Adult Epilepsy Program

The Adult Epilepsy Surgery Program at UPMC Presbyterian is the region’s leading center for the comprehensive surgical treatment of adult epilepsy. Part of the University of Pittsburgh Comprehensive Epilepsy Center, the surgery program offers the latest treatments for patients suffering from multiple types of epilepsy. This program is directed by R. Mark Richardson, MD, PhD, in coordination with our colleagues in the Epilepsy Division of the Department of Neurology.

We offer a variety of minimally invasive procedures for the treatment of epilepsy, including diagnostic stereo-EEG, using the ROSA (Robotic Stereotactic Assistance) system. We also offer responsive neurostimulation (RNS) as well as laser thermal ablation using NeuroBlate as an alternative to traditional open resective surgeries for temporal lobe epilepsy, gelastic seizures due to a hypothalamic hamartoma, and other types of epilepsy. These surgeries are done through an incision about the width of a pencil’s eraser. With laser thermal ablation and RNS, most patients are discharged home the next day

Types of Epilepsy Treated

The only potential cure for a patient’s epilepsy is the surgical removal of the seizure focus, if it can be identified. Chances for seizure freedom can be as high as 90% in some cases of seizures that originate in the temporal lobe. Seizure foci located outside of the temporal lobe can also be treated, even when located near areas of speech and motor function.

Only patients with focal epilepsy are candidates for resective brain surgery. Patients with generalized seizure disorders, however, may be candidates for vagal nerve stimulation or corpus callosotomy. Patients with focal epilepsy who have more than one seizure focus may be candidates for responsive neurostimulation (RNS).

Get more information about Epilepsy and Surgical Options.

Pathway to Surgery

Evaluation for surgical candidacy is a comprehensive process that involves our Epilepsy Neurologists, Neuropsychologists, Radiologists, and neurosurgeon. It is normal for patients to be nervous about the idea of surgery, but there are many opportunities to get to know our team as they guide patients through this process see (diagram below).

Surgical Pathway Diagram

Consultation with the Neurosurgeon

Tragically, it takes an average of 20 years for patients with drug-resistant epilepsy to be referred to an epilepsy surgeon. For this reason, The University of Pittsburgh Comprehensive Epilepsy Center (UPCEC) has a program to give patients and their families more time to learn about epilepsy surgery. Surgical Alternatives For Epilepsy (SAFE) counseling is a process that allows epilepsy patients, and their families, to talk to a neurosurgeon about the role of brain surgery in the treatment of epilepsy, even if surgery has not yet been recommended.  In this program, neurologists are referring epilepsy patients much earlier in the course of their disease, recognizing that surgery for epilepsy is not a “last resort” but a potential cure.

See SAFE counseling brochure (pdf)

Postoperative Care

Our team carefully follows patients after surgery, to ensure that all resources are maximized for optimal recovery. Patients typically leave the hospital within two to four days after surgery, and take steroids to reduce brain swelling for the next three weeks. Patients may return to work in as little as two to three weeks, depending on the type of surgery. The patient’s epileptologist continues to manage antiepileptic medications, which are continued at the usual preoperative doses for at least six months. Importantly, all patients are scheduled for repeat neuropsychological testing at six weeks after surgery to assess for any difficulties in the recovery process that could be aided by outpatient therapies.

Epilepsy Surgery Support Group

In conjunction with the Epilepsy Foundation of Western Pennsylvania, our department hosts an Epilepsy Surgery Support Group every 3rd Friday of the month, where anyone who has had, or is considering having, surgery for epilepsy is invited to come and share their experiences or ask questions.

RSVP: 
Francine Reyher, Adult Services Coordinator, Epilepsy Foundation Western/Central  PA, 800-361-5885 
Danielle Wagner, Physician Assistant, Adult Epilepsy Surgery Program, 412-864-3421

Epilepsy Research

The Surgical Epilepsy Brain and Biomarker Databank, in the Brain Modulation Laboratory, is the foundation of a sophisticated research initiative devoted to investigating basic mechanisms of epilepsy and potential therapeutic targets. We hope that this work will eventually lead to new treatment options for patients.