For epilepsy patients, the erratic nature of seizures creates challenges that impact both physical health and emotional wellbeing. Fortunately, recent advances in epilepsy management have improved treatment outcomes significantly.
At the Nebraska Medicine Comprehensive Epilepsy Center, the paradigm has shifted from reducing seizure frequency to achieving complete seizure freedom for patients. As the region's only comprehensive epilepsy center, a multidisciplinary approach integrates cutting-edge diagnostics with personalized treatment strategies for both pediatric and adult populations.
“Our comprehensive approach ensures that experienced, fellowship-trained subspecialists – whose clinical and research focus is on epilepsy – are involved in the complex decision making appropriate for the care of these patients,” says neurosurgeon Aviva Abosch, MD, PhD. “Our multi-disciplinary epilepsy patient conference includes experts in epilepsy neurology and neurosurgery, neuropsychology, neuroradiology and neurophysiology who come together to review patient data and weigh in on the region’s most complicated epilepsy patients.”
Clinical excellence and accreditation
The National Association of Epilepsy Centers has designated Nebraska Medicine as a Level 4 Center of Excellence – the highest possible accreditation. This recognition indicates that the center:
- Staffs fellowship-trained epileptologists and neurosurgeons with subspecialty expertise in functional neuroanatomy.
- Manages highly complex epilepsy cases.
- Utilizes the latest techniques and technologies.
- Follows approximately 3,000 patients annually.
- Performs over 40 epilepsy surgeries each year, (placing it among the top 10 centers nationally).
The care team includes five board-certified epileptologists working alongside neurosurgeons, psychologists, neuropsychologists, nurse case managers, EEG technologists, and dietitians. This team meets weekly to review cases and coordinate patient care.
“I came to Nebraska Medicine and UNMC, in part, because of the quality of this multi-disciplinary team,” Dr. Abosch says. “My colleagues in epilepsy neurology, neuroradiology, neuropsychology, and clinical neurophysiology, are simply spectacular. They are at the top of their respective fields, thoughtful, collaborative and constantly expanding our collective repertoire of what we can provide for our patients. I am proud of the quality of care we provide to our patients.”
Advanced diagnostic tools
Nebraska Medicine was among the first epilepsy centers in the U.S. to use magnetoencephalography (MEG) for diagnosis and treatment planning. This technology provides detailed mapping of the brain's magnetic fields, allowing physicians to precisely identify where seizures originate.
The center also offers robot-assisted stereoelectroencephalography (sEEG), an advanced technique that uses minimally invasive electrodes placed deep within the brain to record electrical activity. Robot-assisted sEEG provides more precise localization of seizure origin with fewer complications than traditional invasive monitoring, particularly for patients with deep-seated or complex seizure networks.
Treatment options
Treatment for epilepsy has advanced considerably in recent years. The approach may include:
- Medication management: 60% to 70% of patients achieve seizure freedom with proper medication. Treatment begins with a review of current medications and potential adjustments, new combinations of previously trialed medications and/or the addition of new medications.
- Diagnostic monitoring: For patients who are medication-resistant, video electroencephalography (EEG) monitoring in a specialized suite helps determine if surgery might be beneficial. This monitoring occurs in the Level 4 Epilepsy Center with 24/7 supervision by trained staff.
- Surgical options: When appropriate, surgical treatments are tailored to each case. The goal is to remove or disrupt the brain circuits causing seizures while preserving areas that control essential functions such as speech, language, memory and movement. Options include:
- Resective surgery.
- Laser ablation.
- Stereoelectroencephalography-guided procedures
- Corpus callosotomy.
- Neuromodulation: For patients who aren't candidates for resective surgery, alternatives include:
- Vagal nerve stimulation (VNS): A small, implanted device that functions like a pacemaker, sending electrical impulses through the left vagus nerve to the brain to control seizures.
- Responsive Neurostimulation (RNS®) system: An implantable device that continuously monitors brain activity by means of brain electrodes connected to a skull-mounted programmable generator, which delivers targeted electrical stimulation to prevent seizures before they begin.
- Deep Brain Stimulation (DBS): Involves implanting a lead into a specific brain structure and connecting it to an implantable pulse generator (IPG) in the chest, which is programmed to emit electrical stimulation tailored to the patient's unique symptoms and brain features to restore normal brain signals and improve movement.
“The past decade or so has ushered in more advances in surgical techniques for the treatment of epilepsy than we’ve seen in the half century before,” Dr. Abosch says. “This progress in the field brings a sense of optimism to those of us who treat the most complicated epilepsy patients.”
The changing landscape of epilepsy care
The evolution of epilepsy treatment from symptom management to seizure freedom represents a significant advance in neurological care. For physicians managing patients with epilepsy, particularly those with difficult-to-control seizures, early referral to a comprehensive epilepsy center can significantly impact outcomes and quality of life.
The Nebraska Medicine Epilepsy Center continues this progress through ongoing clinical innovation and dedication to excellence in neurological care.
For more information
To learn more or refer a patient, call 402.559.8600.