Comprehensive Epilepsy Treatment at Penn State Health

By Elesa Swirgsdin
Tuesday, April 12, 2022
Specialty: 

While advancing technology is revolutionizing care for epilepsy, a team approach that treats all facets of life touched by the disease also makes a profound difference for patients.

The team at the Level 4 Epilepsy Center at Penn State Neuroscience Institute is on the forefront of epilepsy care, employing newly developed techniques in the diagnosis and treatment of all types of epilepsy. Even patients with the most severe cases are experiencing a better quality of life.

“Improvements in technology are changing the landscape for patients with epilepsy,” says Michael Sather, MD, FAANS, associate professor of neurosurgery at Penn State College of Medicine and surgical director of the Epilepsy Center at Penn State Neuroscience Institute. “Some of the options we can offer today were not available 10 or 15 years ago. These advances are allowing us to treat more and more patients successfully with less potential for problems or complications.”

Multidisciplinary Care, Detailed Monitoring

When a child or adult with medication-resistant epilepsy presents at the Epilepsy Center, a comprehensive multidisciplinary care model is used to determine the best course of treatment. Twice a month, epileptologists, neurosurgeons, electroencephalography (EEG) technologists, neuroradiologists, neuro-anesthesiologists, neuroscience nurses, clinical neuropsychologists, psychiatrists and dietitians gather to examine each case.

“In our patient conferences, we discuss the data we receive from evaluations,” Dr. Sather explains. “These evaluations are divided into two phases. Every patient goes through the first phase, which is noninvasive and, if necessary, we move on to phase 2.”

In phase 1, the team studies anatomic, electrical and clinical data collected from noninvasive monitoring techniques. These include 3-Tesla MRIs that can spot subtle lesions on the brain and inpatient video EEG, which requires a stay of approximately one week in the Epilepsy Monitoring Unit.

“While the patient is in the Epilepsy Monitoring Unit, we use simultaneous video recording with a scalp EEG and medications are sometimes weaned,” Dr. Sather states. “The goal is to capture a seizure on video and determine where the electrical activity suggests the seizures originate.”

The data obtained from these tests helps the team pinpoint the location of the seizures. In some cases, surgery can be performed based on these results. If data is incomplete or not well-defined, further evaluation is necessary. This is phase 2, an evaluation using invasive monitoring to try to better localize the seizures in order to offer a safe and effective surgery.

Breakthroughs in Invasive Monitoring

In the last decade, technological advances have made it easier for patients who need invasive monitoring. In the past, surgeons had to perform open surgery to remove a piece of bone and place a sheet of electrodes on the surface of the brain. Now, a less invasive approach called stereo EEG has greatly simplified the procedure, making it accessible to more patients.

Instead of placing a sheet of electrodes on the brain, the neurosurgeon, with the help of robotic guidance, uses stereo EEG to implant wires through a small incision in the skull. The wires are embedded in specific regions of the brain, creating a three-dimensional area where brain activity can be recorded.

According to Dr. Sather, seizures are successfully localized in more than 90% of patients who undergo a stereo EEG at Penn State Health Milton S. Hershey Medical Center.

“We no longer have to remove bone and expose the brain,” Dr. Sather explains, noting that he was one of the first surgeons in the United States to perform this procedure during his fellowship at the Cleveland Clinic. “In the past, that was a big deterrent for some patients. Being able to localize the seizures in a less invasive way is very beneficial to the patient and allows us to offer surgery to more patients.”

After pinpointing seizures’ origination points, physicians plan interventions in hope of eliminating or ameliorating seizure activity. Laser interstitial thermal therapy, or thermal ablation, is often used for people who have drug-resistant mesial lobe epilepsy. During the procedure, the surgeon uses MRI guidance to place a laser fiber through a small opening in the skull to target and destroy the unhealthy brain tissue causing the seizures.

“Resective procedures — where we remove a lesion or abnormality in the brain that is causing the seizures — or ablative procedures are preferred, when possible, as these give the best chance of a cure,” Dr. Sather says.

Deep Brain Stimulation and Neurostimulation: Leading-Edge Treatments

Resections or ablations are not always feasible because they would cause harm to critical brain activity. Some patients who are not candidates for ablation benefit from deep brain stimulation (DBS) — the application of electrical impulses to modulate brain activity and reduce seizures.

Approved by the FDA for epilepsy in 2018, DBS can be highly effective for certain patients. A generator device is placed in the chest wall, and tiny wires are placed in the anterior nucleus of the thalamus. Periodic electrical impulses help to control brain activity and prevent seizures.

Another effective modality, neurostimulation, responds to seizure-producing brain activity as it happens.

“If we have localized the seizures to an area of the brain that controls speech, motor function or memory, we can’t remove that portion of the brain without causing damage to those functions,” Dr. Sather says. “In the past, we didn’t have a way to treat those patients, but that has changed. Neurostimulation is a very successful option for some of those patients.”

A responsive neurostimulation device called NeuroPace, which is a closed-loop stimulation system that responds to electrical activity in the brain, is used at the Milton S. Hershey Medical Center to safely treat seizures. A neurostimulator is placed in the skull and connected to tiny wires positioned on the seizure focus area of the brain. The device continuously records EEG data and sends an impulse to prevent seizures before they happen. NeuroPace can reduce seizures by 70%.

Moving the Needle Further

Hershey Medical Center continues to push epilepsy treatment forward through research and clinical trials, including its enrollment in a post-market approval study for NeuroPace, drug research and surgical research studies.

“Looking at our performance in our research is another important aspect of our work,” Dr. Sather says. “It helps us continue to determine how to reach the best outcomes and make sure our patients have the highest quality of life they can.”


Find out more about the Level 4 Epilepsy Center at Penn State Health by visiting pennstatehealth.org/neurosurgery or by calling 717-531-3828.

To learn more about deep brain stimulation and make a patient referral, visit pennstatehealth.org/dbs.