ADULT EPILEPSY COVER STORY Specialized epilepsy center offers potential remedies to patients with uncontrolled seizures (continued from cover) with uncontrolled seizures are at five-to-10 times greater risk of dying, and also are at higher risk for depression and suicide. “Every patient who has tried one or two antiseizure medications and is not seizure-free should be referred to a specialized epilepsy center for an evaluation,” says Dawn Eliashiv, MD, codirector of the UCLA Seizure Disorder Center. Patient undergoing an electroencephalogram (EEG) epilepsy screening. Photo: Medical Images STORY HIGHLIGHTS For adults with epilepsy whose seizures are not controlled by medication, a specialized center can ensure proper diagnosis and offer multiple options for effective treatment. Only a small percentage of patients who could be helped by a specialized center are referred. There are approximately 20 approved epilepsy medications operating through a half-dozen different mechanisms, as well as experimental drugs available through clinical trials. UCLAHEALTH.ORG Dr. Eliashiv notes that only a small percentage of patients who could be helped by a specialized center are referred. In the U.S., of the 3 million people who have epilepsy, approximately one-third continue to experience seizures even on medication. It’s estimated that 150,000 of these patients are surgical candidates, but only about 2,500 epilepsy surgeries are performed each year. Dr. Eliashiv says one of the main reasons many patients aren’t referred is the widely held misconception among physicians that epilepsy centers only perform surgery, and that their patients either wouldn’t want an operation or wouldn’t be a candidate. In fact, although surgery can be life changing for patients who need it, many who are referred to the UCLA Seizure Disorder Center can have their epilepsy controlled through medication or nonsurgical procedures. John Stern, MD, codirector of the UCLA Seizure Disorder Center, notes that as many as one-third of patients who undergo a comprehensive epilepsy evaluation are discovered not to have epilepsy. “There is a range of conditions that can mimic epileptic seizures,” Dr. Stern says. “If such patients are being given antiepileptic medications, it’s not going to control those seizures.” At UCLA, patients having nuanced episodes are evaluated to confirm the epilepsy diagnosis, as well as to characterize the condition through MRI, EEG or, when necessary, diagnostic admissions. 1-844-4UCLADR (1-844-482-5237) For patients with a confirmed epilepsy diagnosis, characterizing the condition can lead to the use of a different medication that may be more successful. There are approximately 20 approved epilepsy medications operating through a half-dozen different mechanisms, as well as experimental drugs available through clinical trials. “Consultation in the epilepsy clinic can lead to medication changes that can reduce the seizure burden — or, for some patients who are seizure-free, reduce the side effects of the treatment to improve their quality of life,” Dr. Stern says. Although surgery can be life changing for patients who need it, many who are referred to the UCLA Seizure Disorder Center can have their epilepsy controlled through medication or nonsurgical procedures. For the one-third of patients found to have medically refractory epilepsy, surgery may be an appropriate option, and the UCLA Seizure Disorder Center is able to stop the disabling seizures in a high percentage of these cases with minimal or no side effects. Because of the significant advances that have been made in surgical approaches in recent years, many more patients are candidates for surgery than in the past. Beyond resective epilepsy surgery, the UCLA Seizure Disorder Center offers both neurostimulation and MRI-guided laser ablation. Vagus nerve stimulation (VNS)