The Via Christi Comprehensive Epilepsy Center is a Level IV medical and surgical referral center—an expert resource for more than 1,100 epilepsy patients and their physicians from 80 Kansas counties and surrounding states, and one of the busiest clinical research sites in the nation. We have one goal—to help patients achieve control of their seizures and improve quality of life. Patients are referred to the Epilepsy Center when standard treatment is ineffective or when special circumstances create challenges in epilepsy diagnosis and management. We offer advanced diagnostic services, advanced medical and surgical treatments, regional coordination of national clinical studies and other research studies. The Epilepsy Center is part of the Neuroscience Department of Via Christi Regional Medical Center, a 945-bed tertiary care medical center and clinical campus of the University of Kansas School of Medicine-Wichita.

• Evaluation of new or established seizures/epilepsy
• Definitive diagnosis in patients with unexplained spells
• Evaluation and treatment of refractory (hard-to-control) seizures
• Establish optimal medication regimens to maximize seizure control and minimize side effects
• Management of seizures or epilepsy in special situations such as pregnancy or in the elderly
• Evaluation for Vagal Nerve Stimulator Implant
• Evaluation for ketogenic diets
• Evaluation for epilepsy surgery (temporal, extra-temporal resections and Corpus callosotomy)
• Evaluation for epilepsy drug studies
• Consultation and second opinion on complex and difficult cases
• Neuropsychological evaluations
• Psychiatric evaluations and treatment for epilepsy patients
• Rehabilitation and social services related to epilepsy
• Regional and state-wide educational resources for epilepsy patients and professionals

• Inpatient dedicated Video EEG monitoring. Epilepsy monitoring unit attended by trained Video EEG technicians 24 hours a day
• Outpatient dedicated epilepsy clinic directed by epileptologist
• MRI specifically adapted for epilepsy studies
• FD glucose PET
• SPECT
• 12-bed neuro intensive care unit with epilepsy (EEG) monitoring capability
• WADA Testing (Amobarbital testing for epilepsy surgery)
• Surgical monitoring including grid and depth electrode placement; functional mapping
• Level I trauma center

Epileptologist – Board-certified neurologist with two years of ACGME-accredited formal fellowship training in epilepsy and clinical neurophysiology. Medical director for Epilepsy Center; directs patient care Neurologists – Board-certified physicians with residency training in neurology including epilepsy. Epilepsy neurosurgeon – Board-certified neurosurgeon with advanced credentials and experience in epilepsy surgery. Neuroradiologist – Board-certified radiologist with special training to perform imaging studies specific to epilepsy and seizure disorders. These may include MRI, PET scans, and other studies Neuropsychologist –Psychologist specializing in neurocognitive development in children and adults and expert in mapping language and memory brain regions for surgery. Physician Assistant—Under supervision of epileptologist, sees patients and coordinates Epilepsy Center clincal trials and research. Epilepsy nurse practitioner—Under supervision of epileptologist, sees patients for routine and follow-up care. Epilepsy nurses—Nurses with training/experience in the management of epilepsy, including medication and other issues. EEG technicians—Perform EEG "brain wave" studies Speech-language pathologists—Specialize in language development and reading in patients with epilepsy. Make recommendations for language/reading interventions in school. Physical and occupational therapists—Assess the daily skills and capabilities of patients with epilepsy and make recommendations regarding rehabilitation intervention and the various resources available to epilepsy patients. Social workers - Assist patients with various issues related to epilepsy including medical assistance, medications assistance and others.

Dr. Liow is the Medical Director of the Via Christi Comprehensive Epilepsy Center and Neurophysiology Laboratory and Clinical Associate Professor of Medicine, Psychiatry and Neurology, at University of Kansas School of Medicine. After completing neurology residency training at the University of Utah School of Medicine, Dr. Liow trained in epilepsy/neurophysiology (EEG) for an additional two years at the National Institutes of Health (NIH) in Bethesda, Maryland. This ACGME (Accreditation of Graduate Medical Education)-accredited fellowship in neurophysiology focused on treatment

