Regional
Epilepsy Center
Seattle, Washington,
USA
(206)744-3576 or
(1-800-374-3627)
Community neurologists can provide very excellent care for most patients with epilepsy. However, treatment of the most difficult seizure problems may require a team of specialists, especially when brain surgery to treat uncontrolled epilepsy is being considered. At the Regional Epilepsy Center this team includes
We believe that the Regional Epilepsy Center faculty and staff are, by far, the largest, most experienced, most qualified, and most comprehensive in the northwest United States. We strive to provide the best possible care by working together as a team. To ensure that our center functions as a team, all patients receiving inpatient care for epilepsy diagnosis or possible neurosurgical treatment are presented twice a week at Epilepsy Conference, so that the different members of our faculty and staff share their diverse experience and expertise when we form patient treatment plans.
All neurologists, neurosurgeons and neuropsychologists are faculty in the University of Washington School of Medicine. Faculty have special fellowship training in epilepsy, and not only have expertise in epilepsy, but also have special interest, expertise and research accomplishments in particular aspects of epilepsy assessment or treatment.
All faculty are board certified in their specialty, or, if they have recently completed training, are required to pursue certification. In our main inpatient epilepsy monitoring unit at Harborview medical center, all hospitalized patients are cared for by board certified neurologists (Miller, Holmes, Hakimian, Poolos) and all long-term video EEG monitoring studies are interpreted by neurologists with board certification in EEG and clinical neurophysiology (Miller, Holmes, Hakimian). All outpatient physicians at Harborview are also board certified in Neurology (Miller, Holmes, Hakimian, Poolos, Wilensky, Swanson) or Neurosurgery (J Ojemann). Verifying credentials
Our inpatient care is provided in a newer part of Harborview Medical Center (3W Neuro/Epilepsy). There is a 10 bed epilepsy monitoring unit with the newest and best available EEG equipment. Patients are admitted to the monitoring unit to record their seizures; often their seizure medication is reduced to bring on seizures. To ensure our patients’ safety, they are under continuous closed circuit TV (video) observation by trained epilepsy technicians 24 hours a day, 7 days a week. If patients have a seizure, the monitoring technicians push an alarm, and trained epilepsy nurses run into the room to watch the seizure, protect the patient from injury, and stop the seizure with intravenous medication if needed. Although not all epilepsy centers do this, we believe that having hospital staff watch patients continuously on video is the best way to ensure patient safety in the event of seizures.
Harborview Medical Center is a University of Washington hospital and cares for the largest number of acute neurological problems and emergencies in the region. As a result, we feel that we have the area’s most experienced and best qualified neurology/neurosurgery nurses and staff both on the epilepsy/neurology ward, and in the operating room. Our outpatient clinics are based at the Harborview 4Wclinic, and at the 8th floor neurology clinic at the University of Washington Medical Center. In 2009, our clinic is scheduled to move to the new building under construction across the street from Harborview at Ninth and Jefferson Streets, which will have more than 600 parking spaces in the lower levels.
Epilepsy is a complex medical condition, and our understanding of its causes is incomplete. For some patients with severe, uncontrolled epilepsy, treatment may not be adequately effective. Therefore, we feel that we must always strive to better understand epilepsy and its treatment through clinical and laboratory research. We have one of the most productive active research programs in the U.S., due to the skills and knowledge of our faculty, and because we are part of the University of Washington School of Medicine. Research studies are always optional, and we certainly understand that some patients will decline to participate. Nevertheless, we believe that research makes us better clinicians, and helps us to better treat seizures, even in those patients who are not in a research study. For example, we were the first epilepsy center to use dense array EEG to localize seizures in patients being evaluated for epilepsy surgery, but this method is now being adopted by other large epilepsy centers, and is being introduced into clinical practice.
Training residents and fellows in epilepsy is part of our mission to the community. In addition to residents in neurology who may spend time on our epilepsy service, we have an accredited program in clinical neurophysiology, to train the next generation of epilepsy specialists in EEG and related techniques. After a year of this type of training, fellows typically spend one or two more years training in epilepsy care and research. The department of Neurosurgery also has a fellowship program in epilepsy surgery. Physicians we have trained work at epilepsy centers throughout the world.
