Hemodialysis

Epilepsy

At St Luke’s, there is an Epilepsy Program and a Special Crisis Recording Unit, which offer services to people with epilepsy and other similar problems. The above services belong to the activities of the Epilepsy Center, which was formed in the middle of 2002 and is part of the Neurological Department of the hospital. Its capabilities stand out in Greece, but also in the wider Balkan region, setting the bar high when it comes to the care of patients with epilepsy. We do approximately 100-110 case assessments per year, of which 35% are in children. Of the total assessments, 75% are diagnostic and 25% preoperative. 
Services offered

The Epilepsy Center’s modern Epilepsy Program is for people who experience epileptic seizures (as well as seizures that resemble epileptic ones) and aims to give these people the best possible care. For the success of this goal are required:

Correct diagnosis


Collection and interpretation of information from the history, clinical examination and special tests performed in these cases (this information will lead to a clearer picture and will be evaluated accordingly, so that specific treatments can be recommended).
Continuous information and awareness of patients about the outlook in the field of epilepsy, so that every new development in the disease covers all patients favorably.

Who is the Epilepsy Center for?


The categories of patients who can benefit from the services of the Epilepsy Center are mainly the following:
  • Patients who are not sure that they suffer from epilepsy, while they present seizures that look like it (fainting attacks, anxiety states, movement disorders etc.).
  • Patients who suffer from epilepsy, but we do not know from which type of the disease, which is necessary for us to learn, in order to direct the patient towards the correct treatment of his problem.
  • Patients with drug-resistant epilepsy, that is those whose seizures are not satisfactorily controlled by standard treatments, so at least some of them can be helped by surgical treatment of the problem.
Epilepsy Program

The extent and type of examinations to which each patient is submitted are individualized according to the type of problem.
The main tests are the following:
  • Long-term Video-EEG Monitoring
  • Long-Term Video-EEG Monitoring is done at the Epilepsy Center, in a specially configured Unit and under close monitoring of the patient by medical, technical and nursing staff. During the examination, the patient can do all their usual daily activities. 

With these records we achieve:

  • The final diagnosis of the problem (whether or not it is epilepsy)
  • The clarification of the type of epilepsy the patient suffers from (for example, if the seizures start from a specific area of the brain and which one)


Long-term Intracranial Video-Electroencephalographic Recordings


In some of the patients who are candidates for surgery, we may need to use special recordings, the intracranial ones, made with special electrodes surgically placed in the brain.

Magnetic Tomography (MRI) of the Brain


This examination gives us more specific information about brain damage, which cannot be ruled out as being responsible for the seizures. It is particularly important to know the etiology of epilepsy, especially when considering the possibility of surgical treatment of the problem.
Neuropsychological Tests

These give important information about the mental functions of the patient and their eventual disorders due to brain damage and ongoing seizures or even adverse effects from the drugs. This information is especially important when planning surgery and we want to assess a patient’s mental capabilities and weaknesses in order to advise them on their academics or career path and the kind of help they may need.


Functional Magnetic Resonance Imaging (fMRI) of movement and speech


This examination is done to identify areas in the brain important for movement and understanding-speech production, so that the neurosurgeon can plan the operation in such a way as to avoid these areas and the consequent risks for post-operative deficits in these functions.

EEG and Functional Magnetic Resonance Imaging (EEG-fMRI)


In particular, for the detection of epileptogenic foci, we also apply the combination of EEG and fMRI (EEG-fMRI), a new development in the field of pre-operative assessment of epilepsy, which is constantly gaining ground in the major Epilepsy centers. Our Center is the only one in Greece and the Balkans that has this facility, while in Europe there are no more than 15 other centers with this facility.
Continuous care and monitoring

The result of interdisciplinary collaboration

The Epilepsy Program operates under the responsibility of a team of specially trained neurologists, neurosurgeons, neuroradiologists, neuropsychologists and with the continuous care and monitoring of experienced technical and nursing staff.

Innovative methods for the treatment of patients with epilepsy

The Epilepsy Team of St Luke’s hospital, led by Kyriakos Garganis, Neurologist – Epileptologist, Doctor of Medicine AUTH, applies innovative methods for the treatment of patients with epilepsy. These practices concern patients with epilepsy, resistant to the relevant pharmaceutical treatments. 
 
The key to the success of these practices lies in the following:
  1. Preoperative control of epilepsy. During this, it is determined whether the patient is suitable for surgery. It is also being investigated whether he is at risk to his mental functions or any other neurological function from the operation. Doctors can predict a patient’s chances of being seizure-free after surgery.
  2. Correct and effective surgical treatment of epilepsy. The operation is performed with the use of special electrodes, which guide the excision of the irritated tissue.
  3. Postoperative hospitalization for five to seven days. After postoperative care, the patient returns home. The medication is gradually reduced and sometimes it can be stopped completely.

Epileptic Surgery

With many years of experience and with the contribution of distinguished neurosurgeons, both in Greece and abroad, the department is a specialized center for the surgical treatment of epilepsy, adhering to all modern medical protocols and using state-of-the-art diagnostic equipment. Our goal is to improve the patient’s quality of life with the accompanying cessation or reduction of seizures and the maintenance of all brain functions.

The infrastructure and know-how we have at the Center is that of a quaternary and modern, by international standards, epilepsy center. It includes possibilities for long-term video-EEG recordings, both with extracranial and intracranial electrodes, contemporary imaging, with magnetic resonance imaging (MRI) of the brain, functional magnetic resonance imaging (fMRI), advanced signal analysis methods with the decisive participation of the Department of Computer Electrical Engineering and signal analysis from the National Technical University of Athens.

Epilepsy surgery is indicated for people whose seizures are not controlled by medication. The goal is to improve the patient’s quality of life by permanently stopping or significantly reducing the frequency and/or severity of seizures. The surgery is performed by a specialist neurosurgeon.
What are the criteria for the surgical treatment of epilepsy?


The surgical treatment of epilepsy is aimed at:

  • People who have tried two or more anti-seizure medicines and have not been able to significantly reduce or get rid of their seizures.
  • People who experience focal seizures (seizures that start in a specific area of the brain).
Types of surgery

There are three main types of surgery to treat epilepsy:
 
1. Temporal lobe surgery
 

This is the most common type of neurosurgery for people with temporal lobe epilepsy and may involve a temporal lobectomy (not to be confused with lobotomy) or selective amygdala-hippocampectomy. With this method, the brain tissue in the temporal lobes that causes the seizures is removed.

2. Surgery outside the temporal lobe
 
In this type of surgery, the brain tissue that causes seizures is located in other parts of the brain, for example in the occipital, parietal or frontal lobes. During surgery, this tissue is removed.
3. Lesionectomy
 

This surgery involves removing tumors, abscesses, or other damage to the brain that is causing seizures. The type of surgery depends on the type of seizures and their initial focus. The goal is to remove the entire area of brain tissue that is causing the seizures, without causing any loss of brain function.

People who need epilepsy surgery undergo extensive testing to find the source of the seizures and to ensure that removing that area of the brain will not affect their speech, mobility or quality of life.
Brain mapping or electrocorticography
 

Brain mapping is a diagnostic procedure often necessary if the seizure focus is near important functional areas or if the exact location of the focus remains unclear despite standard diagnostic tests.

 

Making the decision

Interdisciplinary team specializing in the treatment of epilepsy thoroughly examines all the results of the diagnostic tests performed so as to decide if surgery is the best treatment option. The operation is performed only if there is a joint decision that overcomes the chances of complications and that may significantly improve the outcome of the disease.

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