Contact Dr. Liow

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Epilepsy Monitoring Unit (Video-EEG). The Epilepsy Monitoring Unit (EMU) is a specialized four-bed inpatient unit at the Via Christi Regional Medical Center designed to evaluate, diagnose, and treat seizures in patients of all ages. The goal is to record typical events to determine whether there are any brain electrical changes. Continuous monitoring of behavior and EEG can be useful in order to establish the diagnosis of questionable clinical events (differential diagnosis) and for the quantification of seizures, classification of seizure type, and to evaluate patients for epilepsy surgery. It is imperative to establish a correct diagnosis for seizure like events so that antiepileptic drugs are not prescribed inappropriately. Patients who suffer from seizures/spells, which are difficult to diagnose and to manage, are appropriate to be admitted to the EMU. Others are those who are being considered for seizure surgery who need to be monitored to locate where in the brain the seizures begin.

The Via Christi Comprehensive Epilepsy Center EMU is staffed with specially trained EEG technical personnel monitoring patients 24 hours a day, in addition to round the clock specially trained nursing care for epilepsy management. The EMU is equipped with computer-based monitoring equipment expressly designed for the evaluation of seizure disorders. Interpretation of Video-EEG or EEG recorded in the EMU are performed only by the epileptologist or neurologists who have documented competency to interpret Video-EEG as determined by guidelines established by the American Clinical Neurophysiology Society (formerly the American EEG Society).

Surgical Evaluations. Although most patients with epilepsy can achieve satisfactory control of seizures with antiepileptic medications, some patients have seizures that cannot be adequately controlled by medication, and these individuals may be considered as candidates for epilepsy surgery at the Via Christi Comprehensive Epilepsy Center. The evaluation may involve two phases.

Phase I Monitoring (Video EEG Monitoring). A first step in determining whether someone might be considered for epilepsy surgery is often video EEG monitoring. This testing allows your doctor to tell what type of seizures you are having, how many seizures you experience, and where in the brain the seizures begin. Video EEG monitoring is described in the section on the Epilepsy Monitoring Unit. Other testing is usually performed to identify the site of onset of seizures and to address the safety of the proposed surgery. These may include some, but usually not all, of the following:

Magnetic Resonance Imaging (MRI).This test uses the magnetic properties of tissues to create a detailed picture of the brain. Because it is based on the differences in the magnetic properties of tissues, it does not use any harmful radiation. This test can help identify possible abnormal regions in the brain where seizures might begin. In some cases, MRI scans may be repeated to take advantage of new techniques not available in the past or at some other centers. PET Scan. This test may be done as an outpatient. It is a special type of brain scan that looks at brain metabolism, or how the brain uses glucose (sugar). Often the brain region where seizures begin may not use glucose normally, so this test provides one additional way to confirm the region of seizure onset. Wada Test. This test also is done as an outpatient. In some cases, this test is necessary to help determine which part of the brain controls language function, and also helps to tell which parts of the brain are working to support memory function. Your doctor will discuss this test with you in more detail if it is a necessary part of your evaluation.

Phase II Monitoring (Intracranial EEG Recordings). In some cases, the testing described above is not able to adequately pinpoint the seizure focus, and it is necessary to use intracranial EEG electrodes (Phase II Monitoring). The intracranial electrodes are placed directly on the surface of the brain by a neurosurgeon in the operating room. After the electrodes are placed, EEG recordings are made directly from the surface of the brain. The testing takes place on the epilepsy monitoring unit.. In order to record seizures, medications may be reduced or discontinued. During intracranial EEG monitoring, brain mapping is frequently performed. This testing is performed at the bedside. Your physician will explain this in more detail if it is necessary, but, generally, it involves performing some task, such as finger tapping, reading, etc., while a small amount of electrical current is passed to the intracranial electrodes. This is not painful or uncomfortable. This allows information to be gathered about the function of the brain tissue underlying the intracranial electrodes.

