Research

Epilepsy

The University of Chicago neuroscience community is host to a diverse group of researchers investigating epilepsy and seizure disorders. The faculty of Department of Neurology play a key role in this research, conducting critical clinical and neurophysiological studies, and providing valuable collaborations with the neuroscience researchers in other departments.

John Ebersole MD directs a research program aimed at:

  • Clarifying the relationships between cerebral electrical activity and the resultant scalp EEG; and
  • Developing and validating computational techniques of functional imaging and seizure localization using scalp, intracranial EEG, and magnetoencephalography (MEG).

Over the past fifteen years research from his laboratory has established the usefulness of spike and seizure dipole modeling with both EEG and MEG in order to localize non-invasively epileptogenic foci in epilepsy surgery candidates. He is a foremost proponent of and authority on the use of source models in the evaluation of epilepsy. Ongoing projects include studies of the accuracy of dipole and other extended source models of epileptic foci using simultaneously recorded scalp and intracranial EEG, comparisons of real-time EEG imaging with other functional imaging techniques using three-dimensional co-registrations, and the development of a new spatio-temporal analysis technique for intracranial EEG utilizing field and source display on the patient’s reconstructed cortex. These direct applications of neurocomputational, neuroimaging, and electrical engineering developments to the evaluation of epileptic foci in the human brain are an example of translational research at its best.

James Tao MD PhD is interested in determining the cerebral substrates of scalp EEG epileptiform patterns, in order to improve the accuracy of non-invasive seizure localization during epilepsy surgery. His long-term interests include investigations of the mechanisms of epileptogenesis and of new modalities of epilepsy therapy. Current projects include:

  • The impact of cerebral source area and synchrony on recording scalp EEG ictal patterns; and
  • The pathophysiology of interictal temporal delta activity (ITDA) and its value in localizing epileptogenic zone.

His long term goals are to investigate the electrophysiological behavior of cerebral epileptogenic networks and the mechanism of epileptogenesis at the neural network level in order to identify new preventive and therapeutic modalities.

Wim Van Drongelen PhD (Department of Pediatrics) has focussed his research on the long-range goal of optimizing therapeutic intervention in pediatric epilepsy by improved spatial and temporal localization of seizure activity and examining the underlying mechanisms in the pathogenesis of seizures. His research focuses on:

  • Underlying neuronal mechanisms in epilepsy (synchrony, recruitment, oscillation, weak coupling);
  • Relationships between neuronal activity at different scales (neuron, network, brain);
  • Detection and prediction of brain electrical activity during seizures using various signal processing techniques (correlation dimension, Kolmogorov entropy, wavelet analysis);
  • Localization of sources from surface recordings (dipole analysis, MUSIC, LORETA, spatial filtering); and
  • Monitoring of the nervous system in the intensive care environment (EEG, evoked potential

James Tao, MD, PhD.

Sandra Rose, MD

Shasha Wu, MD, PhD.

Naoum P. Issa, MD, PhD.

Peter Warnke, MD, FRCS

David Frim, MD, PhD.

Maureen Lacy, PhD.

Vernon L. Towle, PhD.

Shadrach Castillo, RN

Diane Suarez, REEGT

The Comprehensive Epilepsy Center at the University of Chicago Medicine is at the forefront of epilepsy care. Many of our patients come to us after trying a number of different medications and therapies with little success.

Leading Advancements in Epilepsy Care

Backed by the development of groundbreaking diagnostic techniques and a long history of research, our expert team has the experience to manage nearly all epilepsy-related problems from new onset seizures to rare and difficult-to-treat epileptic syndromes. With non-invasive technology and contemporary diagnostic techniques, we can pinpoint the origin of most seizures with precision. Having this advantage can significantly increase diagnostic accuracy and improve patient outcomes.

Epilepsy is a chronic, non-communicable neurologic disorder defined by two or more unprovoked seizures. Provoked seizures result from some immediately recognizable stimulus (for example, low blood sugar in people with diabetes), while unprovoked seizures have no immediately recognizable cause. Provoked seizures are unlikely to recur if the provocations can be avoided; however, unprovoked seizures have the tendency to recur and are the hallmark of epilepsy. When someone has two or more seizures, doctors diagnose epilepsy.

Types of Epilepsy

There are many types of epilepsy. Some types of epilepsy and epilepsy syndromes include:

  • Benign rolandic epilepsy
  • Childhood absence epilepsy
  • Doose syndrome (myoclonic astatic epilepsy of childhood) 
  • Frontal lobe epilepsy
  • Infantile spasms 
  • Juvenile myoclonic epilepsy
  • Landau-Kleffner syndrome 
  • Lennox-Gastaut syndrome
  • Occipital lobe epilepsy
  • Parietal lobe epilepsy
  • Rasmussen's syndrome
  • Sturge-Weber syndrome
  • Temporal lobe epilepsy 
  • West syndrome

A seizure is a sudden surge of abnormal electrical activity in the brain. Electrical activity in the brain is normal. It’s how our brain works. Seizures occur when there is significant disruption of that normal electrical activity in the brain. The general symptoms of seizures may include changes in consciousness, sensation, movement or behavior.

