An All-Out Effort for Epilepsy

As a Level 4 center, the Johns Hopkins Epilepsy Center enjoys the highest degree of recognition conferred by the National Association of Epilepsy Centers. The designation means that it is a regional or national referral facility offering the full gamut of currently available medical and surgical therapies, particularly for patients with persistent seizures unresponsive to standard treatment.

On the Epilepsy Monitoring Unit, Dr. Gregory Bergey
confers with an EMU nurse.

But the Hopkins center encompasses all that and more: It manages a robust investigational drug program in which new medicines are tested in various stages of development. It offers patients enrollment in any number of clinical studies when appropriate.

And one of its most distinguishing features is a six-bed inpatient unit known as the epilepsy monitoring unit, or EMU. Here, a team of neurologists, neurosurgeons, nurses, psychologists and other specialists diagnose and treat difficult-to-manage seizures. Unlike many other units of its kind, the EMU admits both adults and children. All receive care from the same team of clinicians.

On the EMU, medicine dosages are adjusted so that seizures can occur in a safe environment and be recorded and analyzed. “You actually want patients to have events,” says neurologist Greg Bergey, director of the Epilepsy Center, “and that’s something that would certainly be difficult to do in the outpatient setting.” Patients admitted to the unit are connected to computerized EEG and video monitoring equipment 24/7, Bergey continues. “The video is particularly important because it shows you a pattern of behavior that is classic for the seizure.”

Patients on the EMU are also evaluated for seizure surgery, which, thanks to advances in imaging, recording and electrical brain-mapping, has become an increasingly effective tool in controlling seizures when medications have failed. EMU staff employ a variety of complex diagnostic techniques, such intracranial monitoring and neuro imaging, to identify seizure-generating brain tissue. The key is to find where the seizures originate and to be able to safely resect that tissue. Surgical procedures range from vagus nerve stimulation, to focal resection, to hemispherectomy for devastating epilepsies in children.

A second hallmark of epilepsy care at Hopkins is the unusually close relationship between the adult program and the John M. Freeman Pediatric Epilepsy Center, directed by neurologist Eileen Vining. Patients of all ages enjoy the benefit of the opinions of as many as 10 epileptologists at weekly rounds. “Our adult and pediatric groups are very well integrated, better perhaps than those at any other place in the country,” says Bergey.

Far too many patients have spent years suffering with intractable seizures that take a tremendous toll on quality of life, Bergey says. For patients like these, and for the physicians who treat them, he has one critical message: “Think earlier about evaluation, either as an outpatient or inpatient, at a comprehensive epilepsy center like Johns Hopkins.”

To refer a patient: 410-502-3415 (adults), 410-955-9100 (pediatrics)
Info: www.hopkinsneuro.org/epilepsy