The University of Missouri Epilepsy Center is recognized by the National Association of Epilepsy Centers as a Level 4 epilepsy center. Level 4 epilepsy centers have the professional expertise and facilities to provide the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy. The medical services include the outpatient epilepsy clinics and evaluation of paroxysmal events that are suspected to be seizures. The epilepsy center specializes in the pre-surgical evaluation of patients suffering from medically intractable or drug resistant epilepsy. The surgical services include vagal nerve stimulation implantation, invasive brain monitoring, and resective brain surgery.
The epilepsy clinic is open for consultation from Monday to Friday 8 AM to 5 PM.
To Make An Appointment
- Epilepsy Clinics
- Presurgical Evaluation for Epilepsy Surgery
- Video-EEG or Epilepsy Monitoring Unit
- Magnetic Resonance Imaging
- PET Scan
- SPECT Scan
- Psychiatric consultation
- Neuropsychological testing
- WADA Testing
- Sean Lanigar, M.D. - Epilepsy Program Director
- Susanta Bandyopadhyay, M.D., Ph.D. - Epileptologist
- Xiangping Zhou, M.D., Ph.D. - Epileptologist
- Arayamparambil Anilkumar, M.D. - Pediatric Epileptologist
- Pradeep Sahota, M.D. - Adult Epilepsy; Chairman, Dept. of Neurology
- Brick Johnston, Psy.D. - Director of Adult Neuropsychology, Department of Health Psychology
- Tomoko Tanaka, M.D. - Neurosurgery
- Amolak Singh, M.D. - Nuclear Imaging
- Vivek Sindhwani, M.D. - Neuroradiology
- Douglas C. Miller, M.D., Ph.D. - Clinical Professor of Pathology & Anatomical Sciences
- Marilyn Beeson - Social Worker
- Tammy Hether, R. EEG - Neurophysiology Supervisor
- Jodi Petersen, R. EEG - EMU Supervisor
Epilepsy Clinics are available daily from 8 AM to 5 PM (Monday to Friday). Neurologist specializing in epilepsy (epileptologist) provides medical treatment of different epilepsy disorders. Medication treatment with anti-epileptic drugs (AEDs) are the mainstay of medical therapy in epilepsy. The epileptologist also performs neuromodulation therapy using the Vagal Nerve Stimulator (VNS).
Pre-surgical Evaluation in Epilepsy
Approximately one-third of epilepsy patients have seizures that are difficult to control with multiple anti-epileptic drugs. An alternative option for these patients is epilepsy surgery. The surgery involves identifying the brain focus where seizures are generated and removing (selective resection) this seizure region of brain. Epilepsy surgery requires comprehensive screening and testing. Epilepsy surgery have 3 phases:
Phase I: Non-invasive Evaluation Phase:
The first phase involves admission to an epilepsy monitoring unit (EMU) where video and scalp EEG analysis is done for 5 to 7 days. The patient is tapered off their medication in order to analyze the seizure features and location by EEG analysis. The patient is under medical and nursing care during the epilepsy monitoring. The patient will need a family member or caregiver to accompany them during this phase. When the epilepsy monitoring is done, the patient is restarted back on their medications for seizures.
The other parts of the phase I evaluation includes neuropsychological testing, psychiatric evaluation, functional and anatomical brain imaging. The neuropsychological testing is important in identifying the brain function deficits caused by the epilepsy or brain abnormalities identified. It is also assess the language and memory functions of the patient. Psychiatric evaluation is important in the presurgical evaluation. Many patients with epilepsy suffer from co-morbid depression or anxiety. Some may even have psychosis from their seizures. This may require treatment and follow up before and after epilepsy surgery. If the patient undergoes epilepsy surgery, he or she is evaluated 3, 6 and 12 months after the brain surgery. Brain imaging is a vital component in epilepsy surgery. Finding the brain abnormality causing the seizure increases the success of seizure freedom from epilepsy surgery. An MRI of the brain is the imaging of choice. Usually, functional brain imaging using a PET (Positron Emission Tomography) or SPECT scan (Single Photon Emission Tomography) may be employed to identify areas of glucose and blood flow abnormalities which are also affected in brain regions generating seizures. The epilepsy program has a dedicated case worker that interviews the social aspects of the patient. This will help us know the patient's background, expectations in treatment, and social support.
Epilepsy Patient Management Conference: The phase I evaluation culminates into a multi-specialty meeting. The epilepsy specialist summarizes the seizure analysis with the epilepsy team. The different specialties will discuss their respective findings for the patient. The purpose of the conference is to make a decision for epilepsy surgery. The most common intractable epilepsy remediable by epilepsy surgery is temporal lobe epilepsy. In some patients, non-invasive or invasive testing may be needed in order to refine the location of the seizure and to test the brain areas near the seizure focus. If the patient is not deemed to be a surgical candidate, experimental drug or neuromodulation therapy options will be discussed to the patient.
Phase II: Invasive Monitoring Phase:
The main goal of epilepsy surgery is to resect/remove the brain region causing seizures without causing permanent neurological deficits. It is important to know the risk of losing brain function (language, memory, vision, movement) before epilepsy surgery is done. To determine language and memory functions, WADA testing may be employed. This involves a cerebral angiogram that is performed by our neuro-radiologist. A catheter is inserted via the groin and threaded up to the neck arteries (internal carotid artery). A small amount of anesthesia is injected in one side of the brain (amobarbital or methohexital). The neurologist or neuropsychologist will test the verbal and memory functions of each side of the brain when the anesthesia is injected. This will help us know if the language or memory functions is opposite or in the same the side of the seizures. There is low risk of language and memory impairment if it is on the opposite side of the seizure region. For example, the seizure focus is in the right temporal lobe and the language/memory functions are supported in the left side of the brain.
Another method of identifying the brain seizure focus and functions is through implantation of a subdural grid. A small hole (burr hole) in the skull is made. A flexible, sterile material containing small electrodes are overlaid on the brain region where the seizures are suspected to be generated. When seizure recording is done, electrical testing of the brain area (brain mapping) can help identify important areas to avoid during epilepsy surgery.
Phase III: Epilepsy Surgery:
The phase involves the brain resection of the seizure focus by a neurosurgeon. The non-invasive or invasive testing all pinpoint to only one region of the brain that is responsible for the seizures with minimal risk for neurological deficits. Patients who have undergone epilepsy surgery will have neuropsychological testing and psychiatric testing 6 and 12 months after surgery. A repeat MRI is done 6 months after surgery.
The epilepsy clinic is located at the 3rd Floor of University Physicians Building.
Neuropsychological Consultations are Mizzou North.
The Epilepsy Monitoring Unit is located at University Hospital, 7th floor of the Neurosciences Unit.
The EEG laboratory is located at the 2nd Floor, University Hospital.
MRI and Nuclear Imaging (PET scan) is located at University Hospital.