University of Washington Regional Epilepsy Center at Harborview Medical Center

Neurological Services, Procedures and Treatments

Neurosurgery

Although the majority of patients on medication will ultimately achieve control of their seizures, about 25 percent of patients are medication-resistant. Neurosurgery can dramatically reduce the frequency of seizures and enhance the quality of life for select patients, with benefits far surpassing risks. After surgery, the need for medication is often greatly reduced. Surgical treatment can be considered when disabling or life-altering seizures persist despite an adequate trial of medication. Pre-surgical testing is complex and is designed to find the location in the brain that is causing the seizures, and to determine if that area can be safely removed.

Today, neurosurgeons at the Regional Epilepsy Center, and the Children's Comprehensive Epilepsy Center perform all types of surgery to treat epilepsy, including placement of subdural and depth electrodes, dominant and nondominant temporal lobectomies, extratemporal resections, hemispherectomies and corpus callosotomies. The Regional Epilepsy Center is also among a handful of centers in the nation that perform second operations in selected patients when initial evaluations or resections have been unsuccessful.

Neurological Services

All patients referred to the centers are first evaluated by an adult or child neurologist specializing in the diagnosis and treatment of epilepsy. They oversee all diagnostic procedures and medical and dietary treatments, and work jointly with the neurosurgeons in all surgical procedures.

Clinical Neurophysiology

EEG is an essential tool in the diagnosis and treatment of seizures. While routine EEG testing is sufficient for most patients with seizure disorders, for many patients with uncontrolled seizures, long-term video EEG monitoring is needed to correctly diagnose and classify seizures. This procedure records a patient's EEG during actual seizures or other spells, along with synchronized videotaping of behavior. This is essential for patients being considered for epilepsy surgery. A stay of four to seven days in the hospital is typical. If monitoring with surgically implanted electrodes is required to define the seizure focus, a second hospitalization is needed.

The clinical neurophysiology laboratories in the UW system are staffed by six electroencephalographers. There are more than 12 beds for long-term monitoring in the system. Services not only include all types of routine EEG and long-term video EEG monitoring procedures, but also electrocorticography and intraoperative and extraoperative cortical mapping of essential neurological functions with electrical stimulation and sensory-evoked potentials. All electrodiagnostic procedures for epilepsy surgery patients are supervised by electroencephalographers certified by the American Board of Clinical Neurophysiology. The laboratories have an active post-residency fellowship training program.

Neuropharmacology

Antiepileptic drug treatment is the most important therapy for epilepsy and can successfully control seizures in the majority of patients. The medical staff has extensive experience in the use of the newest antiepileptic drugs. The hospitals have 24-hour, quality-assured antiepileptic drug level services and pharmacokinetic consultative services, and close ties with the Departments of Pharmacy and Pharmaceutics at the UW School of Pharmacy. The centers have a long tradition of clinical and laboratory research and testing of antiepileptic medications.

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