Neuromodulation for Epilepsy

With the highest designation as a level 4 epilepsy center, Norton Neuroscience Institute Comprehensive Epilepsy Center is the epilepsy treatment destination for Louisville and Southern Indiana. Our board-certified and fellowship-trained epilepsy specialists are at the leading edge of seizure treatment.

Treatments for epilepsy can include lifestyle and dietary changes, medication and surgery. Your custom epilepsy treatment plan will be based on several factors, including:

  • Your health history
  • Severity of symptoms
  • The type of epilepsy you have
  • Your age
  • Whether you plan on having a baby

It is important to get treatment for epilepsy as soon as you are diagnosed. Left untreated, your seizures can get worse or happen more often over time. Many people with epilepsy can live seizure-free with treatment. 

Surgical and Advanced Treatment Options for Epilepsy

For some people, medication is enough to control seizures, but in about one-third of people with epilepsy the condition is medication-resistant, meaning medication isn’t enough to control seizures or the side effects are too severe. Epilepsy surgery may be an option for you if at least two different medications fail to control your seizures, or the side effects of the medications are life-altering.

Norton Neuroscience Institute Comprehensive Epilepsy Center, with the highest designation by the National Association of Epilepsy Centers (level 4),  is a leader in epilepsy treatment for Louisville and Southern Indiana.

Epilepsy surgery has come a long way in the last 20 years. New techniques have been developed, and existing treatments have been refined and made more precise. There are minimally invasive approaches that allow the brain to be accessed through tiny holes in the skull using robotic assistance to pinpoint areas. Treatment has become more comfortable allowing for more effective results and quicker recovery.

Who Is a Candidate for Epilepsy Surgery?

Everyone’s epilepsy is different, and everyone responds to treatment differently. In order to determine which surgery is best for you and your condition, your provider will determine what type of epilepsy you have so they know where your seizures are starting. Talk to your health care team to see if surgery for epilepsy is right for you if other treatments aren’t working.

You may be a good candidate for surgery for epilepsy if:

  • You have tried two anti-seizure medications and they failed to control your seizures.
  • Dietary and lifestyle changes have not helped.
  • Anti-seizure devices did not help.
  • Side effects from anti-seizure medications are not tolerable.
  • Your seizures continue to be severe, frequent or debilitating.

In addition to traditional neurosurgical options and laser ablation, Norton Neuroscience Institute offers neuromodulator surgery options to patients with epilepsy

Types of Epilepsy Surgery

Just as there are several types of epilepsy, there are different kinds of epilepsy surgery:

  • Resective surgery involves a surgeon taking a small portion of brain tissue where your seizures are starting. This is one of the most common types of brain surgery for epilepsy. This surgery usually is done on the temporal lobes of the brain, which control visual memory, language comprehension and emotions. It is located behind the ears on both sides of the head.
  • Laser interstitial thermal therapy or LITT, is less invasive than resective surgery. Using an MRI guidance system, the surgeon pinpoints the part of the brain causing seizures. They use a laser to destroy a small portion of brain tissue.
  • Neuromodulation is a surgery that uses MRI guidance to place a device deep inside the brain. The device is connected to a battery-powered generator in the chest. The device releases regularly timed electrical signals that disrupt seizure-causing activity.

Norton Neuroscience Institute Comprehensive Epilepsy Center offers a range of minimally invasive and advanced treatments.

Neuromodulation and Its Role in Epilepsy Treatment

Neuromodulation is a method of changing the way electrical impulses are sent in the brain using small implantable tools, inserted during a minimally invasive surgery. This surgery can reduce seizures or stop them from happening.

Types of Neuromodulation for Epilepsy

While there are many treatments and combinations of treatments to help reduce or stop seizures, every case of epilepsy is different. Your health care team will help you decide the best course of treatment for you. Here is an overview of neuromodulation treatment for epilepsy.   

Vagus Nerve Stimulation

The vagus nerve is part of your parasympathetic (par-uh-SIM’-puh-THET’-ick) nervous system. This system controls processes in your body that you don’t consciously control, such as digestion, breathing and heart rate. The vagus nerve fibers send information to and from the brain, heart and digestive system. The left and right vagus nerves run from your brain to the large intestine, like a highway that runs through the neck, chest, heart, lungs, abdomen and digestive tract.

