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Epilepsy

Epilepsy is a common and serious neurological condition that affects over 50 million people worldwide. Approximately 2% of the US population has recurrent unprovoked seizures, the condition known as epilepsy.

Seizures are spells of altered behavior, consciousness, emotions, and/or sensations. They might be very mild with only a brief sensory experience called an aura, such as a visual disturbance, unusual taste or smell, tingling sensation or sense of déjà vu.  They can also be severe, such as generalized tonic clonic (sometimes called “grand mal”) convulsive seizures with violent muscle contractions.

Seizures are caused by abnormal bursts of electrical activity in the brain. Approximately 10% of the population will experience at least one seizure in their lifetime. About 30% of those who have a first seizure will experience seizure recurrence and thus develop epilepsy.

There are several types of epileptic seizures and epilepsy disorders. Epilepsy can result from head trauma, subtle abnormalities in brain structure, and in some patients there is a genetic tendency for seizures.  But in many cases the cause of seizures remains unknown.

UAMS Arkansas Epilepsy Center

The Arkansas Epilepsy Center at UAMS is the only epilepsy center in the state of Arkansas certified by the National Association of Epilepsy Centers (NAEC). The UAMS Epilepsy Center provides multidisciplinary evaluation for patients with seizures and epilepsy. It includes outpatient clinics, EEG laboratory, and an inpatient epilepsy-monitoring unit (EMU). Our multidisciplinary team includes experienced fellowship-trained faculty and support personnel from Neurosurgery, Neuroradiology, Nuclear Medicine, Neuropsychology, Psychiatry, Pharmacology, and Social Work services.

Faculty/Staff

Bashir Shihabuddin, MD, Medical Director
Kinshuk Sahaya, MD

To Make An Appointment

To schedule an initial evaluation, call the UAMS Access Center at 501-686-8000 or visit our online appointment request to make an appointment with one of our epilepsy specialists. You will need a referral from your primary physician, which can be faxed to the Access Center.

Epilepsy Clinic


Our Epilepsy Clinic is part of the Neurology Clinic at UAMS which is located on the 2nd Floor of the Stephens Spine Institute.  Directions to the clinic can be found here.  You may be evaluated by one of our Neurology Residents as part of your visit, as well as the attending neurologist.  Please bring all medical records and hand-carry any films or CDs of brain imaging studies (CT scan or brain MRI) to your visit. If you keep a calendar or record of your seizures, please bring that as well. You may be asked at the end of your visit to provide a blood sample for antiepileptic drug levels or other tests.  Our clinic has a blood draw station available on site.

Treatment

There are numerous medications available to prevent seizures in people with epilepsy. Most patients require anti-seizure medications for seizure control, and many will have good seizure control with the first anti seizure medication they receive if this medicine is chosen correctly. Our epilepsy specialists have extensive experience in selecting and monitoring various anti-seizure medications. Some patients continue to have poorly controlled seizures despite trying many medications in different combinations.  This is referred to as refractory or intractable epilepsy. In addition to pharmacological options, the Arkansas Epilepsy Center at UAMS offers other treatment options such as epilepsy pre-surgical evaluation and Vagus Nerve Stimulation for refractory epilepsy.

EEG Laboratory

The EEG Laboratory performs electroencephalographic (EEG) recordings on outpatients and inpatients with seizures, spells, and a variety of other neurological conditions. The EEG, which records brain electrical activity, can show signs of electrical irritability that could indicate seizures and epilepsy. The EEG can be helpful in differentiating different types of seizures and epilepsy syndromes.  In addition to routine EEG recordings that last 20-30 minutes, our EEG lab also performs prolonged EEG recordings with or without video, for up to 6 hours in the outpatient setting or continuously for inpatients in need of EEG monitoring.  In addition, our EEG lab can perform outpatient ambulatory EEG studies, where the patient comes to the laboratory to have electrodes attached and then goes home with a portable EEG recording device for up to 3 days.

Inpatient Epilepsy-Monitoring Unit (EMU)

When seizures are refractory and cannot be controlled with medication alone, we may need to record a spell to help with diagnosis or to localize where seizures come from.  Our state-of-the-art, four-bed epilepsy monitoring unit (EMU)  located on the 8th floor of the new UAMS Hospital enables us to determine whether seizures are epileptic or non-epileptic, and can help pinpointthe origin of seizure activity in the brain. Video and EEG recordings of seizure activity are acquired continuously 24 hours a day, with EEG technicians available around the clock to assist in monitoring. Patients admitted for monitoring often have their seizure medications tapered off, and may be sleep deprived on some nights, to increase the chance of recording a seizure.  Computer analysis helps to identify seizures, and patients can press a button to note when a seizure occurs.   We encourage a family member to stay with the patient to help identify seizure activity.  In some cases, a radioactive tracer may be injected at the time of a seizure to help mark the brain area where seizures originate, which is called an ictal SPECT scan.

Pre-Surgical Evaluation

Some patients with refractory seizures may benefit from epilepsy surgery. In some forms of epilepsy, surgical treatment provides seizure freedom to 60-80% of operated patients. For surgery to be successful, the presurgical evaluation is of utmost importance in determining the brain area that should be removed. Our epilepsy team performs comprehensive epilepsy pre-surgical evaluations which usually include a detailed history and physical examination, Video-EEG monitoring, special MRI scans, brain PET scan, and neuropsychological testing.  The workup may also include ictal SPECT scans, Wada testing and functional MRI (fMRI) scans in some cases. If the seizure discharges are difficult to localize, special EEG electrodes (grids or depth electrodes) are implanted over or within the brain. EEG abnormalities can be recorded from these electrodes, and electrical stimulation of the same electrodes helps localize functions in the brain that need to be preserved during surgery.

Vagus Nerve Stimulation 

The Vagus Nerve Stimulator (VNS) is a device that generates weak electrical impulses delivered to the vagus nerve in the neck. These impulses indirectly affect the brain and may improve seizure control in many patients. The VNS generator is a small, flat oval electrical device about the size of a silver dollar that is surgically implanted under the skin below the collarbone or in the armpit. The UAMS Arkansas Epilepsy Center offers this option as a treatment for refractory epilepsy in appropriate patients.  Since this procedure rarely stops seizures completely or eliminates the need for anti seizure medications, it is offered mainly when brain surgery is not a good option.

Education

The UAMS Epilepsy Center provides training to neurology residents and other physicians in training who rotate through the epilepsy clinic, EEG laboratory, and Epilepsy Monitoring Unit.  We also provide educational programs for residents and medical students including a year-long clinical neurophysiology course, multidisciplinary epilepsy surgery conferences, and a journal review conference. Our epilepsy specialists are available to give lectures to medical personnel or epilepsy patient support groups throughout the state of Arkansas.

Research

The epilepsy team at UAMS is actively involved in research and clinical trials to discover new therapies, drugs and medical advancements to improve quality of life for patients with epilepsy. UAMS is currently accepting patients to participate in a variety of clinical research trials.

Please contact Joanna Thurston, RN at 501-526-6239 or email JThurston@uams.edu to learn more about our current research protocols and whether you may qualify. Your participation in any trial is entirely voluntary. You may decide not to participate or to withdraw at any time without losing the benefits of your standard medical care.