The experts at our Level 4, Comprehensive Epilepsy Center provide a wide range of services to diagnose and treat epilepsy and seizures.
Diagnostic Services:
- Detailed medical history
- Blood tests: to help rule out other potential causes of seizures, such as a brain tumor or other disease
- Electroencephalogram (EEG): video monitoring to record brain wave patterns during and between seizures
- Imaging scans
- MRI (head; perfusion/diffusion weighted; spine; tractography functional brain)
- CT scan
- PET scan (also combined 3T brain MRI with PET)
- Neuropsychological testing (631-444-8053)
Treatments
- Antiepilepsy Medications: For a majority of people with epilepsy, anti-epilepsy medications are helpful, with the goal of controlling the seizures while minimizing medication side effects. Properly diagnoses and treated, most people with epilepsy do very well. Nationally, two out of three people with epilepsy can be expected to enter remission; that is, five or more years free of seizures while using medication.
- Stimulation Treatment: For those who cannot have respective surgery, either because they have more than one area where seizures are coming from, or because the region that seizures are coming from is providing an important function (e.g. language or memory), stimulation treatment may be an option. These include vagal nerve stimulation (VNS), responsive nerve stimulation (RNS) and deep brain stimulation (DBS). All three procedures are offered at our Stony Brook Level 4 Comprehensive Epilepsy Center. Though typically not curative, these stimulation treatments — which use an electrical device known as a pacer, can significantly reduce seizure frequency over time. (At times, if may take a number of years to reach a significant reduction.)
- Vagal Nerve Stimulator (VNS) uses a pacer that is implanted under the left clavicle (collarbone) with electrodes that are wrapped around the left vagal nerve and transmit pulses. The exact mechanism of this device is not fully understood. The stimulation is thought to affect the nerve fibers of the vagal nerve that project to the brain stem and from the brain stem, electrical signals eventually reach the cortical areas of the brain.
- Responsive Nerve Stimulation (RNS) uses a pacer that is implanted in the patient's skull. It has two active leads in the brain that are typically implemented near the suspected seizure focus. When seizure activity is detected, the electrodes can transmit a signal that can stop the seizure.
- Deep Brain Stimulation (DBS) is the most recently FDA-approved stimulation device for use in the treatment of epilepsy in the United States. (DBS has been FDA-approved for use in the treatment of tremors for years.) With DBS, a pacer is typically implanted on the chest wall, and the leads (insulated wires) are placed in both sides of the thalamus (part of the brain responsible for relaying motor and sensory signals to the cerebral cortex) in areas called the anterior nucleus. This is a region through which a seizure often spreads and by stimulating the area, we can reduce the frequency of the seizures.
- Laser Ablation: This minimally invasive procedure is also known as thermal ablation or laser interstitial thermal therapy (LITT). Using laser technology, this procedure delivers a set amount of energy to a specific brain region. The laser energy changes into thermal or heat energy. This can remove or destroy the brain cells that are causing seizures (commonly called seizure focus). MRI is used during the procedure to monitor the heat so it targets the correct area of the brain to be "ablated" or removed.
- Ketogenic and Modified Atkins Diet Therapy (631-444-5858): Diet can also be a treatment for some to help control seizures — specifically the ketogenic diet or a modified Atkins diet. The diets are prescribed by a physician and carefully monitored by a dietitian.
- Clinical Trials