Comprehensive Epilepsy Program

What is Epilepsy?

Epilepsy is defined as having two or more unprovoked seizures.  Seizures are sudden changes in the electrical activity of the brain.   They cause changes in behavior, sensations, awareness and motor function.  Epilepsy is now divided into four basic types: Generalized, Focal, Generalized and Focal, unknown if generalized or focal.

Who is Affected by Epilepsy?

1% of the US population suffers from epilepsy:  3 million adults and 470,000 children.

It is the 2nd most common neurologic disorder affecting over 1 million patients in the US.

Epilepsy Treatments:

Medications:

Anti-epileptic medications continue to be first line treatment for epilepsy.  2/3 of patients with epilepsy are well controlled with medications alone.

30% of patients are not well controlled with anti-epileptic medications. Despite the many new medications being introduced over the last 25 years this number has remained stable.  Early consideration for surgical options is important when medications fail to provide seizure control.

Surgical treatment for epilepsy:

When focal epilepsy becomes refractory to medication management then surgical options should be considered early.  Surgical options for medical refractory focal refractory epilepsy can provide a 50-80% chance of seizure freedom.  Alternatively patient who have failed multiple medications have less than a 10% chance at good seizure control.

Localization is the key: For patients who have epilepsy that is not well controlled on medication localization is important to long term management.  Multiple surgical options are available for treating epilepsy and the choice of procedure is often determined by the location of the seizures.  Long term inpatient video EEG monitoring and Stereoelectroencephalography (sEEG) monitoring is available for targeting seizure origins. These services are available for both adults and children at Oishei Children’s Hospital of Buffalo.

RNS- Brain-responsive neurostimulation:  This new technology records the electrical activity of the brain and can recognize the early brain activity seen in seizures.  When a seizure is detected the RNS will stimulate the brain and suppress the seizure activity. Patients report a 75% reduction in seizure activity at 9 years (RNS website)

Anterior Temporal Lobectomy– Surgically the skull is opened and a portion of the Temporal lobe is removed.  Although this is an invasive operation an anterior temporal lobectomy can provide a good chance to cure epilepsy.

Laser ablation– This minimally invasive surgery has less recovery and less pain.  During surgery a laser probe is inserted through a small hole in the skull.  The probe is advanced and guided using MRI to its target.  In real-time the laser is utilized to remove the seizure focus without damage to the surrounding tissue.

VNS – Vagal Nerve Stimulation provides electrical impulses to the brain by utilizing the vagus nerve. These mild impulses are routinely delivered by an implantable device in the chest wall.  Stimulation can additionally be triggered with the use of a magnet that the patient wears on the wrist.  Vagal Nerve Stimulators decrease the overall number of seizures that patients experience and can prevent seizures from occurring.

DBS – Deep brain stimulation: Approved for the treatment of focal epilepsy that is not well controlled with medications when other surgical options are not appropriate.  This therapy uses a surgically placed electrode in the brain to stop brain signals that cause seizures.

How do I become a patient: Contact Dr. Jonathan Riley at 716-218-1000 for epilepsy consultation.

Links to include: John R. Oishei Children’s Hospital https://www.ochbuffalo.org/care-treatment/epilepsy

Epilepsy Foundation https://www.epilepsy.com/

Pre-surgical Evaluation

Electroencephalography (EEG)

This is the first and most important tool for evaluating epilepsy. EEG detects the brain’s natural electrical activity and helps specially trained physicians (neurologists) diagnose and classify epilepsy. When combined with video monitoring in a special hospital unit devoted to epilepsy evaluation, EEG can help neurologists determine what part of the patient’s brain is responsible for their seizures. Other neuroimaging techniques including MRI, PET and SPECT studies can also be used.

Neuropsychological Testing

Neuropsychologists are doctors of psychology who study the relationship between human behavior and brain function. Detailed written and oral testing by a neuropsychologist can help determine how well various regions of an epilepsy patient’s brain are working. The testing usually focuses on language and memory abilities. Sometimes this information can help to localize the origin of someone’s seizures. More often, however, it provides an estimate of how well an epilepsy patient will be able to function after epilepsy surgery.

Adult Neurosurgery Locations

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  • Gates Vascular Institute

  • Summit Medical Campus

  • Conventus Building

  • Comprehensive Neuroscience Center

Surgical Locations:  Sisters of Charity Hospital, Niagara Falls Memorial Medical Center, Millard Fillmore Suburban Hospital, Mercy Hospital of Buffalo, Buffalo General Medical Center, Gates Vascular Institute, Kenmore Mercy Hospital

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