Neurology

UNM Comprehensive Epilepsy Center
A cooperative program of the UNM Departments of Neurology, Neurosurgery, and Neuroscience

Bruce Fisch, MD
Medical Director

Academic Office
Department of Neurology
MSC10 5620
Health Sciences Center
1 University of New Mexico
Albuquerque, NM 87131-0001

Administrative Office
Phone: (505) 272-3342
Fax: (505) 272-6692
Neurology@salud.unm.edu

Treatment Services and Indications

Medications

Seizure medications are the initial treatment for disabling seizures. However, not all people can tolerate some antiepileptic medications and certain medications will provide better control for individual seizure disorders. So the first consideration is which kind of seizure disorder the patient has. In general, the selection of seizure medications depends on the specific diagnosis, the presence or absence of other medical disorders and how they might be affected by the medication, whether or not the patient is taking other medications (to avoid certain drug interactions), and the risk of side effects (for example, some medications should be avoided in women considering pregnancy). In many cases, seizure control can be gained by changing the patient’s medications.

Biomedical Devices (VNS)

Biomedical devices are considered when patients continue to have seizures despite trying several medications and especially if curative surgery is not an option. Vagus nerve stimulators (VNS) are small devices placed under the skin of the upper side of the chest that send signals to a wire placed around the vagus nerve in the neck. In approximately one half of all people with seizures who try a VNS, there will be about a 45 to 50% reduction in the number of seizures they experience. Medications are used with the VNS. The VNS can be surgically inserted in 2 to 3 hours and usually does not require staying in the hospital overnight.

Epilepsy Surgery

Epilepsy surgery is performed either to cure epilepsy or reduce the severity of epilepsy when other measures are unsuccessful. The goal of surgery is to remove the abnormal part of the brain that causes seizures without causing any side effects. Epilepsy surgery is a well-established treatment with excellent results in carefully selected individuals. In general, if the patient’s seizures are thought to come from one part of the brain, and if they have continued to have any seizures despite medication trials with at least 2 antiepileptic medications and one combination, then the patient should be referred to an epilepsy center to determine if other therapies should be tried or if they would be likely to benefit significantly from surgery. In general, the risks of surgery in well-selected patients are far outweighed by the risks of continuing disability, psychiatric co-morbidity, trauma, cognitive decline, infection and death related to seizures. In good surgical candidates, early surgery is recommended due to the aforementioned risks and continuing poor quality of life arising from being unable to pursue education, employment, family and social relationships. After meeting with the epilepsy physician, if diagnostic testing indicates that surgery would be beneficial, an appointment is made with the Epilepsy Center Neurosurgeon to discuss the procedure.