DCEC Complex Epilepsy Program
Epilepsy services available at Duke include the inpatient epilepsy service (or Epilepsy Monitoring Unit), outpatient services at the Duke Epilepsy Center, and the Comprehensive Epilepsy Clinic, which offers outpatient evaluation of both adult and pediatric patients.
Inpatient Epilepsy Service (Epilepsy Monitoring Unit)
The inpatient epilepsy service or Epilepsy Monitoring Unit (EMU) is available for the presurgical evaluation of medically intractable epilepsy and the characterization of spells or seizure type using long-term video-EEG monitoring. Along with attending physicians and epilepsy nurses, neurology residents and neurophysiology fellows participate in the management and care of these patients.
In addition to the video-EEG monitoring, presurgical (Phase I) work-ups may include:
- Prolonged sleep-deprived EEG recording for epileptiform activity localization and quantification
- High resolution MRI of the brain for evaluation of structural lesions such as mesial temporal sclerosis, cortical dysplasia or vascular malformations
- PET scan of the brain to evaluate for functional abnormalities, such as temporal lobe hypometabolism
- SPECT for comparison of interictal and ictal cerebral blood flow
- Neuropsychological testing and intracarotid amobarbital test (Wada) for lateralization of language and memory function
Should invasive (Phase II) monitoring be necessary, depth electrodes, subdural strip electrodes, or grid electrodes are utilized as needed.
Surgical treatment includes lobectomy, lesionectomy, corticectomy, hemi-spherectomy, corpus callosotomy, MRI-guided laser thermal ablation, implantation of neurostimulators (such as vagus nerve stimulator, VNS).
An epilepsy conference is held weekly for data presentation and to recommend site and type of surgery or additional invasive monitoring using intracranial electrodes, if indicated.
In addition to services related to the Epilepsy Monitoring Unit, inpatient services provided include consultations for difficult to manage patients and very busy critical care EEG monitoring service for both adults and pediatrics.
Outpatient Epilepsy Services
The Duke Epilepsy Center offers a full array of outpatient testing including routine EEGs, short-term (4-6 hours) outpatient video EEGs, ambulatory EEGs, and clinical evoked potentials (visual, auditory and somatosensory).
Comprehensive Epilepsy Clinic
The Comprehensive Epilepsy Clinic at Duke offers outpatient evaluation of both adult and pediatric patients. It is staffed by epileptologists, neurophysiology fellows, neurology residents and physician assistants and nurse practitioners who specialize in epilepsy. In addition to evaluation and management of seizures, the clinic specializes in helping patients manage the co-morbidities of epilepsy as well as its impact on their lives.
There is also an Epilepsy Clinic at the Durham VA Hospital, which is an Epilepsy Center of Excellence. They offer both outpatient evaluation and management that meets twice a month, alternating weeks with Duke Epilepsy Clinic. This clinic is staffed by epileptologists, clinical neurophysiology fellows, the Duke residents on rotation at the VA Hospital and nurse practitioners.