Specialized care from recognized leaders
The care and treatment of patients with epilepsy has been a significant mission of the Department of Neurology from its earliest days. Dr. B. J. Wilder and Dr. Richard P. Schmidt performed a number of early neurophysiologic studies of epileptogenesis, and Dr. Wilder was also instrumental in a number of the pivotal studies which led to the approval of many of our second generation anticonvulsant medications. They started the tradition of excellence in epilepsy care at the UFHealth Comprehensive Epilepsy Program and the Malcolm Randall Veterans’ Affairs Medical Center Epilepsy Center of Excellence. The program not only trains residents in basic epilepsy care, but many fellows have completed advanced training in clinical neurophysiology gone on to both academic and community practice.
In 1992, the surgical program was added, complementing the medical aspects of the program and allowing delivery of the full range of care for both children and adults with epilepsy. Since then, we have performed over 1500 surgical procedures for epilepsy. Our multidisciplinary team meets regularly to develop consensus plans for our patients. The goal? Optimize seizure control and improve the quality of life for patients and their families by providing comprehensive, compassionate, patient-centered and innovative care for epilepsy.
As a National Association of Epilepsy Centers certified level 4 epilepsy program, we perform the most complex intracranial monitoring and procedures to find the best surgical solutions for the management of medically refractory epilepsy. Of course, many patients’ seizures can be well managed by medication but approximately 1/3 of all epilepsy patients still have uncontrolled seizures even after trying 2 or more medications. Our center excels in the assessment of refractory epilepsy and in developing the best possible treatment plan to minimize seizures, reducing their impact on the lives of patients and their families. We seek to partner with primary care providers and referring neurologists in order to provide optimal care to our patients, many of whom travel from across Florida, and across the southeast.
If a specific epileptic focus can be identified, surgical options may give patients a greater likelihood of seizure control if they have become refractory to medication. In order to do this, we must record seizures on video-EEG in the Epilepsy Monitoring Unit in the hospital, and obtain corroborating information on neuro-imaging (MRI, fMRI, PET, and others) as well as neuropsychological/ cognitive testing. If additional information is needed, subdural grid electrodes or depth electrodes may be needed, which also allows for functional brain mapping to avoid the resection of eloquent cortex. While excision of the epileptic focus generally has the best outcomes, meaningful reduction of seizure frequency and intensity can be obtained by interrupting the neural pathways which spread the seizures. Examples include functional hemispherectomy, multiple subpial transection and corpus callosotomy. Neurostimulation is another option, with vagus nerve stimulation (VNS) and responsive neuro stimulation (RNS) as FDA approved options.
The comprehensive epilepsy program was one of the original 3 investigational sites for VNS (vagus nerve stimulation), which was FDA approved for the treatment of refractory focal onset seizures in 1997, and participated in the multicenter Neuropace Responsive Neurostimulator (RNS) trial. We were the first center in Florida to implant the RNS after its FDA approval. In addition, the University of Florida is one of only a few institutions that has used LINAC (linear accelerator) radiosurgery specifically for the treatment of focal seizures.
Each individual and their family has a unique perspective on their own goals and quality of life. Whether you seek the latest in surgical and imaging techniques, or want to fine tune medication therapy, the UFHealth Comprehensive Epilepsy Program is ready to help.
For more information on Epilepsy Surgery see “Benefits continue to pile up for Epilepsy Surgery”
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For information on The Epilepsy Art Program click here.