Epilepsy Program

Epileptic seizures result from abnormal electrical discharges in the brain. These may be caused by a range of conditions affecting the brain, such as brain malformation, stroke, scarring, or an upset in the brain’s metabolic function (cellular processes).

Once diagnosed with epilepsy, patients are evaluated for the underlying cause, which is important for determining treatment options.

Diagnosis of Epilepsy

Evaluation of a patient with epilepsy at the Epilepsy Program starts with a thorough consultation performed by a neurologist with expertise in epilepsy. This is followed by careful selection of tests which may include:

• Electroencephalogram (EEG): Performed in the outpatient laboratory, this test measures the electrical discharges in the brain.
• Magnetic Resonance Imaging (MRI): This test uses magnets to create images of the brain in order to determine whether there is damage to the brain tissue that may be responsible for epilepsy.
• Blood tests and other laboratory tests: These tests are used to check for genetic and metabolic (cellular process) abnormalities that may be responsible for epilepsy.

Treatment of Epilepsy

Expert physicians at the Epilepsy Program tailor treatment options to the patient once an accurate diagnosis has been established. Treatment options may include:

• Dietary recommendations
• Medication: Recommendations for anti-seizure medications are based on a review of all test results. About two thirds of epilepsy patients can have their seizures controlled through a careful selection of the right medication for their condition.
• Surgical interventions: Not all patients respond to medication, and up to one third of patients continue to have seizures. These patients, referred to as medically refractory epilepsy patients, require additional, specialized testing, and may be candidates for brain surgery.
• Neurostimulation: This involves surgery to implant a device that delivers electrical impulses to the brain to reduce the frequency of seizures.

The Epilepsy Program offers a range of technologically advanced treatment options for epilepsy, including:

• Ictal SPECT and SISCOM imaging techniques: High-resolution imaging tools to measure blood flow in the brain (cerebral blood flow) and how it changes with seizure activity.
• Positron Emission Tomography (PET) scans: Providing detailed images of brain function and allowing doctors to locate abnormal brain activity in epilepsy patients and identify the area of the brain where seizures may arise.
• Voxel Based Morphometry (VBM): A neuroimaging technique that looking at focal differences in the brain, helping to identify structural abnormalities associated with epilepsy.
• Functional MRI with diffusion tensor imaging (DTI): Combining functional MRI with DTI, the test allows doctors to visualize both brain activity and white matter connectivity, offering insights into how epilepsy affects brain networks and functions.
• Electrical Source Imaging (ESI): An advanced neuroimaging method that localizes the source of abnormal electrical activity in the brain, helping to identify the seizure focus and plan surgical interventions for epilepsy patients.

Patients with seizures that are difficult to control are admitted to the Epilepsy Monitoring Unit, which is equipped for simultaneous EEG recording of video and abnormal brain electricity during seizures. Epilepsy Monitoring Unit evaluation can identify whether a patient may be a good candidate for brain surgery.

A virtual seizure board meeting is held between experts at Cleveland Clinic Abu Dhabi and Cleveland Clinic main campus in the United States to discuss the findings from video-EEG monitoring, neuro-imaging, and other tests in order to make recommendations for brain surgery. If the patient and family members agree with recommendations, surgical treatment is offered by expert neurosurgeons at the Cleveland Clinic Abu Dhabi Epilepsy Program.