Nearly two million Americans suffer from epilepsy -- many of them children. It is the oldest known brain disorder and was mentioned in literature 2,000 years B.C. It is not considered a single disease; the recurrent seizures that mark its presence result from sudden, temporary disturbances in the normal operation of the brain's electrical system that may result from different causes. Epilepsy takes many forms and its severity ranges from mild to completely debilitating.
While many people with epilepsy are successfully treated with antiepileptic drugs that provide partial or complete control over seizures; Approximately 250,000 people do not respond to medication. They may experience catastrophic epileptic seizures daily, making any semblance of a normal life impossible. The Yale Epilepsy Surgery Program provides promising options for many of these adult and pediatric patients. Internationally known for clinical excellence and innovative research, the Yale Epilepsy Surgery Program was one of the nation's first and has evolved into one of the most active and advanced in the world. More epilepsy surgeons around the country received their training at Yale than any other program in the country.
Working with a team of experts in the Yale Comprehensive Epilepsy Program from Neurology, Neuroradiology, Neuropathology, Neuropsychology, and Neurobiology, patients are provided with a comprehensive evaluation of their epilepsy and the treatment options available.
Dennis Spencer, MD
Harvey and Kate Cushing Professor of Neurosurgery
Chief, Epilepsy Surgery
Director, Epilepsy Fellowship
Director, Pituitary Surgery
Jason Gerrard, MD, PhD, FAANS
Assistant Professor of Neurosurgery and of Neuroscience
Chief, Functional Neurosurgery
Chief, Trauma Neurosurgery, YNHH
Surgical Evaluation: A Multi-Phase Process
Many people with epilepsy are referred to the program at Yale by their physicians, other patients or support organizations. They begin with a complete assessment and evaluation by an epileptologist on an outpatient basis. If further evaluation is appropriate, patients undergo an intense inpatient monitoring phase to determine if there may be a way to control their seizures medically or surgically. This extensive evaluation and testing process is required to determine the part of the brain responsible for the seizures and to assess the appropriateness and impact of surgical intervention.
The patient becomes a partner in a team of finely trained specialists representing the spectrum of knowledge about epilepsy care: a neurosurgeon, adult and pediatric epileptologists, neuropsychologists, neuroradiologists, a pediatric neurosurgeon, care coordinators and others who come together to determine the best course of action. Every week this team, along with community physicians, residents and fellows, discuss all of the information available on each patient to help shape the best treatment plan.
Continual improvements in imaging technologies have fueled many neurosurgical advances. The images and functions revealed ever more clearly by MRI, PET and SPECT scans help physicians determine whether seizures are the result of focal damage caused by congenital malformations, vascular lesions, tumors or scar tissue from early disease or injury. This information is a critically important factor in evaluating different treatment options.
The second phase entails performing an angiogram to study the vascular structures and WADA (intracarotid sodium amytal testing), which determines language dominance and memory assessment useful to surgical planning.
If it is necessary to study the brain directly to pinpoint the source of the seizures, the patient may have EEG electrodes surgically implanted either on the surface or within the brain. Yale has two surgical suites equipped with stereotactic workstations that ensure precise placement of the electrodes. Mapping of critical brain functions localized by electrode stimulation may also be conducted. Following the implantation, patients undergo another phase of continual monitoring of seizure activity as inpatients.
Using all the information collected during the prior phases, the interdisciplinary team of specialists is now able to outline for the patient and family whether surgery is possible and what the results might be. If surgery is chosen, neurosurgeons proceed to remove any lesions or damaged brain revealed by the testing process to be the focus of the seizures.
The outcomes of epilepsy surgery are very encouraging: the vast majority of patients experience either no recurrence of seizures or a greatly reduced number of less severe seizures. Extensive, long-term follow-up care and rehabilitation are provided.