February 6, 2024
Epilepsy Care: Collaborating to Prevent Seizures
Whether a patient receives a new diagnosis of epilepsy or they have struggled for years to manage their seizures, they need high-quality care from the partnership of their primary care provider and specialist. UW Medicine neurological surgeons and neurologists are trained to deliver the most advanced epilepsy therapies and treatments, offering relief for a condition that affects approximately 3 million people in the U.S.
“The brain is the coolest organ in the body, and epilepsy is a disorder of the brain’s electricity,” says UW Medicine neurologist Nicholas Pete Poolos, MD, PhD. “Epilepsy is one of our more treatable conditions.”
UW Medicine’s Regional Epilepsy Center is at the forefront of care, helping patients with this condition. Through close collaborations, our expert team of neurologists and neurological surgeons identifies and delivers the best treatments for each patient. We’re also leading the way with groundbreaking epilepsy research.
The importance of treating epilepsy
Every patient’s experience with epilepsy is different. Some people have one seizure a year, while others can suffer multiple episodes daily. Many individuals benefit from medications that can prevent seizures, but one-third of patients don’t respond to them, says Poolos, who directs the Regional Epilepsy Center. If patients don’t achieve seizure freedom after trying two to four medications, it’s unlikely they will find the right drug combination for seizure relief.
When epilepsy medications fail, surgical intervention to limit or eliminate seizures is critical, says UW Medicine neurological surgeon Andrew L. Ko, MD. If left uncontrolled, seizures can cause sudden unexpected death in epilepsy (SUDEP). In fact, over time, a patient’s SUDEP risk can equal the mortality risk for a patient with an aneurysm.
Ultimately, addressing a patient’s epilepsy and preventing seizures helps them return to their regular activities in a safe, healthy way.
“Treating epilepsy is about improving quality of life,” Ko says.“If you can make someone seizure-free, they can drive, sleep better, go back to work and have a better life.”
Delivering high-quality seizure care
Getting patients as close to seizure-free as possible is our top priority. Together, our team of nine neurologists, two board-certified neurological surgeons and two neurology nurse practitioners is uniquely positioned to help patients on this journey.
“We have the best-trained providers who can take on the hardest problems,” Poolos says. “We see the entire range of epilepsy patients. People come to us after their first seizure or when they’ve had epilepsy for years and are heading toward surgery after many medications failed.”
As a referral center, we serve a large patient volume from the Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) region. According to Poolos, on average, our providers schedule 4,500 clinic visits, perform 70 surgeries and admit 300 people for electroencephalography (EEG) studies for epilepsy diagnosis annually. Based on each patient’s individual needs, we offer a wide variety of treatments:
- Minimally invasive laser ablation
- Responsive neurostimulation (RNS)
- Deep brain stimulation
- Vagal nerve stimulation
- Resective brain surgery
Thalamic neurostimulation with the RNS device is our newest procedure. Thalamic neurostimulation directly affects the thalamus, a structure that connects to broad areas of the cerebral cortex, offering the possibility of affecting seizures throughout the brain.
“By using thalamic neurostimulation, we’re trying to hedge our bets and cover a broader territory with brain stimulation,” Poolos says.
Leading advanced investigations
Though several epilepsy medications and surgical therapies exist, there is room for improvement. And the future of research is bright, Poolos says.
- Engineered neurotransmitter cells: As an alternative to resective brain surgery, our Center is evaluating a clinical trial that will inject engineered cells that secrete the neurotransmitter GABA to see if it will inhibit brain activity that prompts seizures. Results of this type of neural transplant look promising.
- Tau protein expression: The protein tau is typically associated with Alzheimer’s disease, but research shows that genetically deleting it has a powerful anti-seizure effect. Our investigators are testing in an animal model the use of the CRISPR gene editing technique to remove tau from neurons located in the areas of the brain where a patient’s seizures start. If successful, this technique would let providers better target their seizure prevention efforts.
- EEG techniques: Our investigators are studying advanced EEG techniques with the ultimate goals of understanding mechanisms and identifying biomarkers of disease.
- Imaging and outcome prediction: Our investigators are engaged in developing methods to better predict seizure outcomes after surgery, including the likelihood of seizure freedom and of cognitive decline. A greater understanding of which patients are likely to be seizure-free will allow better counseling for patients, particularly when risking cognitive side effects.
- Cognitive decline prevention: Our investigators are studying how minimally invasive laser procedures can protect patients against cognitive decline post-surgery.
Collaborating closely to improve care
Our neurological surgery and neurology teams begin their care delivery partnerships with the patient’s first in-person or telehealth visit, Poolos says. The collaboration continues from mapping the patient’s seizures with EEG monitoring through analyzing any imaging and nuclear medicine studies.
Our neurological surgeons, neurologists, neuropsychologists, radiologists and nurse practitioners convene twice weekly to discuss each patient’s case. Together, 10 to 15 people review the patient’s history, epilepsy diagnosis, medication history, EEG monitoring and MRI imaging.
“By being in the same space, we bring everyone’s best ideas together. It’s a very collaborative environment,” Poolos says. “When you have that many people all thinking about a patient’s situation and how we’re going to devise their best treatment path — that’s a very powerful approach.”
Working so closely together also fosters one of UW Medicine’s greatest strengths: clear provider-patient communication.
“We allow our clinicians enough time to sit down and talk to people. Our patients consistently thank us for listening to them and explaining the different treatments,” Poolos says. “I feel like we’re providing care the right way.”