Epilepsy Program

Epileptic seizures result from abnormal synchronized electrical discharges in the brain. These may be caused by a range of conditions affecting the brain, such as cortical malformation of the brain, stroke, scarring, vascular malformations, genetic mutations or an upset in the brain’s cellular metabolic function.

Once diagnosed with epilepsy, patients are evaluated for the underlying cause, which is the first and most important factor for determining treatment options. Our program advocates a holistic approach to epilepsy care, and we offer a comprehensive range of support services including educational resources, counseling, and support groups to enhance the overall wellbeing of patients and their families.

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 a if there is a structural lesion responsible for the epilepsy. Dedicated sequences are used using an epilepsy protocol for finding subtle structural abnormalities.
• Functional MRI: This test uses magnets and tracks blood flow during specific tasks to try to localize important regions in the brain for language, memory, and motor function.
• Diffusion tensor imaging (DTI) and tractography: An MRI–based technique that provides important information about the white matter connections in the brain.
• Voxel Based Morphometry (VBM): A neuroimaging technique that looks at focal differences in the brain’s cortical thickness and grey-white matter junction, helping to identify subtle structural abnormalities that are undetectable on routine review of an MRI and may be associated with the underlying epilepsy.
• Positron Emission Tomography (PET) scans: This test uses a radiotracer to localize the area of the brain that is not taking up glucose (sugar) like the rest of the brain and gives doctors a clue as to the region that is affected by the seizures.
• Ictal Single Photon Emission Computed Tomography imaging (SPECT) scans: This test is performed in the Epilepsy Monitoring Unit under the supervision of a team of experts (nuclear medicine technician, neurophysiology technician and a nurse) during which a radiotracer is injected early in the seizure to localize the blood flow, and is also helpful in giving doctors an idea of the region of the brain where the seizure begins and spreads.
• Epilepsy Monitoring Unit (EMU) Stay: This is the cornerstone or gold-standard examination during which the patient is admitted to the hospital and monitored 24/7 with close supervision by a nurse and continuous video and EEG to try to capture and characterize the seizures and classify the patient’s epilepsy type.
• Electrical Source Imaging (ESI): An advanced electrophyiological-neuroimaging combined method that localizes the source of abnormal electrical activity in the brain obtained from scalp EEG.
• Robotic stereoelectroencephalography (SEEG): For patients requiring invasive evaluation, this minimally invasive procedure allows precise localization of seizure origins, enabling safer and more effective surgical planning.
• 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 as well as to monitor for antiseizure medication levels in the blood.

Treatment of Epilepsy

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

• Medication: Recommendations for anti-seizure medications are based on a review of all test results, patient profile, side effect profile, and the classification of epilepsy. About two thirds of epilepsy patients can have their seizures controlled through careful selection of the right medication for their condition.
• Dietary recommendations and treatment.
• Medication management: Anti-seizure medications can control seizures in approximately two thirds of the patients. There are many types available, and your doctor will work with you to find the one that works best for you, depending on factors such as seizure type, response to previous medications, side effect profile, your age, overall health and more.
• Surgical interventions: If medication isn’t working, and seizures are severe, surgery may be recommended. Interventions include removal of the abnormal tissue causing the seizures (resection), disconnection of nerve fibers in the brain, destroying areas of abnormal tissue via electrical or laser ablation and implantation of a device which sends electrical signals to the brain to reduce seizures (neuromodulation devices).
• Neurostimulation: This applies to patients who are not candidates for resective surgery but are experiencing a significant seizure burden or medication side effects, and involves surgery to implant a device that delivers electrical impulses to the brain via the vagus nerve (in the neck) or directly to the thalamus (inside the brain) to reduce the frequency of seizures.
• RadioFrequency Ablation (RFA): A minimally invasive procedure that uses heat generated by radiofrequency energy delivered through a small probe (often via electrodes that were already implanted for monitoring, called sEEG-guided RFA) to destroy abnormal tissue.
• Laser Interstitial Thermal Therapy (LITT): A minimally invasive neurosurgical procedure that uses a laser probe, guided by MRI, to heat and destroy (ablate) the small, specific area of the brain where seizures originate. It is often used as an alternative to traditional, more invasive open brain surgery for certain types of drug-resistant epilepsy.
• In addition to advanced treatment options, the Epilepsy Program at Cleveland Clinic Abu Dhabi offers comprehensive support services. This includes educational resources, counseling, and support groups to enhance the overall well-being of patients and their families.