What is Epilepsy

What is a seizure?
A seizure is an episode that manifests with variable neurologic symptoms due to abnormal, excessive, and synchronous brain activity. The abnormal brain activity may start from a localized area of the brain, which is called a seizure focus or an epileptogenic zone. The symptoms can range from abnormal sensation (e.g., tingling, abnormal taste), abnormal movements of parts of the body (e.g., shaking, stiffening, convulsion), and/or altered awareness (e.g., staring, loss of consciousness), depending on where and how abnormal brain activity starts and spreads.

What is epilepsy?
Epilepsy is a medical condition in which patients experience recurrent seizures. Epilepsy may have long-term adverse effects on the brain functions, especially when not well controlled. Epilepsy in pediatric patients, if not treated and well controlled, may adversely affect brain growth in addition to brain function.

What causes seizures? Who suffer from epilepsy?
Developmental abnormalities of the brain, which some patients are born with, may cause seizures and epilepsy starting immediately after birth or during childhood. These abnormalities include genetic conditions or injuries suffered during pregnancy (e.g., stroke, infection). Patients may also acquire neurological conditions later on in life that predispose them to seizures, such as brain trauma, infection, or stroke.

How is epilepsy treated?
Most epilepsy patients are successfully treated with medications (anti-seizure medications: ASMs), as they are closely followed and managed by epileptologists (neurologists who specialize in evaluation, diagnosis, and medical treatments of epilepsy patients). Special diets or epilepsy surgery can be considered in certain patients, especially when AMSs are ineffective at controlling seizures.

Who needs surgery?
About 1/3 of epilepsy patients continue to suffer from drug-resistant epilepsy (DRE) despite multiple trials of antiseizure medications (ASMs). When epilepsy is not controlled despite appropriate trials of at least two ASMs, the chance of adequate seizure control with ASMs alone is low. Also, long-term use of ASMs, especially when prescribed at high doses, can cause side effects in some patients. Therefore, after failing 2 ASMs due to ongoing seizures, patients should consider undergoing evaluation for epilepsy surgery, in discussion with their treating neurologist. Results from various non-invasive studies are reviewed and discussed in our multidisciplinary epilepsy surgery conferences to plan for individually tailored surgical treatments, if deemed appropriate. Some patients may require implantation of invasive electrodes directly into the brain (placed by a neurosurgeon in the operating room) to guide their surgical treatment.

Who should come to see the experts at CECNJ at Rutgers?
Any patients who suffer from seizures or epilepsy of any type and resulting from any condition can be evaluated by our experts for evaluation, diagnosis, and management. Typically, they are first seen by an epileptologist who directs the initial work-up and treatment with antiseizure medication (ASM). Patients who have already been evaluated by experts outside our program can be also referred for further evaluation and management, a second opinion, and/or surgical consultation.

What epilepsy conditions are treated by the experts at CECNJ at Rutgers?
Any condition causing seizures or epilepsy, ranging from genetic conditions, developmental abnormalities, stroke, trauma, brain tumor, infection, or otherwise unknown causes are all evaluated and treated by the experts at CECNJ at Rutgers. Some of the examples are as follows:

Infantile spasms
Cortical dysplasia
Malformation of cortical development (MCD)
Hemimegalencephaly
Congenital porencephaly
Rasmussen encephalitis
Sturge-Weber syndrome
Tuberous sclerosis
Perinatal strokes
Focal seizures
Generalized seizures
Hippocampal sclerosis (mesial temporal sclerosis: MTS)
Temporal lobe epilepsy
Frontal lobe epilepsy
Gliosis
Cavernous malformation (cavernoma)
Strokes
Traumatic brain injuries
Low grade glioma

What treatments are offered by the experts at CECNJ at Rutgers?
We offer a wide range of treatments available at leading academic epilepsy centers worldwide, ranging from noninvasive medical treatment, dietary therapy, to invasive surgical treatments. Surgical treatments include traditional resective/disconnection surgeries (e.g., lesionectomy, temporal lobectomy, frontal lobectomy, corpus callosotomy, functional hemispherotomy), vagal nerve stimulation, modern neuromodulation techniques (e.g., responsive neurostimulation [RNS], deep brain stimulation [DBS]), and minimally invasive MRI-guided laser interstitial thermal therapy (LITT). We also offer intracranial recordings to localize a seizure focus and thus to guide treatments, either minimally invasive stereo-electroencephalography (stereo-EEG) or craniotomy (opening of a portion of the skull) with placement of surface and depth electrodes.