Duke’s epilepsy program is a designated Center of Excellence and part of Duke’s nationally ranked neurology program. Our experienced epilepsy specialists offer a comprehensive epilepsy evaluation, a wide range of treatment options including medications, dietary therapies, implantable neurostimulators and surgeries. Our goal is to maximize your quality of life, and make a seizure-free life an attainable goal for you.
Experienced Epilepsy Specialists
We understand that having a wide range of treatment options for epilepsy is important because 30 to 40 percent of people with epilepsy do not respond well to medications and other therapies. Our experienced epilepsy specialists include neurologists with extensive training and decades of experience managing people with epilepsy, as well as neurosurgeons specializing in procedures to treat people with epilepsy who don't have success with medication alone. Our expert evaluation and range of treatment choices help maximize your quality of life while making a seizure-free life a realistic goal. Learn how we treat epilepsy in children.
Choose epilepsy care at Duke because we offer:
- Reputation for excellence. We are a Level 4 Center of Excellence - the highest level of accreditation by the National Association of Epilepsy Centers. Our neurologic disorders programs are also consistently ranked among the top programs in the country by U.S. News & World Report.
- Team approach. Our experienced epilepsy specialists include adult and pediatric epileptologists (neurologists with specialized training in epilepsy), researchers, general neurologists, neurosurgeons, neuroradiologists, neuropsychologists, and specially trained nurse practitioners, physician assistants, nurses and technologists. Our specialists meet weekly to discuss patients scheduled for epilepsy surgery or device implants so we can determine the best course of action.
- Technology designed for safety. Our epilepsy and neuro-intensive care units have an electroencephalogram (EEG) machine and video recording capabilities in every room. This allows for monitoring of the electrical activity in the brain. In addition, there is an MRI scanner in the operating room to assist with the most challenging surgeries. Having this equipment accessible ensures you receive the safest care possible.
- Groundbreaking clinical trials. You may be eligible to participate in ongoing clinical trials for anti-epileptic drugs and medical devices, including efforts to improve the effectiveness of the vagus nerve stimulator and the use of the responsive neurostimulator system. These devices are implanted to help improve seizure control. Our research also focuses on topics such as the genes that may be associated with epilepsy, and the use of EEG and new MRI techniques to monitor and evaluate seizures. By participating in clinical trials, you may have access to experimental therapies before they are available elsewhere.
Anti-seizure medications are the first-line treatment for epilepsy, and may be prescribed to relieve your seizures or reduce their frequency. If 3-5 medications have been prescribed and do not work to control your seizures, our experts will likely recommend evaluation for surgery as the next step.
A pacemaker-like device is implanted in the chest wall with a wire that connects to your left vagus nerve in your neck. The device delivers weak electrical pulses that prevent seizures. Our experienced epilepsy specialists also offer investigational VNS trials to test new ways to program the VNS to detect seizures before they happen.
This device is implanted into the skull and connects to electrodes placed directly on or in the brain. The RNS monitors your ongoing brain waves and gives small electrical shocks to interrupt the electrical patterns that may lead to seizures.
A nutritionist works closely with you, and may recommend a modified Atkins diet or Ketogenic diet - two eating plans that have been effective in controlling seizures in some patients. These plans restrict carbohydrates and focus on high-fat, high-protein foods that may help the body generate and build up ketones, which can prevent seizures for reasons researchers still don’t understand.
As a designated Level 4 epilepsy center, our neurosurgeons are specially trained in epilepsy surgery. Our surgeons use the latest techniques including MRI-guided, laser-assisted removal of brain tissue. This technique, when combined with our MRI scanner in the operating room, allows for the safest and most efficient methods of resecting areas of the brain where seizures may occur. The most common surgical procedures we use to treat epilepsy include:
- Anterior temporal lobectomy. Removes a portion of the brain’s temporal lobe, the most common area for seizure activity to start. This approach has a high degree of success in achieving long-term seizure freedom.
- Resection of seizure-causing lesions or scars. Removes tumors, vascular malformation, and developmental abnormalities that can cause seizures.
- Cortical resection. Removes brain tissue outside of the temporal lobe that is a source of seizure activity.
