Active Minds
Epilepsy Monitoring Unit Is Open for Admissions

Patients whose epilepsy is not under control with medication can now come to Inova Fairfax Hospital for further examination.
The Epilepsy Monitoring Unit “is a unit dedicated to epilepsy monitoring,” says Sanjiv Sahoo, MD, neurologist and epileptologist. “Epileptic patients who have a diagnosis but are not 100 percent certain of it may be monitored in a controlled elective setting. We provide a camera-mounted hospital environment with simultaneous electroencephalographic (EEG) monitoring.”

The Inova Fairfax Hospital Epilepsy Monitoring service has the capacity for monitoring three adult and two pediatric patients. Patients spend between three and seven days with continual monitoring, notes Michael Schmiester, Manager for Neurodiagnostics. During the monitoring period, patients are under the surveillance of the clinical team, consisting of neurodiagnostic technicians and highly skilled nurses and physicians. Medications may be tapered or discontinued to induce seizures in the attempt to localize the region within the brain where the seizure is being triggered. Continuous EEG will monitor brain activity, and video cameras will record body movements during a seizure.

“Here at Inova Fairfax Hospital, we have patients referred for routine EEG studies, but these patients may not realize we are also able to provide this specialized monitoring,” Schmiester says. “They’re so happy to know it’s being done in their backyard and they don’t have to go to other cities in the region.”

People should not have to struggle with epilepsy, adds neurosurgeon James Leiphart, MD, who performs epilepsy surgeries. “Anybody who does not have their seizures completely controlled on medications at least deserves a workup and evaluation for surgery,” he says. “That’s a service we can provide. You don’t have to live with it. There’s something else we can offer you.”

The Surgery Option

The program strives to optimize medication for those having seizures. Unfortunately, medications alone do not control seizures in about 40 percent of epileptics, notes Dr. Sahoo. In these cases, surgery may be the best treatment. The most common type of surgery is the temporal lobectomy, in which part of the temporal lobe is removed in those with temporal lobe epilepsy. Another type involves removing areas of the brain outside of the temporal lobe, also known as extratemporal resections. For this surgery a grid electrode is implanted over the brain. The grid records the seizures and the area from which they are coming. Then, if a specific area can be identified and mapped for safe removal, surgery takes place. Vagal nerve stimulators can also be implanted in nonsurgical candidates.

Other treatments may be on the way. Dr. Leiphart was involved in the NeuroPace neurostimulator trial for a responsive brain stimulation system. The RNS, or Responsive Neural Stimulator, is placed on the brain surface underneath the skull by a neurosurgeon. It is designed to detect abnormal electrical brain activity and to deliver small amounts of electrical stimulation to suppress seizures before there are any seizure symptoms. The device has not been approved by the U.S. Food and Drug Administration yet.