Is a Seizure the Same Thing as Epilepsy?

No. Not all seizures are caused by epilepsy. Approximately 10 percent of the general population may experience a seizure during their lifetime, but only 1 percent of the population has epilepsy. A single seizure may or may not progress to a chronic and recurrent condition or epilepsy.

Although there are many types of seizures, those that people with epilepsy experience commonly fall into generalized and partial (or focal) seizures.

Generalized Seizures

Generalized seizures are characterized by widespread electrical discharges in both sides of the brain. You might think of it as a lightning storm in which the lightning seems to be coming from all areas of the sky at the same time.

There are six types of generalized seizures:

  • Absence seizures are also known as petit mal seizures. When people experience an absence seizure, they may seem to disconnect from the world, blank out or stare into space for at least a few seconds. Their eyes may roll as well. People who have absence seizures usually lose awareness for a short time and have no memory of the seizure afterward. This type of seizure usually begins between the ages of 4 and 14, and it can resemble daydreaming. Subtle body movement may accompany the seizure, but it’s not the jerking movements that occur with tonic-clonic or clonic seizures.
  • Atonic seizures, also known as drop attacks, drop seizures or akinetic epileptic drop attacks, may involve a sudden loss of muscle tone, a head drop or leg weakening. People suffering an atonic seizure may suddenly collapse. This type of seizure may also cause the person suffering it to drop objects.
  • Clonic seizures include jerking muscle movements that are more rhythmic than chaotic. The muscle spasms typically affect the face, neck and arms. They may last for several minutes.
  • Myoclonic seizures are typically short and involve uncontrollable jerking, usually of the arms and/or legs, and last for only a second or two
  • Tonic-clonic seizures, also known as grand mal seizures, are what most people think of when they imagine a seizure. They involve a loss of consciousness, stiffening of the body and shaking or jerking, sometimes followed by loss of bladder or bowel control
  • Tonic seizures include body stiffening, but do not include the clonic phase of uncontrolled jerking or spasms. Back, arm and leg muscles are affected most often. The seizure may cause a patient to fall or collapse.

Partial Seizures

Partial seizures, also known as focal seizures, begin in one side of the brain. They fall into one of two groups:

  • Simple partial seizures (also known as simple focal seizures) may only include the aura stage (see below). During this type of seizure, awareness, memory and consciousness remain intact. This type of seizure may alter emotions or change the way things look, smell, feel, taste or sound. It may also result in involuntary jerking of a body part, such as an arm or leg, or spontaneous sensory symptoms, such as tingling, dizziness and flashing lights.
  • Complex partial seizures (also known as psychomotor seizures) alter consciousness or responsiveness. The person having the seizure may appear to be staring into space or moving without purpose. Some common movements include hand rubbing, chewing, swallowing, and repetitive motion, such as bicycling leg movements or walking in a circle.

Aura Stage

For some types of seizures, an aura happens before a seizure and may alert a person that a seizure may occur. Auras typically begin seconds before the seizure.

The symptoms that accompany an aura can vary depending on the type of seizure and the area of the brain affected. Some symptoms of aura include:

  • Abnormal sensations
  • Deja vu (familiar feelings) or jamais vu (unfamiliar feelings)

  • Distorted emotions, such as panic or fear

  • Forced thinking

  • Nausea

  • Perceived sounds, tastes, or smells (some people report smelling burning rubber, for example)

  • Physical sensations, like dizziness, headache, numbness, and lightheadedness

  • Unusual feelings 

 

At UChicago Medicine, we offer an advanced treatment designed to prevent seizures before they start and often before a patient feels the aura. The NeuroPace Responsive Neurostimulation System (RNS) is a tiny device that detects abnormal brain activity and responds in real time to deliver short bursts of electrical stimulation designed to reduce how often seizures happen.

Similarly, deep brain stimulation (DBS) prevents seizures to spread throughout the brain and stops them from becoming clinically relevant. Neuromodulation is just one of the several treatment options we provide, from the latest anti-epileptic drugs to Visualase MRI-guided laser thermal ablation. 

Ictus Stage

Ictus is another word for the seizure itself — the part of the seizure that outsiders can witness. It can be convulsive, commonly called “grand mal,” or non-convulsive, such as staring and inability to respond normally.

Postictal Stage

The postictal stage occurs after the ictus or active stage of the seizure. During the postictal stage, the body begins to relax and aftereffects may set in. The type and length of aftereffects will vary from person to person and may include:

  • Confusion and agitation
  • Fatigue and drowsiness

  • Headache

  • Loss of bowel or bladder control
  • Loss of consciousness or unresponsiveness
  • Numbness
  • Partial paralysis
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