Epilepsy is a lifelong condition for which there is currently no cure. But most people with epilepsy can get relief from seizures with the right treatment plan.
The Penn Medicine Comprehensive Epilepsy Center is a Level 4 epilepsy center, which means we offer all available nonsurgical and surgical treatments for people living with epilepsy and seizures. Our team of specialists collaborates with each other—and with you—to understand what’s causing your seizures and find the treatment that brings you the best seizure control.
Medication to Treat Epilepsy
The first treatment option for most people with epilepsy is medication. Anti-seizure medications successfully control seizures in about 70 percent of people with epilepsy. Epilepsy that does not respond to medication therapy is known as drug-resistant epilepsy.
These medications are classified into two groups, based on the type of seizures they treat:
- Broad-spectrum anti-seizure medications treat either generalized or focal seizures. Generalized seizures affect the whole brain, while focal seizures take place in a specific or localized area in the brain.
- Narrow-spectrum anti-seizure medications treat focal seizures.
There are dozens of anti-seizure medications available. Your neurologist will choose one for you based on the types of seizures you experience and your individual medical history. Some people get the best seizure control from a combination of several medications.
Lifestyle Modifications to Manage Epilepsy Triggers
Certain exposures, moods, or events called triggers can cause abnormal electrical activity in the brain that results in seizures. Your doctor can help you identify and understand any seizure triggers you may have and work with you to find ways to avoid those triggers.
Common seizure triggers include:
- Alcohol/recreational drug use or withdrawal
- Flashing, bright, or fluorescent lights or patterns
- Hormonal changes, especially during pregnancy or menstruation
- Illness/fever/body temperature changes
- Missed anti-seizure medication doses
- Mood (anxiety/depression/stress)
- Noise
- Sleep disturbances
For people with certain types of epilepsy, dietary changes may help control seizures. The ketogenic diet is high in fat and low in carbohydrates. This diet can reduce seizure frequency in children and adults with drug-resistant epilepsy.
Surgical Treatment for Epilepsy
Doctors may recommend epilepsy surgery for people who do not achieve seizure control with medications and lifestyle changes. Surgery is typically considered after a person with epilepsy does not respond well to two or three different anti-seizure medications.
Surgical treatments for focal epilepsy remove areas of the brain that cause abnormal electrical activity. Surgeries for generalized seizures often involve implanted devices to control or stop seizures within the brain.
Pre-Surgical Planning
Before epilepsy surgery, your surgical team identifies where seizures occur in the brain using a method called brain mapping. Brain mapping helps doctors decide if surgery is the right treatment option and carefully plan surgeries for the best outcomes.
Several different monitoring methods can help map abnormal activity in the brain:
- Intracranial EEG (IEEG): This type of EEG usually takes place in an inpatient epilepsy monitoring unit (EMU). Electrodes placed within or on top of your brain record seizure and brain activity. IEEG helps determine the size of the brain region that is affected by the seizures.
- Subdural grid and strip EEG: Your neurology team places a series of electrodes on a thin piece of plastic on the surface of the brain to monitor a larger area for seizure activity.
- Stereotactic EEG (SEEG): SEEG involves a minimally invasive inpatient procedure to place thin, flexible wire electrodes in the brain to precisely monitor seizures. At Penn Medicine we use the robotized stereotactic assistant (ROSA) robotic system to guide electrode placement. When we are finished recording brain activity, we remove the electrodes in a second surgical procedure.
Focal Resection
Focal resection is the removal of a localized area of abnormal brain cells that causes seizures. Neurosurgeons at Penn Medicine use two approaches for focal resection:
- Surgical resections are procedures that remove areas of the brain where seizures start. Temporal lobectomy is the most frequently performed open resection. During this procedure, the surgeon removes a part of the temporal lobe of the brain to treat temporal lobe epilepsy, the most common form of focal epilepsy.
- Laser interstitial thermal therapy (LITT), also called MRI-guided laser ablation, is a minimally invasive procedure to destroy brain tissue causing seizures with a precise laser. You lie in an MRI scanner during the procedure. Your neurosurgeon uses MRI imaging to guide the laser through a small hole into the brain. You receive general anesthesia during LITT to keep you comfortable.
Neuropace Responsive Neurostimulation System (RNS®)
The Neuropace Responsive Neurostimulation System (RNS®) is an option for people with seizures in multiple locations in the brain. It can also help people with seizures in places that are not safe to remove with surgery.
A neurosurgeon implants the RNS device in the skull. Electrodes lead from the device to areas of the brain that cause seizures. The electrodes sense abnormal brain activity during a seizure. Your epileptologist programs the device to send out pulses of electrical stimulation to stop the seizure activity.
Vagus Nerve Stimulation
Vagus nerve stimulation (VNS) stimulates the vagus nerve to stop seizures. During this minimally invasive outpatient surgery, a neurosurgeon places a vagus nerve stimulator in the chest wall. A wire connects the device to the vagus nerve in your neck. The device sends electrical pulses through the vagus nerve to the brain to stop seizure activity.
VNS decreases seizures by about 60 percent in half of people who undergo the procedure.
Deep Brain Stimulation
Deep brain stimulation (DBS) relies on a device placed in an area of the brain called the thalamus. The device delivers electrical stimulation to decrease seizure frequency. Most people spend one night in the hospital after the procedure.
Why Choose Penn Medicine for Epilepsy Treatment
Penn Medicine’s Comprehensive Epilepsy Center is home to an epilepsy team with decades of experience treating even the most rare and complex seizures. People who come to us for care find:
- Collaborative care: Our multidisciplinary team of epilepsy specialists works together to find the right care plans for each patient. We meet weekly to share our unique perspectives. Our epilepsy team also works closely with referring providers outside of Penn Medicine to coordinate care close to home.
- Advanced surgical technology: Our neurosurgeons use the most advanced technology that enables minimally invasive procedures to improve seizure control while decreasing recovery time, discomfort, and infection risk. The stereotactic navigation platform guides accurate placement of electrodes and devices in the brain. The robotic stereotactic assistant (ROSA) uses MRI imaging to guide laser placement in ablation surgeries.
- Research focus: As part of an academic medical center, our physicians are active researchers who investigate the next generation of epilepsy treatments. Our participation in epilepsy research and clinical trials gives our patients access to cutting-edge therapies still in development.
- Second opinion program: Our expert neurologists and neurosurgeons offer their expertise for second (and third) opinions. If you’ve been told you need surgery for epilepsy or a seizure disorder, Penn’s Neurosurgery Second Opinion Program can help answer your questions.
Make an Appointment
Please call 800-789-7366 or make an appointment.