SETTING THE GOLD STANDARD Neurosurgical Protocol for Epilepsy Developed at UCLA ur outcomes for epilepsy surgery lead the world because we use an advanced, three-pronged protocol developed at UCLA, which is the standard for neurosurgeons worldwide. In the first phase, we evaluate patients in our telemetry unit, which is equipped with video and non-invasive scalp electroencephalograph electrodes, to document and characterize seizures. As part of the evaluation, patients undergo extensive brain imaging, including advanced MRI protocols such as T1- and T2- weighted inversion
O
recovery, FLAIR, 3D reconstruction, diffusion tensor imaging (DTI) and positron emission tomography (PET) scans. In some cases a special technique probing magnetic dipoles in the brain (magnetic source imaging) is used. The findings are then presented to the epilepsy surgery team, a panel consisting of neurologists, neurosurgeons, electrophysiologists, radiologists, psychologists and our coordinating clinical nurse specialist. If the source of the seizures cannot be localized or if it is near a language or movement center of the brain, we will perform
stimulation mapping using subdural (over the surface of the brain) or depth electrodes implanted in the brain. The patient will then undergo another round of observation and recording of the seizures in the telemetry unit. In the final phase, our team uses imaging technology, including electrocorticography (ECoG), functional brain mapping and intra-operative image guidance to map the route to the region of the brain, while protecting vital control centers. Finally, the neurosurgeon removes the abnormality in the brain and as result eliminates the seizures.
UCLA STUDY SHOWS THAT SURGERY CAN LEAD TO A SEIZURE-FREE LIFE Research Shows Surgery Should Not Be Delayed Surgery for epilepsy was once seen as a last resort for patients and was only performed when anti-seizure medications failed to stop the seizures. A recent, evidence-based, multi-center study led by UCLA set the guidelines that if a patient continues to experience seizures after two anti-seizure medications have failed, then an evaluation for surgery from a comprehensive epilepsy center should not be delayed. The recent controlled, randomized UCLA study published in the Journal of the American Medical Association in March 2012, examined 38 patients who failed to have seizures controlled after trying two anti-seizure drugs. The team randomly assigned 15 to brain surgery and 23 to continued medical treatment, all patients were similar in age and diagnosis. During the second year follow ups, the 23 patients on anti-seizure medications still suffered from seizures. Eleven of the brain surgery patients were seizure free. Evidence-based research now shows that surgery should be considered as soon as possible. Epilepsy will strike one in a hundred Americans at some point in their life. Seizure disorders are rising in people after the age of 60 and will continue to increase as the baby boomers age. Research has shown patients
46 | ADULT EPILEPSY SURGERY PROGRAM
live an average of 22 years with uncontrolled seizures before considering surgery. On average, patients living with uncontrolled seizures are at increased risk for drowning and other fatal accidents. Depression, progressive memory loss and other cognitive disorders debilitate these patients’ quality of life. Children are at risk for slow-to-no development of vocational and social skills. Our evidence now shows patients should consider evaluation for surgery early, before the harmful consequences become irreversible. With 50 years dedicated to the surgical treatment of epilepsy, we are world leaders in helping hundreds of patients go on to live productive, seizure-free lives.
UCLA NEUROSURGERY: INTO THE BRAIN AND BEYOND