Duke’s epilepsy program is a designated Center of Excellence and part of Duke’s nationally ranked neurology program. Our experienced epilepsy specialists offer a comprehensive epilepsy evaluation, a wide range of treatment options, and perform complex surgeries. We strive to make a seizure-free life an attainable goal for you.
Experienced epilepsy specialists
We understand that having a wide range of treatment options for epilepsy is important, because 30 to 40 percent of people with epilepsy do not respond well to medications and other therapies. Our experienced epilepsy specialists include neurologists with extensive training and decades of experience managing people with epilepsy, as well as a neurosurgeon specializing in procedures to treat people with epilepsy who don't have success with medication alone. Our expert evaluation and range of treatment choices help maximize your quality of life, while making a seizure-free life a realistic goal.
Choose epilepsy care at Duke because we offer:
- Reputation for excellence. We are a Level 4 Center of Excellence - the highest level of accreditation by the National Association of Epilepsy Centers. Our neurologic disorders programs are also consistently ranked among the top programs in the country by U.S. News & World Report.
- Team approach. Our experienced epilepsy specialists includes adult and pediatric epileptologists (neurologists with specialized training in epilepsy), a research epileptologist, general neurologists, neurosurgeons, neuroradiologists, neuropsychologists, and specially trained nurses and technologists.
- Technology designed for safety. Our epilepsy and neuro-intensive care units have an electroencephalogram (EEG) machine and video recording capabilities in every room. This allows for monitoring of the electrical activity in the brain. In addition, there is an MRI scan in the operating room to assist with the most challenging surgeries. Having this equipment accessible ensures you receive the safest care possible.
- Groundbreaking clinical trials. You may be eligible to participate in ongoing clinical trials for anti-epileptic drugs and medical devices, including efforts to improve the effectiveness of the vagus nerve stimulator and the use of the remote neurostimulator system. These devices are implanted to help improve seizure control. Our research also focuses on topics such as the genes that may be associated with epilepsy, and the use of EEG and new MRI techniques to monitor and evaluate seizures. By participating in clinical trials, you may have access to experimental therapies before they are available elsewhere.
Anti-seizure medications are the first-line treatment for epilepsy, and may be prescribed to relieve your seizures or reduce their frequency. If 3-5 medications have been prescribed and do not work to control your seizures, our experts will likely recommend surgery as the next treatment.
A pacemaker-like device is implanted in the chest wall with a wire that connects to your left vagus nerve. The device delivers weak electrical pulses that prevent seizures. Our experienced epilepsy specialists also offer investigational VNS trials to test new ways to program the VNS to detect seizures before they happen.
This device is implanted into the skull and connects to electrodes placed directly on or in the brain. The RNS monitors your ongoing brain waves and gives small electrical shocks to interrupt the electrical patterns that may lead to seizures.
A nutritionist works closely with you, and may recommend a modified Atkins diet or Ketogenic diet - two eating plans that have been effective in controlling seizures in some patients. These plans restrict carbohydrates and focus on high-fat, high-protein foods that may help the body generate and build up ketones, which can prevent seizures for reasons researchers still don’t understand.
As a designated Level 4 epilepsy center, our neurosurgeons are specially trained in epilepsy surgery. We use the most sophisticated surgical techniques available to treat your epilepsy. Our surgeons use the latest techniques including the use of laser assisted resection of the brain tissue. This technique, when combined with our MRI scan in the operating room, allows for the safest and most efficient methods of resecting areas of the brain where seizures may occur. The most common surgical procedures we use to treat epilepsy include:
- Anterior temporal lobectomy. Removes a portion of the brain’s temporal lobe, the most common area for seizure activity to start. This approach has a high degree of success in achieving long-term seizure freedom.
- Resection of seizure-causing lesions or scars. Removes tumors, vascular malformation, and developmental abnormalities that can cause seizures.
- Cortical resection. Removes brain tissue outside of the temporal lobe that is a source of seizure activity.
- Hemispherectomy. Removes portions of one half of the brain (a ‘hemisphere’) where seizures occur and cuts the corpus callosum that connects the two hemispheres. As a result, seizure activity cannot spread from one half of the brain to the other.
Our experienced specialists perform a comprehensive epilepsy evaluation to determine if surgery is right for you. It may occur in two phases:
- Complete medication review.
- Outpatient awake and sleep EEGs to detect electrical activity in your brain.
- Inpatient video EEG monitoring, which records your brain way activity and video records your seizure activity during a hospital stay.
- SPECT (single photon emission computed tomography) scans, which use radioactive materials to produce images that show changes in blood flow to your brain when you are having a seizure.
- Imaging studies with specialized MRI and PET (positron emission tomography) create detailed pictures of your brain, allowing doctors to find any lesions that could be causing seizures.
- Wada test (also referred to as the intracarotid amytal test) studies language and memory in one half of your brain by putting the other half to sleep with a temporary anesthetic. The Wada test is done to assure the surgical procedure being considered is a safe and appropriate for you.
We may recommend surgery after Phase I monitoring. Others may require more testing including invasive monitoring. Invasive monitoring involves using electrodes inside of the skull to pinpoint where the seizures are starting. These electrodes can either be an array of electrodes placed on the surface of the brain, or a depth electrode that is actually inserted into specific structures in the brain.