Cedars-Sinai and its affiliate Huntington Health are partnering to bring treatment and care to epilepsy patients in the San Gabriel Valley through a new epilepsy monitoring unit.
Epilepsy causes excessive electrical activity in the brain, resulting in seizures that can affect muscle control, speech, vision, and cognition. Seizures can be controlled with medication in most cases. However, about one-third of the 3 million US adults with epilepsy do not control their symptoms with medication alone.
The new epilepsy monitoring unit at Huntington Hospital allows patients with uncontrolled epilepsy to be evaluated locally, referred to Cedars-Sinai for advanced treatment as needed, and then continue their care with a Huntington Health neurologist.
Avriel Linane, MD, medical director of the Epilepsy Unit at Huntington Hospital, said patients with drug-resistant epilepsy should not delay evaluation for additional treatment.
Uncontrolled seizures increase the patient’s risk Sudden unexpected death from epilepsy, and for damage during a seizure. They affect patients’ lives, their ability to work, drive, and care for their children. Our goal is to help them get their lives back.
Avriel Linane, DO, Medical Director, Epilepsy Unit, Huntington Hospital
The unit at Huntington, which opened last August, includes patient rooms equipped with cameras and bedside electroencephalograms (EEG) to measure brain wave activity.
Patients who come into the room have 21 EEG electrodes—each corresponding to a different part of the brain—fixed on their scalp. Staff neurologists eliminate or stop the patient’s seizure medication, then monitor patients continuously for several days to record seizure activity. This monitoring is the first step in determining where the seizures are coming from in the brain.
Linan and neurologists Yafa Minazad, DO, and Adena Shahinian, DO, personally monitor patients during their stay, monitoring seizure activity, adjusting medications as needed, and determining when enough data has been collected for the patient to go home.
Patients may undergo MRI, PET, and other imaging studies, and neurocognitive, memory, and language testing. When testing and follow-up are complete, each patient’s information is discussed in a meeting between Huntington and Cedars-Sinai epilepsy physicians and nurses.
“We review the patient’s history and imaging and look at the EEG and video together so we can all get to know the patient,” Linan said. “Then, as a team of neurosurgeons and epileptologists, we will decide what the best next steps would be.”
Patients who need extensive treatment can undergo surgical procedures at Cedars-Sinai to place electrodes on or into the brain, followed by in-hospital monitoring to closely pinpoint the source of the patient’s epilepsy. In some patients, surgery to remove the abnormal part of the brain identified by these tests can eliminate seizures.
Other patients may be candidates to receive a neuromodulation device such as a vagus nerve stimulator, a reflex neurostimulator, or a deep brain stimulator. Implanted at Cedars-Sinai, these devices send electrical signals to the brain to reduce the frequency of seizures.
“The goal of this collaboration is for patients to have their initial evaluation at Huntington Hospital, then be referred to Cedars-Sinai for specific diagnostic and surgical procedures,” said Lisa Bateman, director of the Epilepsy Program at Cedars-Sinai Surgery. . “Once they are evaluated after the procedure, they can return to their providers in Huntington and continue to receive their epilepsy care there.”
This means less travel time without compromising patient care.
“It’s a good model for us in other programs,” Bateman said. “People stay close to home, get good care and love it.”