- Hemispherectomy. Removes portions of one half of the brain (a ‘hemisphere’) where seizures occur and cuts the corpus callosum that connects the two hemispheres. As a result, seizure activity cannot spread from one half of the brain to the other.
Our experienced specialists perform a comprehensive epilepsy evaluation that includes several tests to determine if surgery is right for you.
- Phase 1 epilepsy evaluation will include a complete history, records and medication review. It may also include EEGs, neurological testing, imaging studies and a Wada test.
- Phase 2 epilepsy evaluation may be performed if surgery is recommended after Phase I, and will include more invasive monitoring.
Routine EEG, or electroencephalography, records brain waves using electrodes placed at defined locations on the scalp using conductive paste or glue. You will lie still on a bed and may be asked to perform some simple tasks. Flashing lights and hyperventilation may be used during the test to provide additional information. In most cases, the brain waves during both waking and sleep are recorded. The test typically takes one to two hours.
Records brain waves for a longer period of time and possibly during seizures or events that are concerning for seizures. Electrodes are placed on the scalp to record brain waves, however, they are held in place with a special adhesive. You will home with the electrodes and a miniature, portable recorder for one to four days. Brain waves are recorded continuously. You will be asked to push a button for any events or seizures, and maintain a detailed log of your activities and events.
Records actual events or seizures, which can assist with diagnosis and surgical evaluation. As with ambulatory EEG, electrodes are glued onto the scalp, although more electrodes are typically used. During the test, which takes place in the hospital, antiepileptic medications are often reduced or stopped to improve the chances of recording seizures. A typical admission lasts three to five days, although it may be shorter or longer depending on how long it takes to obtain the necessary data. You will be closely monitored a large team including physicians, nurses, technologists and other staff to ensure we collect high quality data and for patient safety. Video EEG can also be performed using electrodes that have been surgically implanted on or in the brain. This allows for more precise mapping of brain function, as well as the part of the brain from which seizures are originating.
MRI, PET and SPECT are used to create high-quality images of the brain, and to map brain activity.
- MRI can detect obvious or subtle abnormalities that may indicate a potential seizures focus.
- Functional MRI uses an MRI scan to detect brain areas involved in particular functions, and uses special settings to detect changes in blood flow in the brain.
- PET (positron emission tomography) measures the brain's metabolic activity, which can indicate how much energy a particular part of the brain is using.
- SPECT (single-photon emission computed tomography) may be performed during a video EEG. Like PET, this test involves the injection of a radioactive solution. It must be injected near the very beginning of a seizure, and is only active in the body for a brief period of time.
A series of tests including interviews, puzzles, questionnaires and timed tasks. Your performance is compared to data from matched (similar age and education levels) control subjects. By looking at areas of relative strength and weaknesses, the neuropsychologist can determine parts of the brain that might not be functioning normally. This can be helpful in the evaluation for epilepsy surgery. By better defining strengths and weaknesses, it may also lead to suggestions/strategies for improving your function.
Also know as the intracarotid amytal test. May be used during evaluation for epilepsy surgery to determine language and memory function on the left versus right side of the brain. A catheter is threaded from a blood vessel in the leg to the brain. The catheter is used to inject a short-acting anesthetic into just one side of the brain, effectively putting that side to sleep for 5-10 minutes. During this time your language and memory are tested. After recovery, the procedure is repeated on the other side of the brain. The entire procedure takes 2-3 hours and you typically go home the same day.
Locates parts of the brain responsible for movement, sensation, language and vision. It is used to reduce the risk of loss of function from surgery. Brain mapping can be performed in the operating room using electrodes placed directly on the brain, or outside the operating room using electrodes that were previously implanted in/on the brain. Brief pulses of electrical current are passed through these electrodes. These may produce a brief response like a muscle jerk or tingling. They may also temporarily (for seconds) make you unable to perform certain tasks like speak or name.
Neurosurgeons use a 3D reconstruction of the brain to identify possible origins of seizures, and a robotic arm to make small, two- or three-millimeter holes in the scalp through which electrodes are passed. The robotic-assisted procedure is faster, more precise, and better tolerated by patients.