Epilepsy

Epilepsy is a brain disorder in which clusters of nerve cells sometimes signal abnormally, often causing a seizure.

Having one seizure does not mean you have epilepsy. But it does mean you should speak to a doctor to try to determine the cause. 

Epilepsy can develop as a result of damage to the brain from a head injury or from disorders that affect the brain, such as a brain tumor or stroke. Often, there is no detectable risk factor for developing epilepsy.

Types of Seizures

The International League Against Epilepsy reclassified seizure types in 2017. Seizures are now described by the following:

• Where the seizure starts in your brain (generalized affecting both sides or focal starting on one side)
• How aware you are during a seizure (aware or impaired)
• Whether movement occurs during the seizure (motor or non-motor) and what type of movement: muscles twitching (myoclonus), becoming limp (atonic), jerking (clonic) or becoming rigid (tonic)

Epilepsy Diagnosis at Rush

If you have had a seizure, your primary care provider may refer you for specialized testing.

Epilepsy testing often includes an electroencephalogram (EEG) to measure electrical activity in your brain and try to locate the source of seizures. This is known as "seizure localization" or finding the seizure's "focus."

EEGs performed at Rush Copley Medical Center in Aurora and Rush University Medical Center are read by epilepsy specialists from Rush University Medical Center. Pediatric EEGs performed at Rush Oak Park Hospital are read by epilepsy specialists from Rush University Medical Center. 

We use multiple types of EEG and other seizure visualization at Rush, depending on your situation and where you have your test:

• Routine EEG: Routine EEG records electrical activity in your brain for a short period of time (typically 20 to 30 minutes). Routine EEG is offered at Rush Oak Park Hospital, Rush Copley Medical Center and Rush University Medical Center. 
• Continuous video EEG (VEEG): Continuous video EEG uses scalp electrodes that record video and audio of your seizure. Continuous video EEG is used for longer-term monitoring to capture seizures and/or to evaluate you for epilepsy surgery. VEEG is offered at Rush University Medical Center.
• High density EEG (HEEG): Similar to a scalp EEG, an HEEG uses more electrodes combined with high-quality imaging. This gives doctors a better sense of where the seizures come from and can be used to plan epilepsy surgery. If we also need to do an intracranial EEG, an HEEG gives us more targeted planning and guidance. HEEG is offered at Rush University Medical Center. 
• SISCOM: SISCOM is a brain mapping tool that epileptologists use to visualize activity in your brain during a seizure. SISCOM is performed in the epilepsy monitoring unit at Rush University Medical Center. It is less invasive than an intracranial EEG and can be used to plan surgery. 
• Intracranial EEG monitoring: An intracranial EEG (also called invasive EEG) uses electrodes implanted in your brain by a neurosurgeon to record brain waves on your brain. An intracranial EEG helps more precisely identify where your seizures come from than an MRI, scalp EEG or other imaging. Intracranial EEG is offered at Rush University Medical Center. 
• Stereotactic EEG (SEEG): Similar to an intracranial EEG, stereotactic EEG uses electrodes implanted in your brain. SEEG is less invasive, however, than intracranial EEG. With SEEG, Rush neurosurgeons use stereotactic guidance. This means they combine at least two forms of imaging to provide a more three dimensional map of your brain. SEEG is offered at Rush University Medical Center. 

Epilepsy Treatment at Rush

Rush general neurologists across the system collaborate with our epileptologists in downtown Chicago. If your seizures are difficult to control, they may recommend you see a Rush epileptologist for specialized epilepsy care.

Seizure Control

• Between 60 and 70 percent of patients with epilepsy achieve full seizure control through medical treatment.
• Epilepsy specialists at Rush focus on selecting the best regimen of seizure medications for each patient. Our goal is to stop your seizures completely, while avoiding drug side effects whenever possible.

Intractable Epilepsy

• If you have seizures that have not been controlled by two or more medications, you may have intractable epilepsy. This is also known as "refractory epilepsy" or "drug-resistant epilepsy."
• Some people with intractable epilepsy may have the wrong initial diagnosis or be on the wrong medication.
• Rush epileptologists may recommend a medication that is more effective for you, surgical options that can help decrease seizures, and/or advanced EEG monitoring for more precise seizure localization.