VNS has been used since 1997 when the U.S. Food and Drug Administration approved its use. It works via a device implanted in the chest, which is attached to wires that transmtit mild pulses of electrical stimulation to the vagus nerve in the neck. This makes the vagus nerve send pulses to the brain. The device is programmed to send pulses at regular intervals, with the goal of reducing electrical activity in the brain to lessen or prevent seizures.

If you feel you are having an aura (the signs you will soon have a seizure), you or someone else can use a special magnet to send an extra electrical pulse over the device in your chest. This may help stop the seizure.

VNS has proven to be effective in people who have drug-resistant epilepsy. Studies have shown that:

  • People with VNS had an average decrease in seizures by 28% in the first three months.
  • In a study of 112 adults with focal epilepsy who did not respond to medicines, the patients who had had VNS:
    • May have a shorter recovery time after a seizure
    • Reported improved quality of life
    • Had less worry about seizures and improved alertness
    • Reported their seizures were less severe

Responsive Neurostimulation

RNS was approved by the FDA in 2013 as an effective treatment for drug-resistant epilepsy. Similar to VNS, RNS uses a small implant and wires to control electrical impulses in the brain. The device — called a neurostimulator — is implanted under the skull. Wires (called leads) connect the device to the parts of the brain where your seizures start. RNS can stop seizures before they start by constantly monitoring brain activity.

You may be a good candidate for RNS if you:

  • Have partial (focal) onset seizures
  • Have seizures that originate in one or two areas of the brain
  • Have frequent and disabling seizures, even after trying two or more anti-seizure medications
  • Have seizures that start in an area of the brain that serves a critical function like speech or movement, which makes it difficult or impossible to surgically remove the seizure-causing tissue

Deep Brain Stimulation

DBS is similar to RNS — a small, battery-powered device is implanted and connects to wires into the brain. In DBS, however, the small device is implanted in the upper chest area instead of under the skull. DBS does not detect seizures before they happen, which is what RNS can do. Like RNS and VNS, DBS helps people who don’t respond to epilepsy medications. You might be a good candidate for DBS if other surgeries are not an option for you or if two medicines didn’t control your seizures.

Benefits of Neuromodulation for Epilepsy

Neuromodulation has been a great relief to the roughly 1 million Americans with drug-resistant epilepsy. Other benefits of neuromodulation for epilepsy:

  • The procedure is reversible — the devices and wires can be removed, if needed.
  • It is a minimally invasive procedure, meaning generally faster recovery.
  • New techniques make placement of electrodes and leads very precise, which means better outcomes for patients.
  • Fewer or no seizures can mean an improved quality of life for patients.

In general, neuromodulation is very safe. However, everyone’s body responds to medicine and surgery differently, and everyone has a different experience with neuromodulation. It is important to talk to your doctor about risks associated with surgery.

Pre-surgical Testing

Epilepsy pre-surgery tests help determine where your seizures begin in your brain and whether that tissue can be removed or disabled with a laser or similar tool. Tests also help your health care team understand what functions are controlled by those affected parts, and to predict the possible outcome of the procedure.

You might be referred to the Norton Neuroscience Institute’s epilepsy monitoring unit, where your unique situation will be evaluated by a team of neurology specialists over the course of a few days. While there, you might have some tests, including:

Electroencephalogram (ee-leck-troh-en-SEFF’-uh-luh-gram) or EEG ­­will use electrodes to measure the brain’s electrical activity to identify the source of the seizure.

Positron emission tomography (POZ’-eh-tron ee-MISS’-shun toh-MOG’-gra-fee) or PET can identify where a seizure begins even when you’re not actively having a seizure. Health care providers may use it along with MRI.

Neuropsychological (nur-oh-sy-coh-LOJ’-eh-cul) evaluation and functional MRI check your verbal skills, memory function and other learning skills. This testing serves as a baseline for measuring and comparing any changes before and after surgery. A functional MRI test measures brain activity while performing a cognitive function, such as reading. This helps your health care provider know which areas of your brain control these functions.

Wada testing involves using a needle to inject a medicine into your body that puts one side of your brain to sleep for one to five minutes. This lets your care team test your language and memory in the other (awake) half. The test helps identify which side of your brain is dominant for different functions.

The Surgical Procedure

Once your care team develops a plan for you, it may include surgery. There is some variation depending on type of surgery, but here is what you can expect:

Pre-surgery, your provider will determine where hair may need to be adjusted over the section of the skull that will be removed during the operation to prevent infection. A small, flexible tube called an IV is placed in your arm to give you fluids, anesthetics or other medicines during the surgery.

