment
Surgical procedures are performed only after an in-depth evaluation is completed. Identification of the epileptic area may, when appropriate, be accomplished using surgically implanted epidural, subdural and depth electrodes in conjunction with EEG/video monitoring.

In some cases, intra-carotid methohexital (or Wada) testing may be necessary before surgery to determine hemispheric speech dominance and memory function. The surgical resection may be completed under local anesthesia. Functional mapping and electrocorticography by electrical stimulation of the cortex is then routinely performed. Thus, the critical language, motor and sensory areas of the cortex can be identified and the resection tailored to exclude these important areas.

Some patients with intractable epilepsy are not good candidates for removal of a seizure focus but may be appropriate for other operations such as corpus callosotomy, multiple subpial transection, or vagus nerve stimulation.

Epilepsy can also be treated by using stereotactic techniques which allow precise targeting of both abnormal and normal brain areas. A variety of hardware including MRI-compatible stereotactic frames and frameless stereotactic neuronavigation equipment is employed.