Non-epileptic Seizures

• One-third of all patients admitted to an epilepsy monitoring unit for intractable seizures are found to actually have non-epileptic seizures, or NES (also known as psychogenic non-epileptic seizures, or PNES). 
• Though they resemble epileptic seizures — either generalized seizures (falling and shaking) or focal seizures (staring spells, or other changes in perception or behavior) — nonepileptic seizures are not caused by abnormal electrical activity in the brain. 
• Non-epileptic seizures may be associated with past traumatic experiences or other psychiatric or psychological factors. But sometimes none of these factors are identified by the patients at the time they come to the clinic.
• Because NES do not respond to typical anti-seizure mediations and are not under the person's voluntary control, they can profoundly affect quality of life. In fact, people with NES often require multiple trips to the ER or hospitalizations before being diagnosed with NES.

Anti-Seizure Dietary Approaches

• Dietitians and epileptologists at Rush counsel patients on use of the ketogenic diet (or, keto diet) and low glycemic diet to control epilepsy.
• The keto diet is a special high-fat, low-carbohydrate diet that your doctor may advise for your epilepsy.
• A low glycemic index diet also monitors your total carbohydrates, but instead focuses on carbohydrates that have a low glycemic index. Glycemic index refers to the amount by which the food raises your blood glucose after eating.

Specialized Care for Women With Epilepsy

• Epilepsy specialists at Rush University Medical Center are committed to addressing the unique concerns of girls and women with epilepsy — from increased seizure activity during your menstrual cycle (or, catamenial epilepsy) to the effect certain anti-seizure drugs and oral contraceptives can have on each other.
• If you are ready to start a family, we're here to help keep you and your baby safe. Through a partnership with your OB/GYN, we strive to minimize seizures as much as possible during your pregnancy and delivery.
• If you're having difficulty conceiving, which can happen because some anti-seizure drugs can affect reproductive hormones, we'll work closely with your reproductive endocrinologist to regulate your medications so they won't interfere with fertility treatments but will still help manage seizures.

Epilepsy Surgery and Nonsurgical Procedures

Rush neurosurgeons perform the following surgeries and minimally invasive procedures:

Removal of Seizure Focus

• Focal resection: Rush neurosurgeons remove the part of the brain causing seizures (the "focus"). One of the most common focal resections performed is temporal lobectomy. In temporal lobectomy, neurosurgeons remove parts of the temporal lobe and other areas of the brain to treat temporal lobe epilepsy.

Neuromodulation

• Deep brain stimulation (DBS): Rush neurosurgeons in downtown Chicago offer asleep deep brain stimulation for epilepsy. Asleep DBS is performed while the patient is under general anesthesia, not awake. Asleep DBS may be beneficial for people with uncontrolled, or intractable, focal seizures. 
• Vagus nerve stimulation: Rush neurosurgeons implant a device that prevents seizures by sending mild pulses of electrical energy to the brain through the vagus nerve. The epilepsy team at Rush uses vagus nerve stimulation in children and adults.
• Responsive neurostimulation (RNS): Rush neurosurgeons implant a neurostimulator device (also known as NeuroPace) that monitors brain electrical activity. They use an electrode-mapping system to determine where to implant the device for better seizure control. The device detects abnormal brain wave activity. The neurostimulator then delivers small pulses to stop the seizure from happening.

Laser Interstitial Thermal Therapy (LITT)

• In laser interstitial thermal therapy (LITT), Rush neurosurgeons heat the tip of a laser catheter to burn the lesion area causing seizures. LITT can significantly improve seizures using only a small hole in your skin that is easily stitched.
• LITT may be a good option for people who have seizures that come from very specific areas of the brain that are not involved in speech (non-eloquent).
• People with mesial temporal sclerosis are often ideal candidates for LITT.

Corpus Callosotomy

• Rush neurosurgeons cut the corpus callosum, which connects the left and right sides of your brain. This stops seizures from spreading from one side of your brain to the other.
• It is most often used for people with intractable drop seizures. Although not a cure, it can reduce how often you have seizures.

Telemedicine Options

• If you are unable to travel to downtown Chicago for specialized epilepsy care, we offer telemedicine visits. With telemedicine, we talk with you through a virtual visit (online video call) about your potential options.

