Adult Outpatient Clinic
The Adult Epilepsy Clinic is a subspecialty clinic of the Department of Neurology staffed by Drs. Granner and Werz, both of whom are fellowship trained in epilepsy. The clinic is located on the second floor of the Roy Carver Pavilion (2RCP) directly across from elevator D.]
Pediatric Outpatient Clinic
As child neurologists, Drs. Afifi, Bonthius and Mathews all have extensive experience in managing children with epilepsy. The child neurology clinic sees 1,000 to 1,100 individual patients per year for evaluation and management of seizures, spells, and epilepsy. The pediatric epilepsy program offers a full array of epilepsy management, including medications, ketogenic diet, vagal nerve stimulator and evaluation for epilepsy surgery.
Electroencephalography (EEG) Laboratory
EEG is one of the principle diagnostic tools in the evaluation of epilepsy and seizures. EEG is used to identify abnormality and localize seizures, document the distribution of sodium amytal during pre-surgical Wada testing, and to identify brain areas with irritable seizure discharges during surgery. The University of Iowa EEG laboratory, located on the Lower Level of the Roy Carver Pavilion, was one of the first five EEG laboratories in the country, and currently performs over 1000 EEG studies a year.
Epilepsy Monitoring Unit
The accurate diagnosis of epilepsy and other seizure disorders often requires performing prolonged outpatient or inpatient video-EEG monitoring. This test uses a simultaneous video and EEG recording to document one or more of the patient’s typical spells, in order to determine their cause, nature and optimal treatment. Outpatient (typically lasting 2-6 hours) and inpatient (typically lasting 1-7 days) video-EEG studies are performed in the Epilepsy Monitoring Unit, located on the second floor of the Roy Carver East Pavilion (2RCE). Pediatric video EEG studies are performed at the University of Iowa Children's Hospital, located on the second floor of the John Colloton Pavilion (2JCP). The care of inpatients is provided by round-the-clock nurses who specialize in the care of seizure patients, and a team of physicians assigned to the 2RCE inpatient service. The video-EEG studies are interpreted by Drs. Granner and Werz. More information on inpatient video-EEG monitoring can be found on the Frequently Asked Questions (FAQ) page.
Neuroradiology and Functional Neuroimaging
Patients with seizures often benefit from state-of-the-art neuroimaging modalities to evaluate for underlying structural or functional brain dysfunction.
Magnetic resonance image (MRI) of the brain with a specialized seizure protocol is used to identify brain lesions associated with seizures such as scar tissue or regions of abnormal brain development. Such findings may help guide therapy, by identifying patients who would more likely respond to surgical, rather than medical, treatment. Proper interpretation of such studies by neuroradiologists in consultation with the ICEP neurologists and neurosurgeons ensures appropriate correlation to the patient’s seizure disorder and allows for integration of the findings into the patient’s comprehensive evaluation.
Functional neuroimaging tests such as positron emission tomography (PET) and ictal and interictal single photon emission tomography (SPECT) are also available. Unlike MRI, these studies measure blood flow or metabolism in areas of the brain. Both PET and SPECT are commonly performed on patients undergoing evaluation for epilepsy surgery. PET is most often performed as an outpatient, while ictal SPECT (performing the injection of radioisotope during a seizure) requires admission for prolonged video-EEG monitoring.
Image co-registration, 3D volumetric brain reconstructions, and selected brain volume measurements are utilized in preoperative patients in collaboration with the Human Neuroanatomy and Neuroimaging Laboratory, directed by Hanna Damasio, MD.
Benton Neuropsychological Laboratory
The Benton Neuropsychological Laboratory is a nationally respected clinical and research service of the Department of Neurology at the University of Iowa Hospitals and Clinics. Cognitive problems, especially memory dysfunction, are particularly common in epilepsy, and may result from frequent seizures, brain lesions accompanying seizures, or adverse side effects of medication. Neuropsychological testing evaluates for these causes, and often provides helpful information about the location of origin of a person’s seizures (especially useful in the evaluation for epilepsy surgery). Cognitive and behavioral rehabilitation is available for patients with epilepsy and nonepileptic behavioral spells. Neuropsychologists also perform the sodium amytal (Wada) test in evaluating patient’s memory and language function before epilepsy surgery, and serve as integral members of the team in the presurgical evaluation at ICEP.
Epilepsy Surgery Program
While epileptic seizures are well-controlled in the majority of patients, the others may have seizures that are resistant to treatment with medications (so-called "intractable or refractory epilepsy"). If a patient’s seizures arise from a single, identifiable area of the brain, the patient may be a candidate for epilepsy surgery, a neurosurgical procedure where the abnormal area producing the seizures is removed. The evaluation for epilepsy surgery (for more information, please see the FAQ section ) is directed by Drs. Granner and Joshi. Information gained during the evaluation is then comprehensively reviewed at Epilepsy Surgery Case Conference, attended by epilepsy neurologists, nurses, and surgeons, EEG technologists and neuropsychologists. Surgical procedures, including invasive video-EEG recording and the resection surgery itself, are performed by Drs. Howard and Kawasaki.
Vagus Nerve Stimulator Program
The Vagus Nerve Stimulator (VNS) is offered as a therapeutic option for selected epilepsy patients (generally those for whom medicines have not worked, and who are not candidates for or choose not to have epilepsy surgery). Approval for VNS therapy follows a thorough evaluation that includes a clinic visit, imaging studies (usually MRI), EEG and video-EEG recording of the patient’s seizures. As with epilepsy surgery, this information is reviewed at the Epilepsy Surgery Case Conference to ensure VNS therapy is offered to those patients most likely to benefit from it. After surgery is performed to place the VNS device, follow-up visits are made in the clinic for check-ups and device programming.
Ketogenic Diet Program
The ketogenic diet is a very precise and specific diet that can reduce, and occasionally eliminate, seizures in selected patients. Like surgery and the Vagus Nerve Stimulator, it is reserved for those who do not respond to medication. Parents and patients work with a team consisting of dietitian, nurse, pharmacist and physician to institute and regulate the diet. A three to five day hospital stay is required initially, with frequent monitoring thereafter. Although not an easy diet, it can be very effective for some.
Epilepsy Care Throughout Life
Specialized epilepsy care throughout life is central to the philosophy of ICEP. Specialized services for infants and children with epilepsy are available through Charuta Joshi, MD, in the Pediatric Division of the Comprehensive Epilepsy Program. Women with epilepsy may obtain cooperative care through consultation with physicians in Endocrinology, Family Medicine, Gynecology, and Reproductive Endocrinology. Bone mineral densitometry studies are helpful in evaluating women and men at potential risk of osteoporosis associated with their epilepsy or antiepileptic drugs. The fastest growing segment of the population with epilepsy is those over 60 years of age. Older adults with epilepsy often have milder seizures than younger patients, but are often more vulnerable to medication side effects and drug interactions. Sometimes, seizures in elderly patients are difficult to diagnosis and require integrated services with internal medicine, cardiology, and psychiatry as well as spell recording with video-EEG monitoring. To ensure that elderly patients' antiepileptic medications may be safely and tolerably administered given any other significant medical problems or complicated medication programs, pharmacologist or geriatrics consultation is available.
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