The Epilepsy Program at The Alan and Barbara Mirken Department of Neurology
offers all the latest expertise, technology and multidisciplinary approaches
to diagnose and treat epilepsy, as well as provides support to you and your
When you first arrive at the epilepsy program, an epileptologist (a neurologist
with special training in treating epilepsy) will lead the team to accurately
diagnose and further understand the kind of seizures you experience and
what kind of epilepsy you have. These conclusions will inform what kind
of treatment you will begin. Diagnostic approaches and tests include:
A physical examination will be conducted and a comprehensive personal
and family history taken. Close friends or family may be asked to report
their observations of your seizures. Blood work may also be taken to rule
out other conditions that may be causing your seizures.
Several imaging tests may be used to both rule out other conditions that
may be causing your seizures and to further explore if there are brain
abnormalities like a tumor that may be triggering your epilepsy. Imaging
technology includes Computed Tomography Scan or CT scan (pronounced sometimes
as "cat"). This is an X-ray procedure enhanced by a computer, which results
in a three-dimensional view of the brain.
We also have Magnetic Resonance Imaging (MRI), which uses a magnetic
field and radio waves to produce highly accurate, computer-enhanced, cross-section
images of the brain. Beth Israel's epilepsy program uses the new 3-tesla
MRI, which increases the magnetic strength of the standard MRI and is
able to better detect more subtle brain abnormalities.
Positron Emission Tomography (PET) scans and Single Photon Emission Computed
Tomography (SPECT) scans are tests that use tracers injected into the
body to view the brain's metabolism and function. These tests complement
the MRI scan. The MRI scan provides neuroanatomical information; the PET
and SPECT scans provide more information about brain function.
The standard outpatient EEG records and measures 30 minutes of your brain's
electrical activity. About half of the patients with epilepsy will show
the conclusive diagnostic abnormalities in a single EEG. When conducted
in a larger series (typically three), the EEGs will catch the conclusive
abnormalities in nearly 90% of the patients with epilepsy.
If, after a thorough outpatient evaluation (and with other possible
seizure-causing conditions being ruled out), diagnosis is still unclear,
video EEG monitoring can be conducted. Patients are admitted overnight
to the epilepsy program's dedicated monitoring unit at Mount Sinai Beth Israel. The 24-hour EEG monitoring can often spot the subtle abnormalities
that the standard EEG does not always find.
Neuropsychological Testing and Brain Mapping
Often used as a pre-surgical evaluation, the epilepsy team has several
ways to map the brain so as to better understand what parts of the brain
are being affected by epilepsy, so that important functions like language
or memory are not compromised during surgery. First the epilepsy team
carefully and safely anaesthetizes various parts of the brain, while keeping
the patient conscious. Then, using either EEG technology or MRI technology,
as well as interviewing the patient, the epilepsy team's epileptologist
and neuropsychologist (along with appropriate test technologists) pinpoint
the affected areas in the brain.
While many cases of epilepsy cannot be cured, they can be managed effectively
with medication, electrical stimulation and sometimes surgery. Treatment
The first line in the control of epilepsy is medication. Many tried and
true medications have been in use for decades and are still available,
but newer generations of drugs are offering many patients better quality
of life with good seizure control and less side effects in the short-
and long-term. Beth Israel's epilepsy team has years of experience in
matching the right drug to the right person and to the right seizure history,
helping the patient navigate the early trial period when side effects
and seizures are noted and dosage and types of medications are tailored.
Nearly 75% of people with epilepsy will find a satisfactory outcome with
Vagus Nerve Stimulator (VNS)
This electrical simulator device can be implanted under the chest muscle
(similar to a heart pacemaker) with the wire tunneled under the skin and
ending in the neck under the vagas nerve. The epilepsy experts program
the stimulator to give a series of intermittent and ongoing stimulations
to the nerve at various strengths and frequencies.
It is not entirely clear how the VNS works, but scientists speculate
that the device scrambles or blocks some of the abnormal electrical discharges
in the brain. While the VNS works on an automatic, preprogrammed cycle,
it also has the ability to be activated when a magnet is swept over the
device from the outside of the body, allowing patients to self-activate
it. For those who can sense a seizure is about to start, the VNS can be
useful in stopping the process. For patients who cannot sense an impending
seizure, it can be useful for family and companions to shorten the seizure,
which leads to faster recovery. The magnet also provides an easy and non-invasive
way for the epilepsy team to both test and fine-tune the VNS's programming.
Some people with epilepsy have seizures caused by brain tumors, vascular
malformations in the brain, or developmental brain abnormalities. If these
abnormalities can be found, mapped and identified through the epilepsy
program's sophisticated imaging technology, these people are possible
candidates for surgical removal of the offending brain formations. Other
people can be good surgical candidates, too, not because of obvious brain
malformations, but because rigorous diagnostic tests have determined that
their seizures are localized to a focused area of the brain and can be
surgically treated. A thorough pre-surgical screening is done on all candidates
to evaluate whether surgery can be done without compromising normal brain
function. We work closely with the neurosurgery team at Mount Sinai West, led by Dr. Robert R. Goodman, to determine which patients would benefit from surgical treatment.When appropriate and successful, such surgeries are, in effect,
The epilepsy team stays abreast of the latest thinking in treatment including
the potential of complementary medicine. Patients who are interested in
such alternative approaches are encouraged to bring up discussions with
the team during their evaluation.
Epilepsy and Other Conditions
Epilepsy can both complicate other conditions or other conditions can
cause barriers to the use of certain epilepsy medications and treatments.
The epilepsy team is well experienced in managing both epilepsy and other
conditions (called co-morbidities) including: high cholesterol, osteoporosis,
pregnancy, diabetes, and mood and anxiety disorders, among many others.
This expertise is especially essential when treating older adults with
epilepsy, as many older adults often cope with several chronic conditions.
Searching for, diagnosing and analyzing co-morbidities is an important
part of Beth Israel's epilepsy program's comprehensive evaluation.
While Beth Israel's epilepsy program is built on a foundation of state-of-the-art
clinical excellence and research, it is infused, too, with a spirit of
compassion, support and patient education. From evaluation and diagnosis,
to prognosis and treatment, to careful and ongoing monitoring and management,
the patient and his or her family are carefully taught how to live with
epilepsy and what to expect.
Patient education is provided in individual sessions and through an
ongoing series of patient education seminars, including some conducted
Emotional and practical support is further provided via our access and
referral to counseling, social services and support groups.