Issue link: https://viewer.e-digitaledition.com/i/808749
Charles Szabo, MD, Co-director of the South Texas Comprehensive Epilepsy Center, Professor of Neurology at UT Health San Antonio The patient's medications are reduced or stopped to induce seizures under controlled conditions. Technicians watch and record the brain waves and video images of the patients in their rooms to capture the seizure as it occurs. Sta monitors patients around the clock. That's particularly important with children, who can be fidgety and restless while in bed for extended periods, says Linda Leary, MD, Associate Professor of Neurology at UT Health San Antonio, who oversees the pediatric epilepsy program. "When children come here for video monitoring, an EEG tech is there all the time making sure the electrodes stay on the child's head," Dr. Leary says. "The tech can also move the camera if a child gets out of bed." Imaging studies, including anatomical MRI, PET and SPECT, are among the tools that can pinpoint seizure activity and determine if a lesion in the brain is the cause. If a patient doesn't have a lesion, or if a greater level of detail is required from an EEG, surgeons now have a method called stereotactic EEG, which is less invasive than previous methods and allows them to collect precise information by placing electrodes into the brain through 10 to 20 tiny holes rather than removing a section of the skull. "You can put the electrodes right over the areas in the brain and pinpoint what needs to be resected," says Alexander Papanastassiou, MD, Assistant Professor of Neurosurgery at UT Health San Antonio, whose expertise is the surgical management of epilepsy and movement disorders. Furthermore, with implantation of subdural grid and strip electrodes, the functions of the brain can be mapped to see if it's safe to resect. WHEN SURGERY IS INDICATED If a patient is a surgical candidate, the first obstacle is usually fear. "That's a common misperception — not just among the patients, but among treating physicians who are not specialists in epilepsy," Dr. Papanastassiou says. "People overestimate the risk of surger y a nd underestimate the risk of epilepsy. The typical risk we have is about a 1 percent chance that we'll permanently hurt the brain. But what's interesting is, that's about the same chance Lola Morgan, MD, Co-director of the Center, Medical Director of the Epilepsy Monitoring Unit at University Hospital and Associate Professor of Neurology at UT Health San Antonio EEG epilepsy video monitoring 0 7 M D N E W S .C O M /// M D N E W S S A N A N T O N I O ■ 2 017