Our training program gives us several advantages. We believe that having the responsibility of educating bright, intelligent residents and fellows makes us better doctors and improves patient care. We also have the opportunity to invite the very best of the physicians finishing our fellowship program to join the Regional Epilepsy Center as UW faculty.
Patients in our center are always cared for by attending physicians/University Faculty. Only a very small percentage of outpatients are seen by residents, and these patients will always also be seen and examined by the attending physician, who is responsible for all decisions and followup care. On the inpatient service, patients may sometimes be seen by residents or fellows, but the attending physician will also see and examine each patient each day and make all decisions.
Because the UW Regional Epilepsy Center was established more than 30 years ago, many of our neurologists and neurosurgeons have not years, but decades of experience in treating epilepsy. Because we are the largest epilepsy treatment center in the region, we have experience in treating the most rare and most difficult forms of epilepsy. We especially value the continuing presence of Dr. George Ojemann, one of the most experienced and renown epilepsy neurosurgeons in the world. His surgical experience includes more than 1,000 brain resections to treat uncontrolled epilepsy. Although he is retired from the operating room, he continues to share his advice and wisdom in epilepsy conferences.
When patients suffer new onset of seizures, or a patient with seizures experience a period when seizures go out of control, they cannot safely wait weeks to get an appointment with an epilepsy specialist. When physicians in the community need to transfer a patient for monitoring and treatment of uncontrolled seizures, they also need prompt action. Our center is organized to deal with these situations. Because of our size--we have 6 treating epileptologists at Harborview alone, and the epilepsy center outpatient clinics see 300-350 adult patients each month--most of the time we can see new patients in the clinic within one to two weeks. Certain times of the year, the wait may be longer, but at those times we monitor the situation, and will make special arrangements to see patients with urgent medical needs more quickly. Because our inpatient epilepsy monitoring unit has the capability of monitoring up to 10 patients, and because we admit almost 300 patients a year for monitoring, we typically can arrange for urgent hospital admissions when needed. However, certain times of the year Harborview Medical Center itself may operate at full capacity; at such times we request that referring physicians call our center at (206) 744-3576, so we can arrange for admission to our satellite monitoring unit at the University of Washington Medical Center, or make other special arrangements.
A key to excellent epilepsy care is good two-way communication between patient and their health care providers. Epilepsy can have very different causes, treatments, and outcomes in different people. We emphasize communication and education during visits with out neurologists and neurosurgeons in the clinic, and we encourage patients discuss their questions and concerns freely and openly. It is even more important that patients be able to call and get help when seizures occur unexpectedly or unexpected medication side effects occur. We are very fortunate to have two friendly, dedicated and experienced full time resource nurses, Lynne Smith, RN and Cathy Goodnow, RN. They are readily accessible during working hours at (206) 744-3576, and are constantly in touch with the center physicians to relay patient concerns and receive treatment recommendations. After hours, calls are handled by the Harborview Community Care Line, but there is always an attending epilepsy center neurologist on call, to handle urgent issues, 24/7.
The Regional Epilepsy Center works cooperatively with many neurologists in the area. Many patients receive their day-to-day care by a neurologist or epilepsy specialist close to home, but come to our center for special tests or treatment. Many of the other epilepsy centers in the region will occasionally refer patients to our center, performing the initial workup and then sending the patient on to us for additional tests or surgery. As a service to community physicians and patients with epilepsy, we will analyze EEG monitoring studies, MRIs and other tests previously performed in another facility, and then present the patient at our epilepsy conference for treatment recommendations to be communicated to the referring physician or patient. Typically the data is provided on CDs. There is no charge for this service, which typically will take 2-3 weeks to complete.
It is our policy to communicate frequently with referring physicians during inpatient evaluations. This communication includes discharge summaries, copies of tests results, letters summarizing the opinions and recommendations of epilepsy conference, as well as doctor-to-doctor telephone calls.
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