Comprehensive Epilepsy Program
The UC Davis Medical Center’s Comprehensive Epilepsy Program is a leading program for the medical and surgical management of complex epileptic disorders. The National Association of Epilepsy Centers (NAEC) has designated UC Davis as a Level 4 Comprehensive Epilepsy Program, the highest rating awarded.
A wide array of services are available in conjunction with the program:
The program provides a state-of-the-art inpatient epilepsy monitoring unit (EMU) with beds for four adults, high-resolution magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). There are also two pediatric EMU beds.
The program also offers an ACGME-accredited, clinically-oriented Epilepsy Fellowship that includes opportunities for participation in faculty research. In addition to clinical research opportunities on the UC Davis Health System campus in Sacramento, associated research facilities in the basic neurosciences are housed at the Center for Neuroscience on the Davis campus.
Epilepsy is a brain disorder characterized by recurrent seizures. A seizure is a brief alteration of consciousness (level of awareness), muscle control, behavior or sensory perception. Seizures can last a few seconds to several minutes.
During a seizure, brain cells behave abnormally and show unusual repeated electrical discharges. This often begins within a small cluster of abnormal nerve cells and spreads to involve normal cells in other areas of the brain.
For more information, please see:
What are psychogenic non-epileptic seizures? Also known as PNES, psychogenic non-epileptic seizures may be difficult to distinguish from seizures caused by epilepsy, especially by observation alone. True epileptic seizures are triggered by abnormal electrical activity in the brain, whereas PNES are physical responses to extreme emotional stress. If PNES are misdiagnosed as epileptic seizures, patients are unlikely to receive the treatment they need.
Because they so closely resemble epileptic seizures, proper diagnosis of PNES can be very difficult without video monitoring and EEG studies, which require specialized facilities such as our UC Davis EEG Laboratory. Correct diagnosis also requires careful analysis of video and EEG tracings by a neurologist who specializes in diagnosis and treatment of epilepsy, like the members of our Comprehensive Epilepsy Center team.
For a helpful online source of more information about PNES, please see Psychogenic (Non-Epileptic) Seizures: A Guide for Patients & Families (PDF).
Patients with medically intractable seizures are referred to the Comprehensive Epilepsy Program. The patients are evaluated to determine whether the current therapeutic regime is adequate and appropriate. Staff examines anticonvulsant drug levels and dosage schedules, performs neuropsychological tests, performs baseline electrographic studies and monitors and documents the response to medications at various dosages.
One goal of our intensive evaluation is to identify patients who would benefit from surgical therapy. Based on a preliminary evaluation, a patient can be admitted to the hospital for video electroencephalogram (EEG) monitoring to document the site of an epileptogenic lesion. Patients determined to be candidates for surgery undergo angiography and Wada testing to establish the lateralization of language.
The Wada test consists of the injection of sodium amytal into the arteries carrying blood to the brain in order to anesthetize half the brain for about one minute. This allows the physician to determine the impact of the intended surgical removal on language. The procedure is done as an outpatient under local anesthesia by a neuroradiologist who places a small catheter in an artery in the groin. The neuropsychologist and neurologist participate in the testing of the patient's language and memory during the test.
In selected cases, depth or subdural grid electrodes are implanted on the surface of the brain by a surgical procedure to further localize the area of the brain from which the seizures are arising. Intra-operative electrocorticography and depth recordings are also used to further delineate the epileptogenic cortical focus.
Single photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI) studies can be done in appropriate patients to delineate the area of the brain from which the seizures are arising. These procedures are done prior to the more invasive studies discussed above. Patients are followed in the clinic for at least two years after surgery. Those patients not considered candidates for surgery are also followed for extended periods and are often enrolled in protocols to study new pharmaceuticals.
Also assisting in the evaluation of epilepsy is the Clinical Neurophysiology Laboratory. This laboratory performs more than 3,000 procedures annually and include routine studies as well as specialized procedures related to epilepsy and sleep disorders.