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as somebody dying or having a serious injury from epilepsy each year." Dr. Leary agrees. "There are two sides to it. Epilepsy surgery can seem terrify- ing. On the other hand, the long-term decline that you can see in children with continued, uncontrolled seizures is ter- rifying as well." Patient education is a big part of what physicians and sta at the Center do. Not only do patients and family members learn about their particular condition and options, but a lso about the brain itself. Dr. Papanastassiou explains to patients the cortical association areas, in which various parts of the brain are able to contribute to a particular task. If one of those parts is surgically removed, the other parts can take over those duties. I f pa t ient s a r e c onc er ne d a b out c ut t i n g h a i r for epi lep s y s u r ger y, Dr. Papa na st a ssiou says a lmost a l l surgica l procedures can be done with hair-sparing techniques. Surgical resection is the "gold stan- da rd" for the treatment of medica lly refractory patients who don't respond to medications, Dr. Papanastassiou says. Cure rates in those who are good candi- dates for surgery are in the range of 50 to 70 percent for temporal lobe epilepsy, a nd about 30 to 50 percent for neo- c or t ic a l epi leps y — " wh ich mea n s epilepsy outside the tempora l lobe," Dr. Papanastassiou says. "That might not sound amazing, but when you start comparing them to less than 5 percent (the chance of success with a third or subsequent medication), it's pretty amazing," he adds. Some patients may be candidates for a less-invasive laser ablation technique that is a significant improvement over ea rlier ablation procedures. Pa r t of the improvement is the availability of ma g netic resona nce t hermog raphy, which is an MRI that not only provides the anatomical makeup of the brain, but can measure temperature — making it safer and more precise. While the laser ablation is best suited for patients with smaller lesions, it's very good for lesions that are deep and small — which makes them hard to reach in open resection, Dr. Papanastassiou says. For patients who aren't candidates for surgery or who continue to have seizures after surgery, neurostimulation is an option. Vagus nerve stimulation uses a pacema ker-li ke dev ice that sends impulses to the brain through the vagus nerve that passes through the neck. A newer option is the Neuropace RNS device, which uses implants in the brain to detect the onset of a seizure and then stimulate the brain to interrupt it. CHILDREN WITH EPILEPSY Some children have epilepsy syndromes at a young age, but their symptoms can resolve after puberty. Others may have hard-to- treat seizures that can aect their cognitive abilities over time. And some may not have epilepsy at all. "Sometimes what we're doing is evaluat- ing children who have strange spells and people aren't sure if they're seizures," Dr. Leary says. "So some of our monitoring is oriented toward just trying to figure out if it's epilepsy or not, and guide appropri- ate treatment." Children and adolescents a lso have unique psychosocial needs. "There certainly are challenges as far as children progressing in school and remem- bering the information that's presented if they're having frequent seizures," Dr. Leary says. "With adolescents, sometimes the downside isn't the seizures. It's the fact their parents don't let them do things because they're afraid they'll get hurt. A driver's license is huge." "Kids have a lot more plasticity in the brain, so especially if they have a large malformation of cortical development, the best time to address it with surgery is early on when they have the most plasticity," Dr. Papanastassiou says. "And the earlier a kid can get to a comprehensive epilepsy center, the sooner we can figure out if he or she can benefit from surgery." The Center works closely with com- munity neurologists, who can arrange to have their patients admitted to the Epilepsy Monitoring Unit. "We oer referring physicians the oppor- tunity to evaluate their patients, giving feedback to help them provide more eective medical care to their patients," Dr. Szabo says. "Or, if the patient turns out to be a good surgical candidate, we can oer further evaluation of the risks of surgery so the patient, caregivers and neurologists can decide on the best therapeutic approach." To learn more about the South Texas Co mp reh e n s ive E p il e ps y Ce nte r, v i s it unive rs it yh ea lth s yste m .co m /se r v i ces/ neuroscience/epilepsy or call 210-358-1587. ■ Linda Leary, MD, Associate Professor of Neurology at UT Health San Antonio The South Texas Comprehensive Epilepsy Center offers a range of surgical options for complex epilepsy patients. 0 8C O V E R S T O R Y