When epilepsy does not respond to first-line treatment through medication, patients come to Sutter's Comprehensive Epilepsy Program to gain a definitive diagnosis and explore specialized treatment options. The program offers the complete range of current therapies, providing patients and families with hope and help. In addition, the program's physicians are actively involved in research so that patients have access to clinical trials of the latest advances in diagnosis and treatment.

Tailored treatment plans may include:

• Medication


• Surgery


• Gamma Knife® Radiosurgery


• Vagus Nerve Stimulation Therapy


• Ketogenic Diet


• Complementary Therapies

Medication

More than 70 percent of epilepsy patients can achieve full seizure control through a skillful balance of conventional medications. A major emphasis of the institute is selecting the best medication for each patient. Sutter physicians stay informed of the latest newly approved medications and participate in various clinical trials of promising new medications moving through the FDA-approval process. Participation in clinical trials is completely voluntary.

Surgery

Though once uncommon, surgery is now considered standard practice, offering a practical alternative to many patients dealing with medication side effects or seizures that are severe or difficult to control. The recent success of surgical treatment is due to several technology advances that offer better imaging of the brain, enhanced mapping of seizure focus and brain function, and improved surgical techniques. In addition to surgical skill, the primary key to Sutter's success is an excellent prescreening program to ensure the patient is a good surgery candidate.

Sutter neurosurgeons have helped pioneer many of these advances and continue to research new and better ways to treat epilepsy through surgery and noninvasive techniques such as Gamma Knife® radiosurgery. Treatments offered through the Comprehensive Epilepsy Program include:

Lobectomy

Also referred to as a lesionectomy or cortical resection, this technique removes a clearly defined seizure focus or region of the brain with significant amounts of epileptic tissue. The seizure focus is first located through imaging and testing and defined by its abnormal electrical activity. If testing demonstrates that the abnormal tissue can be removed without causing the patient to lose vital functions associated with that portion of the brain, surgery proceeds. Especially in cases where the seizure focus is small and defined, this type of surgery is often successful in reducing or completely eliminating seizures.

Multiple Subpial Transection

When the region of the brain containing epileptic tissue cannot be removed, surgeons may surgically isolate or disconnect the region. During the procedure, the surgeon cuts pathways connecting cells, limiting the seizure to the originating region and preventing its spread to other parts of the brain. According to the NINDS, about 70 percent of patients undergoing multiple subpial transaction surgery experience satisfactory improvements in seizure control.

Corpus Callosotomy

Patients with drop attacks or severe seizures involving large areas of the brain may be candidates for a surgical procedure that cuts some or all of the pathways between the left and right sides of the brain. By disconnecting the nerve pathways, seizures are limited to the originating side, which helps lessen the severity. This type of surgery is most commonly performed to help children struggling with severe seizures that begin on one side of the brain and spread to the other.

Hemispherectomy

Children with uncontrolled, debilitating seizures or progressive epilepsy, such in Rasmussen's encephalitis or Sturge-Weber syndrome may undergo removal of the outer layer (cortex) of the side of the brain causing seizures. Though performed only in cases where no other alternative provides sufficient relief, hemispherectomies generally eliminate seizures completely. The surgery is typically reserved for children younger than age 13 because of the maturing brain's ability to develop new pathways to compensate for missing regions. Children will likely experience weakness of the side of the body that corresponds with the removed hemisphere but can often achieve normal or near normal abilities through rehabilitation.

Gamma Knife® Radiosurgery

Since the 1970s, doctors have been using the Gamma Knife to treat brain tumors and blood vessel malformations without surgery. The Gamma Knife aims 160 tiny beams of energy at a carefully selected area of the brain. When the beams converge at the target, the combined energy destroys the targeted tissue. Because epilepsy centers were difficult to pinpoint until recent advances in imaging technology and brain mapping techniques, epilepsy has only recently been added to the list of conditions that may be treated with the Gamma Knife. Sutter Neuroscience Institute houses one of the most advanced Gamma Knife systems capable of treating adults and children. For more information, see the Sutter Gamma Knife Web site.

Vagus Nerve Stimulator

This new treatment option helps certain patients with medically intractable epilepsy who are not candidates for brain surgery. Vagus nerve stimulator treatment involves implanting a pacemaker-like device that electrically stimulates the left vagus nerve in the neck by sending a burst of electrical energy to the nerve. The stimulator typically reduces seizures by 20 to 40 percent with minimal side effects. The stimulator goes off and on automatically, but also allows patients to manually activate the stimulator. This helps patients avoid oncoming seizures and gives them a sense of control over their epilepsy.

Research is underway on other devices that may help patients control seizures, including devices that deliver medication directly to the affected region of the brain.

Ketogenic Diet

The ketogenic diet is an alternative treatment for certain children and adults with epilepsy. The diet consists of high fat, low carbohydrates and low protein. The diet features food products that are easy to obtain, and is not like the previously used triglyceride oil version. The diet produces ketosis, relying on fat as the primary source for energy. Two out of three children placed on the diet achieve seizure reduction and the diet eliminates seizures in one out of three children. Though the exact seizure-control mechanism is not known, it is thought that circulating ketones may have a direct anticonvulsant effect, or the ketotic state may alter cerebral metabolism, reducing excitability. For further information, see the Ketogenic Diet Program in Sutter Children's Services.

Complementary Therapies

Though researchers are constantly looking for better ways to control epilepsy without medication or surgery, there are no known approaches that have proven consistently effective. Because the underlying cause, seizure focus location and metabolism of each patient varies greatly, popularized approaches (including vitamin, mineral, amino acid and herbal supplements) seldom work and may even cause harm to certain patients. The physicians at Sutter's Comprehensive Epilepsy Program are always looking for ways to reduce or eliminate epileptic seizures in the least invasive ways and with minimal side effects. Before considering an alternative approach, please talk with your physician about the potential benefits and risks.