Epilepsy Surgery. After the appropriate tests have been performed, your case will be discussed at the Comprehensive Epilepsy Center Surgical Case Conference. This is a multidisciplinary conference that includes the epilepsy neurosurgeon. At this conference, all test results are reviewed, and a consensus recommendation is made regarding candidacy

for epilepsy surgery. If the consensus is that a surgical option can be offered, your physician will meet with you to discuss the risks and benefits of epilepsy surgery. If you decide with your doctor's guidance to go forward with epilepsy surgery, you will be eval- uated by the epilepsy neuro-

surgeon, and a date for the surgery will be scheduled. Postoperative care includes most often an overnight stay in the intensive care unit, followed by often 2 to 4 days in a regular hospital room before discharge. By the time of discharge, you will be eating, walking, and using the bathroom. It may be several weeks before you feel like you have fully recovered your energy and endurance. Most patients, even after successful epilepsy surgery, stay on antiepileptic medications for at least 2 to 5 years, and many continue medication indefinitely. Your physician will discuss medication issues with you.

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Surgeries Performed at Via Christi: Benefits and Risks

Lobectomies. While there are risks in all surgical procedures, including the placement of depth electrodes and grids, most brain surgery for epilepsy appears to be relatively safe. The success rate for epilepsy surgeries depends on the type of operation performed and can usually be predicted after all the test results are available.

For temporal lobectomies (operations on the temporal lobe of the brain), 65 to 85 percent of patients will be seizure-free. Complications occur in about four out of every 100 of these operations. Depending on the kind of surgery that's performed and in what part of the brain it is performed, possible complications include: partial losses of vision, motor ability, memory or speech. Infection or temporary swelling of the brain may also sometimes happen.

Corpus Callosotomies. Among patients having a corpus callosotomy (split brain operation), risks of major and minor complications after surgery are around 20 per 100 operations. Generalized seizures may stop or happen less often than before the operation. Partial seizures (that is, changes in movement, feeling or emotion without loss of consciousness) will probably continue and may even get worse. Still, the uncontrolled drop attacks and generalized tonic clonic seizures that the operation is designed to treat have risks of their own. Decisions to operate take all these possibilities into account.

Cortical Resections.There are times when the surgery is limited to removal of a small area of one part of the brain. The results and the complications of this procedure depend upon the specific area of the brain that is removed.

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Vagal Nerve Stimulation. For certain types of epilepsy as well as those patients who are not suitable surgical candidates, vagal nerve stimulation (VNS) is another form of treatment that may be tried when medications fail to stop seizures. The therapy is designed to prevent seizures by sending regular small pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck.

If the person with the VNS feels a seizure coming on, he or she can activate the discharge by passing a small magnet over the battery. In some people, this has the effect of stopping the seizure. It is also possible to turn the device off by holding the magnet over it.

Side effects of VNS treatment are mostly hoarseness and, sometimes, discomfort in the throat. There may be a change in voice quality during the actual stimulation. Although complete seizure control is seldom achieved, the majority of people who have the VNS implant experience fewer seizures. In some its effectiveness increases with time, and patients report an improved quality of life. As with surgery and the ketogenic diet, it may be necessary to continue with antiepilepsy medication in addition to VNS therapy.

The Via Christi Comprehensive Epilepsy Center works with the Via Christi Neuro Implant Program to provide VNS therapy to our patients.

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Ketogenic Diet. The ketogenic diet, which is very high in fats and low in carbohydrates, was first developed almost 80 years ago. It makes the body burn fat for energy instead of glucose. When carefully monitored by a medical team familiar with its use, the diet helps two out of three children who are tried on it and may prevent seizures completely in one out of three. It is a strict diet, and takes a strong commitment from the whole family. The ketogenic diet is not a do-it-yourself diet. It is a serious form of treatment that, like other therapies for epilepsy, has some side effects that have to be watched for. More research is being done to learn about the underlying reasons for the diet's positive effect.

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Research/drug studies. The Via Christi Comprehensive Epilepsy Center is one of the busiest clinical research sites in the nation. It collaborates on research projects with other departments and serves as a research learning site for post-doctorate and doctoral candidates, graduates, and undergraduate students.

Current studies include:

• Responsive neurostimulator Neuropace study (www.neuropace.com)
• Clinical drug trials for various epilepsy types and conditions (call for more information)
• NIH-funded multi-center study of the neurodevelopmental effects of antiepileptic drugs (NEAD) on babies and children