Epilepsy Team Support

• The downtown Chicago epilepsy team includes nurse practitioners and social workers. They provide you with ongoing epilepsy education and support.
• We also have a psychiatrist at our downtown Chicago center who specializes in working with epilepsy patients and their families to address depression, anxiety and other mental health concerns that are often associated with epilepsy.
• The epilepsy team's goal is to make sure you don't have to live with seizures that are not controlled. If you live in an area without access to specialized care, the team can help find you the resources (such as transportation or telemedicine) necessary to get a new perspective on your seizure control.
• We also work with your current provider to arrange for follow-up care in your location after an epilepsy procedure at Rush University Medical Center in Chicago.

Epilepsy Clinical Trials

• Our clinicians actively seek new treatment options for epilepsy. Your epilepsy team may talk with you about a clinical trial for a potential new treatment.

Rush Excellence in Epilepsy

• Epilepsy expertise: Rush Epilepsy Care treats more than 5,000 adults and children with epilepsy each year. Our center in downtown Chicago is a level 4 NAEC-accredited center. That means they meet the highest standards for seizure diagnosis and care.
• State-of-the-art EEG facilities: Rush offers routine EEG — where we monitor electrical activity in the brain for a short period of time — at all three of our hospitals. If you or your child need more advanced monitoring, including continuous video EEG, long-term EEG monitoring, intracranial (invasive) EEG, stereotactic EEG or SISCOM analysis, Rush University Medical Center’s EEG Laboratory is here to provide you with the highest level of care in a comfortable setting. Our EEG facilities include an outpatient lab, a dedicated 10-bed adult epilepsy monitoring unit (EMU) in the Rush Tower and a pediatric epilepsy monitoring unit in Rush University Children’s Hospital.
• Safe seizure monitoring: Because we know going off seizure medication for continuous monitoring can be dangerous, the Rush University Medical Center EMU always has at least one highly trained EEG technologist monitoring you for an extra level of care. We also have inpatient nurses with EMU-specific safety training. 
• Alternative ways to find seizure focus: Locating a lesion on your brain is important so we can target where your seizures come from. Our epilepsy specialists are trained to manually measure the hippocampus as a way to "find" a scar when it is not visible through imaging. This technique (called measuring "hippocampal volume") offers similar outcomes to our patients who have a clear lesion image. It can be particularly helpful for patients with mesial temporal sclerosis. 
• Medication selection: Finding the right medication to control your seizures requires expertise and an understanding of your overall health. For example, if you have migraines, the wrong anti-seizure medication might make them worse. Rush epilepsy specialists look at your other health issues to choose the right medication for you.
• Epilepsy surgery: Rush neurosurgeons have extensive experience performing epilepsy surgery to remove the part of your brain causing seizures. They also offer minimally invasive options, such as deep brain stimulation and laser interstitial thermal therapy (LITT). Based on their extensive experience, the epilepsy team is able to recommend which intervention is likely to have the most benefit for your seizures.
• Specialty pharmacy for anti-seizure medications: Our downtown Chicago location has a specialty pharmacy that processes all patients' anti-seizure medications. The medications are mailed directly to your home. The pharmacy also sends reminders when your medication is about to run out so you do not miss any doses.
• Specialized care for non-epileptic seizures: To help achieve seizure control and improve quality of life for people with nonepileptic seizures (NES), we created the NEST Clinic at Rush University Medical Center. Here, our team of psychiatrists, neurologists, seizure specialists, psychologists and clinical social workers collaborate to determine the nature of the disorder and address the multiple factors that contribute to this condition. We have expertise managing the seizures and underlying psychiatric conditions that coexist in people with NES, including the use of evidence-based treatments like cognitive-behavioral therapy (CBT) and mindfulness therapy. We’ll work with you to reduce seizure frequency and severity, improve your mental health and enable you to enjoy life to the fullest. 
• Ketogenic diet therapy for adults: Rush is one of only a few places in the U.S., and the first in Illinois, to offer ketogenic diet therapy for adults with epilepsy. Dietary approaches have been shown to make seizures less severe and improve quality of life in many people with epilepsy.
• Emotional and mental health support: The downtown Chicago team includes dedicated social workers and a psychiatrist who specializes in helping people with epilepsy cope. Their focus is on your emotional, spiritual and mental well-being, including addressing depression, anxiety and other mental health concerns. They evaluate your overall well-being, provide therapeutic support, and help you address any needs for resources or outside support.