Epilepsy and Seizures
If you have epilepsy—or you’ve recently had seizures for the first time and don’t know why—it’s important to seek expert care. Without proper diagnosis and treatment, epilepsy and other seizure disorders can take a toll on your quality of life.
Neurologists from University of Iowa Health Care can pinpoint the cause of your seizures and help you control them.
We’re the first and only health system in Iowa accredited as a Level IV epilepsy center by the National Association of Epilepsy Centers (NAEC). This is the highest designation an epilepsy center can achieve.
Level IV NAEC accreditation confirms we have advanced testing that can distinguish epilepsy from nonepileptic seizures. It also verifies that we offer life-changing treatments for people whose epilepsy can’t be controlled with medication (intractable epilepsy).
The first step in preventing your seizures is to find out why you’re having them.
What causes seizures?
All seizures are associated with abnormal electrical activity in the brain, which can be measured on an electroencephalogram (EEG). Provoked seizures are caused by an acute head injury or infection, a systemic condition like low blood glucose, or a medication reaction. In other words, your normal brain is being provoked by some external factor.
Unprovoked seizures lack an immediate identifiable cause. Two or more unprovoked seizures fulfills the diagnosis of epilepsy—that is, an increased tendency of a brain to produce seizures.
Seizure mimics are episodes that might seem to be epilepsy but have no associated electrical activity on the EEG. Examples of this include:
- Physiologic causes like syncope (fainting), and sleep attacks
- Psychogenic causes like anxiety, depression, PTSD; these are also known as psychogenic, nonepileptic episodes (PNEE).
UI Health Care offers more seizure testing options than anyone else in Iowa.
Depending on your medical history, including the frequency and severity of your seizures, you may have one or more of the following tests:
- Electroencephalogram (EEG): Sticky metal discs (electrodes) placed on your scalp record electrical currents in your brain.
- Video EEG: This test requires admission to our inpatient epilepsy monitoring unit. It combines 24/7 EEG and video surveillance to capture the exact moment you have a seizure. UI Health Care is home to Iowa’s first and largest epilepsy monitoring unit; we admit more than 400 adults and 300 children to this unit every year.
- Intracranial EEG: This advanced type of EEG helps us see if you’re a candidate for epilepsy surgery. EEG electrodes are placed on and into the brain by a neurosurgeon, the locations tailored to your specific condition. This shows us where to operate.
- MRI scan: An imaging procedure that uses a magnetic field (instead of radiation) to take detailed pictures of your brain.
- Nuclear medicine studies: These advanced imaging tests, including PET scans and SPECT scans, use a small, safe amount of radioactive material and a special camera. They create 3D pictures that show how well different areas of your brain work.
Epilepsy and seizure care from UI Health Care
The treatments you’ll need depend on whether your seizures are caused by epilepsy or something else.
Treatment for nonepileptic seizures
If we confirm that you do not have epilepsy, we’ll connect you with specialists who can treat the underlying cause of your episodes.
And if they are the result of PTSD (post-traumatic stress disorder), we’ll refer you to a psychiatrist or another provider who can help. With the right mental health care, it’s possible to overcome seizures caused by stress and trauma.
No matter the severity of your epilepsy, we offer treatments that can help. Our goal is to improve your safety and quality of life.
We also offer pediatric epilepsy care at UI Stead Family Children’s Hospital.
Roughly two-thirds of people with epilepsy can reduce or prevent their seizures with prescription medicine. These medicines go by several names, including antiepileptic drugs, antiseizure drugs, and anticonvulsants.
The type of medicine you’ll need depends on the type of epilepsy you have. Some drugs treat generalized epilepsy (your seizures occur in both halves of your brain). Others work better for focal epilepsy (your seizures start in a specific area on one side of your brain).
Our neurologists are skilled at choosing epilepsy medications that will offer you the most benefit with the fewest side effects.
And, if you’d like to try a promising new epilepsy drug before it’s widely available, we can help you enroll in a clinical trial.
If medication alone doesn’t control your seizures—or it causes serious side effects—you may need more advanced care.
A neuromodulation device may be an option if you aren’t ready (or eligible) for surgery. These small, implantable devices help prevent seizures by stopping the abnormal electrical activity that causes them.
UI Health Care offers:
- Deep brain stimulation (DBS): A device (pulse generator) placed under the skin on your chest connects by a wire to electrodes in your brain. The pulse generator sends scheduled bursts of electricity to the electrodes.
- Responsive Neurostimulation System (RNS): After precisely locating where your seizures begin, electrodes are surgically implanted in this area and connected to a detection device placed in your skull. The device watches for the onset of seizures and delivers programmable electrical pulses to shorten or stop the seizures. The seizure information and response to the therapy will be reviewed at your clinic visits.
- Vagus nerve stimulation (VNS): A wire running from a pulse generator in your chest is attached to one of two vagus nerves in your neck. The pulse generator sends electrical signals to your vagus nerve, which transmits those same signals up to your brainstem and into your brain.
For some people with intractable epilepsy, surgery is the best way to prevent seizures. We offer several procedures that remove or disconnect the part of the brain where seizures occur. These include:
- Laser interstitial thermal therapy (LITT): During this minimally invasive procedure, your neurosurgeon uses a laser to burn away (ablate) targeted brain tissue.
- Brain surgery: Your neurosurgeon temporarily removes a piece of your skull (craniotomy), then cuts out a small section of brain. Different procedures—including frontal lobe resection and temporal lobe resection—are named after the part of the brain being treated.
Today’s technology-driven surgical techniques make epilepsy surgery safer than ever. Using special planning procedures such as intracranial EEG, our neurosurgeons can map your brain ahead of time. This lets us see which sections of tissue to ablate or remove, and which sections to avoid.
Sudden unexpected death in epilepsy
We’re nationally recognized for our efforts to prevent sudden unexpected death in epilepsy (SUDEP).
What is SUDEP?
Certain people with epilepsy—especially young adults who have a hard time controlling their seizures—have a higher risk of sudden death. When otherwise healthy people with epilepsy pass away without warning, it’s known as SUDEP.
Although you can lower your risk of SUDEP, there’s no clear way to prevent it—yet. UI Health Care researchers are working to change this.
Leaders in SUDEP research
We’re among a handful of medical centers in the U.S. and Europe taking part in an international research collaboration. This collaboration is called the Center for SUDEP Research (CSR), and it’s funded by the National Institutes of Health.
By bringing together top epilepsy experts from around the world, the CSR aims to pinpoint the causes of SUDEP—and then stop it from happening.
Our neurologists also conduct their own SUDEP research. We’ve discovered a link between serotonin levels in the brain and the development of epilepsy, depression, and SUDEP. We’re also investigating SUDEP risk factors and prevention techniques.