Epilepsy Program

Measures electrical activity in the brain to identify abnormal patterns.

Provides continuous video and EEG monitoring in a safe, comfortable setting to directly observe seizures and determine their source.

For some patients, diagnosis requires observing seizures directly. Hoag’s Level 4 Epilepsy Monitoring Unit offers around-the-clock video and EEG monitoring in a supportive hospital setting. Our team of epileptologists, nurses, and technologists carefully analyzes this data to determine if seizures are epileptic and, if so, their type and origin. This information is critical in designing the most effective treatment plan.

Learn more about Hoag's Epilepsy Monitoring Unit here.

High-resolution 3T MRI scans detect subtle abnormalities. Images may be combined (“fused”) with PET, MEG, or SPECT for even greater detail.

Maps language and motor areas to protect critical brain functions during surgery.

Identifies areas of abnormal brain metabolism linked to seizures

Detects magnetic fields from brain activity, revealing clusters of abnormal signals.

Measures blood flow and metabolism in the brain.

Provides detailed cross-sectional images of the brain, often used in emergencies.

Antiepileptic drugs (AEDs) are designed to reduce the brain’s tendency to generate abnormal electrical activity that leads to seizures. The goal is not only to stop seizures but also to allow patients to live as safely and independently as possible. For many people, medication is the best way to control seizures while avoiding surgery.

Selecting the right medication is a personalized process. Hoag specialists will:

• Review seizure type and frequency:

  Different medications work better for different seizure types.

• Assess patient lifestyle and health:

  Factors such as age, pregnancy plans, and other health conditions guide treatment choices.

• Start with the lowest effective dose:

  To minimize side effects while achieving seizure control.

• Adjust over time:

  Medications are often fine-tuned based on response and tolerance.

Because epilepsy medications can interact with other drugs, it’s essential to have ongoing management from an epileptologist—a neurologist with specialized training in seizure disorders.

While treatment is always individualized, commonly prescribed antiepileptic drugs may include:

• Levetiracetam (Keppra®)

  • Often well tolerated with fewer drug interactions.

• Lamotrigine (Lamictal®)

  • Frequently used for focal and generalized seizures, with mood-stabilizing benefits.

• Valproic acid (Depakote®)

  • Effective for many seizure types but not recommended in all patient populations.

• Topiramate (Topamax®)

  • May be used in patients with both epilepsy and migraine.

Your care team will discuss the risks, benefits, and alternatives to ensure you understand the best option for your situation.

Stereoelectroencephalography (sEEG) is a diagnostic procedure using miniature electrodes measuring less than 1 mm in diameter to record brain activity in the location of seizures. This minimally invasive technique does not require traditional incisions or hair shave, while still permit a 3-dimentional map of the seizure network. By localizing seizures with sEEG, Hoag neurologists and neurosurgeons can predict how to cure seizures with subsequent treatments. Patients stay in the Epilepsy Monitoring Unit for one week, on average, during brain mapping and go home the day after sEEG removal.

Laser therapy is a minimally-invasive, hair-sparing procedure that can cure seizures by treating the seizure-origin within the brain. Following a short procedure performed in the MRI scanner, patients stay overnight before returning home. Since there is no incision, patients return to normal activities quickly with minimal discomfort.

Patients who have benefited from this technology have a 87% seizure freedom rate compared to the national average of 61%.

MR-guided-focused ultrasound is a technique used to treat the brain noninvasively. This treatment is FDA-approved for movement disorders and used on clinical trials to treat seizure disorders without requiring general anesthesia or operation.

RNS technology combines real-time surveillance for seizures with gentle stimulation to stop seizures at their origin before they spread. This fully implantable neuromodulation system reduces seizures by up to 80%. Importantly, RNS is the only technology that records seizure frequency and EEG at home. This provides valuable information for the patient’s provider when managing treatment.

Originally developed in the 1980’s, this technology gained approval for the treatment of seizures in recent years. DBS blocks seizure propagation, preventing seizure spread even when seizures are generalized. Seizures may be reduced by up to 80%. Additionally, the system is rechargeable, thereby tripling the life expectancy of the implanted battery before needing replacement.

VNS activates the vagal nerve in the neck to modulate nervous system activity. VNS is an effective therapy for those who are not candidates for other therapies. VNS may reduce seizures by 50-60% and be used in children as young as four years old.

