Spring 2012 Issue

Seeking Out Seizures
Electrocorticography Provides Map For Eliminating Epileptic Seizures

An epileptic seizure begins when a tiny electrical "spark" spreads uncontrollably from one area of the brain to another. The cascading effect results in patients losing control of their bodies during the seizure and feeling as if they have no control over their lives. However, if physicians can identify the source of the seizure and pinpoint the specific part of the brain where the spark originates, it is possible for these patients to find the relief they desperately need. This outcome is the ultimate goal of epilepsy surgery offered at Carolina Neurosurgery & Spine Associates.

Michael Heafner, MD
"For nearly one-third of epilepsy patients, medicine cannot adequately control seizures. Epilepsy surgery can offer dramatic relief for many of these individuals," said Michael Heafner, MD, of Carolina Neurosurgery & Spine Associates.

Where Epileptic Seizures Begin
Before epilepsy surgery can be planned, the area of the brain where seizures begin must be identified. In some cases, noninvasive techniques such as scalp EEG can provide enough data to locate the seizure origination point. If it is determined that seizures emerge near important centers of the brain, electrocorticography is used to map the brain so that resection can be performed without damaging important functions like language, vision or movement.

Electrodes placed directly on the brain determine the precise area where epileptic seizures originate.
Brain mapping and monitoring with electrocorticography requires our surgeons to implant electrodes in and on the brain. These electrodes then stay in place for several days, gathering data while the patient is awake or asleep and, most important, when experiencing seizures. A surgical plan is then created based upon the results of this monitoring and other neuroimaging studies. For some patients, electrocorticography is used during surgery, with electrodes in place on the brain throughout the procedure.

Types Of Epilepsy Procedures
A temporal lobectomy to remove the seizure focal point in the patient’s temporal lobe is the most common and most effective surgical procedure for epileptic seizures. Post-operatively, more than 90% of patients experience significant improvement in seizure control and 65% to 70% of patients become seizure-free. After the lobectomy, patients usually remain on anticonvulsants for 6-24 months, though often at lower doses. If they remain seizure-free, patients may eventually be taken completely off of their anticonvulsants.

If electrode monitoring cannot find a seizure focal point in the brain, or if there are multiple points that cannot be removed, a corpus callosotomy may be the best treatment option. With this procedure, the corpus callosum, which connects the two hemispheres of the brain, is cut in order to keep seizure activity from spreading.

For over 50% of the patients who are not candidates for surgery, implantation of a Vagal Nerve Stimulator (VNS) may significantly improve seizure control. A VNS serves as a type of programmable pacemaker for the vagus nerve in the neck.

An Epilepsy Team Focused On Each Patient
Carolina Neurosurgery & Spine Associates currently performs the majority of the epilepsy surgeries in the Charlotte region. Dr. Heafner points out that teamwork with physicians in other specialties is crucial to epilepsy treatment and monitoring.

"Our practice conducts a weekly, regional multidisciplinary epilepsy conference to discuss cases. Our neurosurgeons collaborate with epileptologists, neuropsychologists, epilepsy unit nurses and neuroradiologists prior to recommending any epileptic procedures," said Dr. Heafner, who is committed to expanding the epilepsy services in this region.

To learn more about epilepsy treatment, call Carolina Neurosurgery & Spine Associates at 800-344-6716.
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