During epilepsy surgery, your heart rate, blood pressure and oxygen levels are monitored throughout. An EEG monitor may record brain waves during the operation to better localize the part of the brain where seizures start. Brain surgery for epilepsy is usually done with general anesthesia, which means you will be asleep during the procedure.

After surgery for epilepsy, you will go to a special recovery area to be monitored carefully after awakening from anesthesia. You will usually be moved to the intensive care unit for the first night after surgery. The average hospital stay for most epilepsy surgeries is three or four days.

The surgery incision will be swollen and painful. Most people need to take pain medicine for at least the first few days. An ice pack on the painful area also may help. Most swelling and pain go away within several weeks.

Most people are not able to return to work or school for about one to three months. You will concentrate on resting and relaxing during this time. It will take some time before you feel “normal.” It’s important to go to any follow-up visits with your health care team and call with any questions or concerns.

After Epilepsy Surgery and Beyond

Brain surgery can have a profound impact on your life. Recovery from brain surgery depends on what sort of procedure you had, how you respond to the procedure and how your body heals.

During your recovery period, you will be adjusting to a new normal. You will notice changes in memory, thinking ability and energy levels. You will adjust to the number of seizure episodes you have. It is very common to experience a wide range of emotions such as fear of the unknown, depression and anxiety. Talk to a mental health specialist who can offer support and guidance.

We know more now about epilepsy and its treatments than ever before. As techniques and treatments are refined, Norton Neuroscience Institute continues to be at the forefront of these treatments and research.  The Norton Neuroscience Institute Comprehensive Epilepsy Center’s goal is to help you live a full life with epilepsy through advanced treatment, specialized care and patient support resources.

Care That’s Focused on You

It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition.

  • Dedicated patient navigators can help schedule follow-up appointments, coordinate prescription assistance, create customized diet plans and provide guidance on disability benefits, housing, financial and employment concerns, and more.
  • Patients can access support groups, exercise classes and other educational events to connect with others and learn how to make the most of life while managing a neurologic condition.
  • Access an on-demand video library of educational content across a variety of condition-related topics is available.
  • We want to help prevent illness. Get help quitting smoking, and learn the signs of stroke.

A Louisville Leader in Neurological Care

More patients from Louisville and Southern Indiana seek their neurology and neurosurgery care from Norton Neuroscience Institute’s nationally recognized specialists than any other providers in the area.

Your Norton Neuroscience Institute medical provider has the expertise, experience, diagnostic tools and sophisticated treatments to provide care tailored to your needs.

  • More than 130 medical, surgical and research specialists are dedicated to providing innovative care to those with brain, spine and nervous system conditions.
  • Advanced, minimally invasive neurosurgery equipment can speed your recovery and minimize pain.
  • Multidisciplinary clinics provide easy access to care in one convenient appointment for your neurologic condition, with specialists in oncology, cardiology, orthopedics and behavioral health.
  • Norton Healthcare’s four adult-service hospitals in Louisville are certified by DNV, recognizing excellence and expertise in stroke care.
    • Norton Brownsboro Hospital is recognized as a Comprehensive Stroke Center.
    • Norton Audubon Hospital and Norton Hospital are Primary Stroke Centers.
    • Norton Women’s & Children’s Hospital is an Acute Stroke Ready Hospital.
  • Norton Neuroscience Institute is at the forefront of neuroscientific research. As investigators on numerous trials, our physicians contribute to groundbreaking studies and publications in peer-reviewed journals. Also, patients may be eligible to take part in these experimental treatments.
    Learn more about current neuroscience clinical trials and studies.
  • The American Heart Association Get With the Guidelines stroke care program has recognized all four of Norton Healthcare’s adult service-hospitals in Louisville for exceeding national averages in getting patients in the door and administering lifesaving treatment to restore blood flow to the brain.
  • Norton Neuroscience Institute’s multiple sclerosis (MS) program has been designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society.
  • The National Association of Epilepsy Centers has recognized Norton Neuroscience Institute Comprehensive Epilepsy Center as a level 4 center, providing the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy.
  • Norton Hospital’s neurosurgical intensive care unit is recognized with a silver-level Beacon Award for Excellence by the American Association of Critical-Care Nurses.
  • Norton Neuroscience Institute Resource Center navigators help educate patients and their families about new diagnoses, available treatments and ways to manage their disease.
  • Communicate with your provider, manage appointments, refill prescriptions, get an alert if an earlier appointment becomes available, and more anytime from a computer or mobile device with a free Norton MyChart account.

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