Hoag offers minimally-invasive approaches to reduce or cure seizures. These techniques include noninvasive procedures, minimally-invasive procedures, and endoscopic procedures. By reducing trauma to the tissue, patients are exposed to less surgical risk, faster recovery, less pain, and improved cosmetic result.

Hoag utilizes hair-sparing surgical approaches. From laser surgery to open surgery, our neurosurgeons utilize plastic-surgery style approaches to maximize positive results. In many of our procedures, minimal- or no-hair is shaved during surgery. This permits individuals to return to normal activities without the feeling of stigma associated with brain surgery.

Hoag surgeons have mastered surgical approaches by training across the globe to bring the latest surgical techniques to the individuals of Orange County. The range of surgical approaches routinely performed at Hoag include craniotomy, lobectomy, lesionectomy, topectomy, corpus callostomy and disconnection procedures.

The Pickup Family Neurosciences Institute at Hoag became one of the first hospitals in the nation to obtain and use the Medtronic Stealth Autoguide Robotic Platform to treat epileptic seizures and the first hospital in the world to perform minimally invasive brain biopsy using this technology.

The Stealth Autoguide Robot uses a small pinpoint hole through which neurosurgeons can place electrodes or biopsy needles precisely in the brain to diagnose or treat epilepsy, cancer or other neurological conditions. Without this tool, these procedures typically involve shaving large portions of the scalp, making larger incisions and removing pieces of skull to expose the brain for surgery.

The highly advanced surgical tool replaces open cranial surgery for certain patients and greatly increases accuracy and patient recovery. The device can be used for a range of neurological conditions that require precision guidance for placement of diagnostic electrodes, biopsy or targeted laser ablation.

Hoag is a Level 4 Epilepsy Center, the highest accreditation for epilepsy care. Our team includes three full-time epileptologists, a functional neurosurgeon, and specialized nurses and technologists. We combine advanced diagnostics, personalized treatment, and compassionate care to help patients achieve the best possible outcomes.

The first step is a detailed discussion with one of our epilepsy specialists (epileptologists). Your doctor will ask questions about your seizure history, symptoms, and any warning signs you may notice before an episode. This information helps us decide which tests are needed to confirm a diagnosis.

Our specialists use a variety of advanced tools, including:

• Electroencephalogram (EEG): Records brain activity.

• MRI and fMRI scans: Provide detailed images of the brain.

• PET, MEG, and SPECT scans: Show brain function and metabolism.

• Epilepsy Monitoring Unit (EMU): Allows doctors to safely observe and record seizures

An EMU is a specialized hospital unit where patients stay under continuous video and EEG monitoring. This allows doctors to see exactly what happens during a seizure, determine whether seizures are epileptic, and identify where in the brain they start.

There are many things that can cause increased risk of seizures in people that are prone to seizures. People with epilepsy should not drink alcoholic beverages or do illicit drugs. Doing so will increase the risk of seizures significantly. Many people with epilepsy have identified certain things that seem to increase the number or severity of their seizures. Sometimes these connections are just coincidences, but in many cases a link has been proven between these factors (also called triggers) and the occurrence of seizures.

Examples of typical seizure triggers include: lack of sleep, skipping a meal, or increased stress.

Many conditions can mimic epilepsy, such as fainting, sleep disorders, or movement disorders. An accurate diagnosis ensures you receive the right treatment and avoid unnecessary medications.

About two-thirds of people with epilepsy achieve good seizure control with medications. For the one-third of patients with drug-resistant epilepsy, advanced options such as surgery, neurostimulation, or dietary therapy may be recommended.

People who have recently had a seizure or are having active seizures should not drive. However, people with epilepsy whose seizures are fully controlled with medication can qualify to drive. With close follow-up with a neurologist, you can often drive after being seizure-free for a period of time. The physician will work with you to help you drive as soon as your seizures are controlled and there is no risk of losing consciousness from seizures.

If driving is not an option, alternatives such as using public transportation, signing-up with local services for the elderly or disabled, or even moving to an apartment complex or community that has its own transportation may be among the alternatives.

Women with seizures and on seizure medication can get pregnant. However, certain medications can cause harm to an unborn child. There are many medications that are safe and supplements can be taken to decrease the risk of certain birth complications associated with epilepsy medication. The neurologist should be made aware of any upcoming planned pregnancy. The doctor will work with your obstetrician to provide individualized counseling or make changes to current medications.