Level 4 Epilepsy Center

Long-Established Excellence at Epilepsy Center Earns National Kudos

Perhaps one of the surprising things about epilepsy is that about 30% of those admitted to the Epilepsy Monitoring Unit (EMU) at the University of Maryland Medical Center (UMMC) for treatment of the seizure disorder don’t actually have it. Yet, that statistic showcases the strength of UMMC’s Epilepsy Center, where the highly advanced EMU can determine which patients truly suffer from epilepsy or another, mimicking condition, pointing the way toward the right treatments for each individual.

Providing care to about 2,000 adults and children each year with epilepsy and related neurological disorders, the UMMC program recently earned a renewed designation from the National Association of Epilepsy Centers (NAEC) as a Level 4 center. This distinction is achieved only by those centers offering the most complex forms of intensive neurodiagnostic monitoring along with extensive surgical, medical, neuropsychological and psychosocial treatment. UMMC’s Epilepsy Center has long held the Level 4 designation, first achieving the honor shortly after the NAEC was founded in 1987.

“One of my goals has been to always provide comprehensive epilepsy care with a patient-centered focus — not only to be involved in clinical care and research, but to make patients feel they have a one-on-one caring response from their physician,” says Jennifer Hopp, M.D., an associate professor of neurology at University of Maryland School of Medicine and acting director of the Maryland Epilepsy Center.

“We’re focused on everything that goes along with epilepsy,” she adds, “like quality of life, getting back to driving and being able to go to school.”

Continuous EEG Monitoring Unique

An Inpatient Continuous Monitoring Program was initiated in 2012 at UMMC. This portable EEG monitoring effort, coupled with the long-established 4-bed inpatient Epilepsy Monitoring Unit, allowed the program to offer superior diagnostic capabilities throughout the entire Medical Center because of more video EEG equipment and, at minimum, two in-house EEG technicians 24/7. “We’re the only program in the area that has that level of staffing and volume,” Dr. Hopp notes.

While the technology has been crucial in helping pinpoint the status and treatment of epilepsy patients with ongoing, uncontrolled seizures, it also zeroes in on those whose seizures aren’t actually caused by epilepsy. This number is higher than thought, she notes, since epilepsy’s many “mimickers” include cardiac or psychiatric conditions.

Of all patients whose epilepsy diagnosis proves accurate, Dr. Hopp and her colleagues can focus on providing effective treatment. For most of them, their seizures are uncontrolled when they first arrive at the Epilepsy Center. Even certain patients who are seizure-free — such as those with sleep disorders related to epilepsy or women who are pregnant — need a higher level of management, which the Center is able to provide because of physicians’ extensive expertise.

Seizure Medications and Treatments

The Epilepsy Center’s Level 4 designation belies the extensive array of treatments currently available at UMMC including surgery and vagal nerve stimulators. A newly FDA approved neurostimulator, NeuroPace, will be offered in the near future. Medications, however, remain the first-line therapy for most patients and manage to control seizures in a majority, Dr. Hopp says.

 When first-line approaches don’t work, “a lot of data suggests that when someone has failed two or three seizure medications, we really need to look at other treatments,” she says. “The second goal is to be aggressive to see what else we can offer that’s not available in the community. We also want to see what works to improve the patient’s cognition and mood — all of the things that, to us, are just as important.”

Most faculty members at the Epilepsy Center are involved in some form of research, and Dr. Hopp’s current project is examining the evaluation and treatment of those with “psychogenic” seizures, which presents like epilepsy but has psychological causes.

“I think it’s really critical for people who are carrying a diagnosis of epilepsy, who may be taking medication, to be able to make this diagnosis for them,” she says. “We determine if they have something else. We want to be able to offer a treatment for them that will be effective for these folks who don’t have epilepsy … I think that’s quite unique.”