Patients are referred to a subspecialty clinic in one of these areas for an initial assessment. The individual clinics are well integrated with one another so patients benefit from all available treatment options, including experimental drug trials, as well as surgical intervention.
The UCLA Adult Epilepsy Program was started in 1961. Since its inception, the program has continued to promote a scientific approach to the localization and treatment of partial seizures for surgical treatment. The key feature of the surgical program is patient management by scientific protocol. The UCLA Epilepsy Surgery Program offers: 1) presurgical evaluation, 2) surgery, and 3) post-operative follow-up for patients with medically intractable (uncontrollable) epileptic seizures. Presurgical and surgical procedures are carried out according to predetermined protocols, and decisions regarding surgery are made for each patient at a weekly epilepsy surgery team conference.
To determine if a patient is a candidate for surgical treatment there is a Phase I and, when necessary, a Phase II, for evaluation.
Continuous EEG telemetry and video monitoring. Additional testing includes MRI (magnetic resonance imaging), PET (positron emission tomography), detailed neuropsychological evaluation, and intracarotid amytal tests.
Continuous EEG telemetry and video monitoring with stereotactically implanted depth electrodes or subdural grid electrodes (only if necessary).
With the use of confirmatory tests, over three-fourths of the patients receive surgery without requiring Phase II intracranial electrode evaluation. Phase II is carried out only when the Phase I evaluation in not conclusive. EEG telemetry and long-term depth electrode recording originated at UCLA, and there have been more depth electrode EEG recordings carried out at UCLA than at any other surgical facility in the world. MRI is used to select targets for depth electrodes and to verify the location of these electrodes within specific anatomical sites in the brain.
When a discrete epileptogenic region can be identified and removed without introduction of unacceptable additional neurological deficits, resective surgery is performed. Occasionally, section of the corpus callosum is performed in carefully selected patients. Most patients undergo a standard anterior temporal lobectomy, but an increasing number are receiving extratemporal cortical resections. Seventy to eight percent of patients can expect to become free from disabling seizures following temporal lobe surgery, while all but three to five percent experience a worthwhile improvement in seizure frequency, with marked improvement in the quality of their daily lives. The UCLA Seizure Disorder Center is one of the few centers conducting ongoing research regarding quality
of life and long-term follow-up after surgical intervention.