All About the Epilepsy division
The foundations of epilepsy patient care and scientific epileptology at the University of Florida were laid by BJ Wilder and RP Schmidt over half a century ago. Dr. Wilder (known to friends and colleagues the world over as ‘BJ’) was instrumental in several pivotal studies that led to the approval of many second generation anticonvulsant medications. In 1992, the epilepsy surgery program was launched to complement the medical aspects of the program and offer truly comprehensive care for both children and adults with epilepsy. Today, we are a National Association of Epilepsy Centers Level IV program that provides compassionate, patient-centered and innovative care for epilepsy.
‘It takes a village’. Quality comprehensive care for epilepsy can only be provided by a multidisciplinary effort that is coordinated to serve the patient’s best interests. At UFHealth, direct patient care is provided by a vibrant team of physician and nurse practitioner providers that partners with an adult and pediatric neurosurgeon. The provider group is the tip of an iceberg that includes a large team of EEG technologists, administrators and administrator assistants, a research nurse, hospital nursing staff and clinic medical assistants. For complex patients, our team also includes neuropsychologists, neuropathologists, neuroradiologists and a dietary biochemist.
The Epilepsy Division is staffed by a multidisciplinary team of expert physicians and healthcare providers. As an NAEC Level IV program, we endeavor to provide the best care, and the most-up-to date information about all aspects of epilepsy to our patients. While there is an abundance of information about epilepsy available on the Internet, our team has compiled a list of websites that contain authentic and useful information about epilepsy. Please remember that the field is constantly evolving, and information gathered should always be discussed with your provider. We are always available for patients and their carers to contact us directly with questions.
Our outpatient program services over 5000 patients from north and central Florida, and we see referrals from all over the state of Florida and the southern United States. We offer expert evaluation of patients suspected to have seizures, new patients following their first suspected seizure, and patients with a longer history whose seizures remain difficult to manage.Our waiting list for new patients is under two weeks, and we can usually see urgent patients sooner. All outpatients are offered a detailed and unhurried evaluation of their seizure disorder. Patients always have access to our staff through our phone lines and the patient portal of our electronic medical record system.
Inpatient services revolve around hospitalized patients undergoing continuous EEG monitoring of some type. The Epilepsy Monitoring Unit (EMU) is a dedicated 8-bed unit on the 5th floor of the Neuromedicine Hospital (NMH) serving epilepsy patients specifically admitted for diagnosis or pre-surgical workup of of refractory epilepsy. Patients undergoing invasive EEG monitoring are jointly managed by the epilepsy faculty, critical care faculty and the neurosurgery service in the Neurointensive Care Unit on the 4th floor of NMH. The Epilepsy Division also oversees continuous portable video-EEG monitoring (long-term monitoring; LTM) on acutely ill patients across the entire UFHealth Gainesville campus.
Neurodiagnostic services are fully integrated into our bright and airy workspace at the UFHealth Neuromedicine Hospital. The outpatient EEG lab performs routine EEG, multi-day ambulatory EEG, short (6-hour) video-EEG, evoked potentials and PET-EEG. The inpatient EEG service performs long-term monitoring (LTM) across the entire UFHealth hospital complex, in addition to serving the Epilepsy Monitoring Unit (EMU). Magnetoencephalography (MEG) and transcranial magnetic stimulation (TMS) are planned additions within the next year, which will make UFHealth neurodiagnostics among the most comprehensive clinical neurophysiology services anywhere in the nation.
The epilepsy surgery program at the University of Florida was started in 1992 to expand treatment options for patients with seizures not controlled by medications alone. Since then we have performed over 1500 surgical procedures for epilepsy. Epilepsy surgery is a complex process supported by our entire interdisciplinary team of physicians, surgeons, radiologists, neuropsychologists and many other providers. We combine a substantial historical experience with adoption of the emerging technologies of stereoelectroencephalography (SEEG), minimally invasive approaches (laser ablation therapy) and responsive neurostimulation (RNS) to offer a truly comprehensive treatment approach tailored to the individual patient.
While the traditional methods of treating epilepsy – with antiseizure drugs and with brain surgery – continue to advance, a further method of controlling seizures – neuromodulation – is rapidly evolving. ‘Neuromodulation’ is the process by which certain brain areas are activated electrically so that they may influence other brain areas to reduce the tendency for seizures. The science behind neuromodulation remains incompletely understood, but the positive effect on seizures can be significant. The first neuromodulatory treatment to be FDA-approved was vagal nerve stimulation (VNS), but in recent years RNS (responsive neurostimulation) and DBS (deep brain stimulation) have been approved for use in selected patient populations.
Treatments for epilepsy are under constant evolution, as the epilepsy community tries out new therapies to improve epilepsy care. Several of the major pharmaceuticals currently FDA-approved for the treatment of epilepsy underwent early trials at UF. Our team believes that complementary therapies – diet based, such as the Modified Atkins Diet, or hormone based for catemenial seizures – can have a strong therapeutic effect. We offer clinical trial participation for eligible patients, and alternative treatments are always available for those who have failed more conventional treatments in the past. While conventional treatments are always offered first, our providers will be happy to discuss alternative treatments.
Resident training in epilepsy and EEG is fully integrated into the overall training scheme of the UF neurology residency program. Despite the breadth of the subject of clinical epileptology, members of our Division aim to impart knowledge that is clinically important and comprehensive for the practicing general neurologist, yet succinctly conveyed. In addition, being a tertiary referral center, we also expose trainees to the challenges of complex and surgical epilepsy syndromes, so that they may glimpse the excitement and promise of this rapidly-evolving neurology subspecialty.
Fellowship training has been a long tradition at UF and we currently offer a one-year fellowship in Clinical Neurophysiology. Two positions are available, with the relative EEG/Epilepsy versus EMG/Neuromuscular emphasis left to the interest of the Fellow. Starting in the academic year 2020, we will offer a full-fledged Epilepsy & EEG fellowship as an ACGME accredited, one-year program. The latter fellowship will offer a structured educational curriculum with ample opportunity for clinical and translational research, underscored by significant experience of complex adult and pediatric epilepsy.
We are proud to exist in the #1 university in the State of Florida and the #8 public university in the country; UF’s combined neuroscience research program recently ranked #2 among public universities. The Wilder Center for Epilepsy Research houses the Division’s research efforts and our core members and affiliates pursue a number of themes in the brain science around epilepsy; interdisciplinary collaborations are encouraged. The Wilder Center also hosts a week-long annual visiting professorship of epilepsy each spring, at which time an annual update conference for the UF community is held.