CCE Seizure Disorders: University of Washington

University of Washington Regional Epilepsy Center
Seattle, Washington

"Uncontrolled seizures are disabling," says John Miller, MD, PhD, director of the University of Washington Regional Epilepsy Center and professor of neurology and neurosurgery. Seizures can interfere with being able to hold a job, being able to drive, being able to pursue an education, and being able to develop normal social relationships.

"The sooner that the seizures can be stopped, the sooner patients can get back into a normal life, and the better off they are."

As one of the first six epilepsy centers in the United States, the Regional Epilepsy Center has helped to pioneer the concept of a comprehensive facility for more than 30 years, and it continues to research ways to treat seizures and epilepsy, whether it is with new agents or new technology.

One of the key areas of research is the use of a dense-array electroencephalogram to record seizures using 256 electrodes instead of the normal 20 or 25; it can detect small seizures that cannot be seen on standard EEG readings, Miller says. Using these recordings, surgeons are able to determine where in the brain the seizures originate and whether it is safe to resect that area.

This summer, the center will participate in a multicenter trial using the gamma knife, which uses focused radiation as a surgical alternative, to treat temporal lobe epilepsy.

In the laboratory, the center is developing an experimental model of posttraumatic epilepsy. "The overall purpose of the model is to develop interventions or treatments that can prevent the development of epilepsy" following brain injury, Miller says, because current methods only block or control seizures.

The center is also studying the role of ion channels in epilepsy. Because many anti-epilepsy medications act at those channels, the center is studying how the medications work "in the hopes that this will lead to a rationale for developing new agents," Miller says.

Treatment options

The two main ways to help control seizures in everyday practice are medication and surgery, Miller says. Side effects, however, may be one of the most common reasons why patients do not adhere to their medication. Common side effects are depression, sedation, impaired concentration, and dizziness.

The other reasons for nonadherence are financial (patients may not be able to afford the medication) and inadequate patient education (they may not understand or fully accept the need to take the medication daily).

Surgery is an option only when it has been determined that medication will not control seizures, and that the seizures originate in an area of the brain that can be safely resected.

"The surgeons [at the Regional Epilepsy Center] are top-notch," says Tim Powell, MD, epileptologist, Rockwood Clinic, Spokane, Washington, who has been referring patients to the center for the last 8 years and refers about 20 to 25 patients per month. "I never hesitate sending my patients to them. . . . I trust these surgeons to complete the complicated task of getting rid of seizures without adversely affecting the functioning of the normal brain."

Home-based treatment program

Depression is an extremely common issue associated with epilepsy, and it is typically caused by the anti-epilepsy medication patients take, the disabling nature of the condition, and the lack of independence patients experience, Miller says.

The center offers a home-based, depression treatment program developed by center psychiatrists led by Paul Ciechanowski, MD, MPH, and funded by a grant from the Centers for Disease Control and Prevention.

Because of the unpredictability of seizures and because they cannot drive, many patients with epilepsy are somewhat homebound, Miller says. Through the program, the interventionalist, or therapist, will go to the patient's home to provide lifestyle coaching, which includes helping the patient achieve regular social interaction and regular exercise, according to Miller. The supervising psychiatrist will work with the patient's primary care physician or neurologist to ensure patients understand the appropriate use of anti-depressant medication, but lifestyle issues are more important, he says.

Team approach

What makes the center unique is "the diversity of our center, the size of our staff, the number of neurologists, the research protocols we do, and the fact that we have so many different specialists-psychologists, neurosurgeons, neurologists-all working together as a team," Miller says.

Although many patients are referred to the center by neurologists, primary care physicians also are often involved in the care of patients. When the seizures are well controlled, the epilepsy center will return patients to the care of the primary care physician who will prescribe and dose medication with the epilepsy center acting as a consultant, Miller says.

In addition to taking a team approach in the management of patients with seizures and epilepsy, the center focuses on helping these patients live as normal of a life as possible.

"Patients should not settle for occasional seizures," Miller says. "The goal really is to see if we can control all seizures, which is possible in the majority of patients."