1. Gaetha Mills, RN, CNRN

2.  4 bed monitoring unit (with 4 additional beds being constructed)  5 epilepsy fellowship trained Epileptologists  An epilepsy fellowship trained Neurosurgeon  4 epilepsy trained neuropsychologists  10 neuroradiologists and interventional neuroradiologists  5 registered EEG Technologists  2 biomedical scientists/engineers  An RN Nurse Navigator and Epilepsy Trained floor Nurses

3.  Goal for our patients  Hospitalization for seizure monitoring  Technology used to create patient’s treatment plan  Surgical options in Epilepsy  Future technology/management of Epilepsy

5.  “No seizures, no side-effects”  70% of patients’ seizures are controlled by medications

7.  Admission to Epilepsy Monitoring Unit for several days  Continuous EEG with audio and video monitoring  Seizure induction by discontinuing meds, sleep deprivation, exercise, hyperventilation, and photic stimulation

8.  Curry computer system  Can superimpose multiple images for increased accuracy (called co-registration)  Example: EEG and MRI co-registration used to better localize seizure-onset zone/circuits

9.  WADA Testing- developed during World War II, used in North America since the 1950’s  Cerebral language and memory representation of each hemisphere  Barbiturate medication injected into Internal Carotid Artery to test each brain hemisphere  Meds put that side of brain “to sleep” to allow testing of language and memory on opposite side of brain

10.  Functional MRI- “brain mapping” – newer technology, non- invasive, rapidly becoming more advanced, may eventually replace Wada testing

11.  SPECT and PET  Both used to help with seizure foci localization

12.  SPECT (Single Photon Emission Computed Tomography) scan ◦ Examines blood flow ◦ Injection of radioisotope given during seizure to view increased blood flow at seizure site  PET (Positron Emission Tomography) scan of Brain ◦ Examines glucose metabolism ◦ Performed “inter-ictally” or between seizures to view areas of hypometabolism

13.  Accepted treatment for medically refractory epilepsy since the late 19 th century  Numerous studies report seizure freedom at 53-84%  Usually need to continue AEDs for 1 year then taper

14.  Promising new device created by Neuropace  Responsive NeuroStimulation (RNS) – effective in reducing seizures by 50% in >50% of patients  Only effective in focal onset epilepsies, but can be effective if 2 foci in a given patient

17.  Vagus Nerve Stimulator – effective in reducing seizures by 50% in >50% of patients  Good for both focal onset and primary generalized epilepsies

18.  Invasive procedure yielding high resolution information  Provides the most localized area of seizure activity  Allows mapping of language areas

19.  Temporal lobectomy-most often removal of the anterior portion of temporal lobe  Lesionectomy-removal of a seizure causing lesion in any part of the brain  Partial corpus callosotomy- corpus callosum severed to prevent seizure spread through intrahemispheric pathways  Multiple subpial transections- small incisions to “interrupt” seizures performed when seizures originate in brain areas that cannot be removed

20.  Genomics-Personalized Medicine: Finding the right drug for each patient through gene testing ◦ Only need saliva or blood to perform test

21.  Deep Brain Stimulation-implanting electrodes into specific areas of the brain, and then stimulating these areas with small regular electrical impulses

22.  Emfit Tonic-Clonic Seizure Monitor

23.  SAMi Sleep Monitor ◦ Sounds alarm when an unusual movement is detected during the night ◦ Audio video information from a remote infrared video camera is sent to an app which can run on a smart phone ◦ Totally portable

24.  Smart Watch and Embrace Seizure Watch ◦ Measures electrodermal activity and motions