Epilepsy & Seizure Care
Experts in diagnosing seizure, epilepsy medication and more
Comprehensive Epilepsy Care in Boston
The Comprehensive Epilepsy Program at Beth Israel Deaconess Medical Center (BIDMC) provides advanced diagnosis, treatment and support for adults with epilepsy and seizure disorders, including complex and drug-resistant epilepsy.
For nearly 40 years, BIDMC has been a leader in epilepsy diagnosis, treatment, research and education. As a National Association of Epilepsy Centers (NAEC) Level 4 Epilepsy Center, we provide the highest level of epilepsy care available, including advanced diagnostic testing, surgical evaluation and innovative treatment options.
What is Epilepsy?
Epilepsy is a chronic (long-standing) medical condition marked by recurrent unprovoked seizures, and it affects about 1 in 26 people in the United States. A seizure is a sudden surge of electrical activity in the brain that alters brain function. The symptoms of a seizure can vary greatly from a subtle sensory change or feeling of déjà-vu to a convulsion, depending on which part of the brain is affected.
Focal seizures begin in one localized area of the brain, whereas generalized seizures quickly affect both sides of the brain at the same time. A seizure can begin as focal at the onset but later spread to the entire brain, causing a convulsion.
We can distinguish 30 to 40 different kinds of seizures. A person may have multiple types of seizures as part of their epilepsy. It is of great importance that all seizure types are tracked meticulously and reported consistently to a treating physician.
A Legacy of Excellence in Epilepsy Care
Our longstanding leadership in epilepsy care is built on decades of innovation, clinical expertise and a commitment to improving outcomes for every patient.
- First Comprehensive Epilepsy Center in New England
- Level 4 Epilepsy Center designation for more than a decade
- Nearly 40 years of experience treating epilepsy and seizure disorders
- First program in New England to offer Deep Brain Stimulation for epilepsy
- Harvard Medical School teaching hospital
- Multidisciplinary team approach
When To Seek Emergency Care
Call 911 or go to the nearest emergency department if you or someone you know has these symptoms:
- A seizure that lasts more than five minutes
- Multiple seizures that happen closely together
- Inability to full wake up between seizures, choking or breathing problems during a surgery
- Head injury during a seizure
- Loss of bladder or bowel control during a seizure
First Seizure Program
If you or a loved one has experienced a first seizure, BIDMC’s First Seizure Program provides timely evaluation, diagnostic testing and guidance on next steps.
Your Multidisciplinary Epilepsy Care Team
At BIDMC, epilepsy care is highly collaborative. Patients benefit from the expertise of specialists across neurology, neurosurgery, neuropsychology, psychiatry, radiology, nursing and other disciplines.
For patients with complex or treatment-resistant epilepsy, our team meets regularly to review diagnostic findings and discuss personalized treatment options.
Your care is led by an epileptologist, which is a neurologist with advanced training and experience in diagnosing and treating epilepsy and seizure disorders. Depending on your needs, your care team may include:
- Epileptologists
- Neurosurgeons specializing in epilepsy procedures
- Cognitive neurologists
- Neuroendocrinologists
- Clinical neuropsychologists
- Neuropsychiatrists
- Neuroradiologists
- Social workers
- Epilepsy nurse specialists
- Neurodiagnostic technologists
More About Epilepsy & Seizure Care
Accurate diagnosis is the foundation of effective treatment. The evaluation of a person with epilepsy is aimed at determining the type(s) of seizures they have as well as their cause. The answers to these questions are typically found through the following:
- Medical History
- Description of seizure, as well as any aura (warning) that may be present
- Frequency (how often) and duration (how long) of seizures
- Age at seizure onset
- Risk factors for epilepsy (for example, brain injury, stroke, or tumor)
- Seizure triggers (for example, flashing lights or lack of sleep)
- Present general health and family medical history
- Use of any drugs or alcohol now or in the past
- Previous medications taken to treat seizures and any side effects that occurred
- Physical Exam: A standard, focused neurological exam will be performed
- Tests
- EEG: This is a recording of your brain waves that looks for changes in the brain’s electrical patterns that are related to seizures. Small electrodes(metal, cup-shaped discs) are attached to measured locations on your scalp and connected to a recording device.
- MRI: This study reads magnetic waves to generate a detailed picture of your brain to assess for any structural abnormalities that could be causing seizures.
- Blood work: These tests can be used to determine the concentration of various cells, compounds, and electrolytes in your blood.
- Advanced imaging: Depending on the results of your medical history, exam, and tests, more specialized noninvasive imaging tests may be recommended including:
- Single-photon emission CT (SPECT) scan
- Neuropsychological testing (NPT)
- PET scan
- MEG (magnetoencephalogram)
- Epilepsy Monitoring Unit (EMU)
For further evaluation, some people might need to stay in our eight-bed, state-of-the-art Epilepsy Monitoring Unit (EMU) at BIDMC for three to ten days to undergo testing. Our EMU is a subspecialized diagnostic unit that provides gold standard testing for patients with epilepsy and similar disorders.
During this study, we use a video EEG (VEEG) to record seizures and assess the electrical impulses that cause them. VEEG is a simultaneous recording of clinical symptoms with video and brain activity via EEG for the purpose of getting the most accurate diagnosis and identification of a seizure.
Treatment is personalized based on your seizure type, diagnosis, health history, goals and lifestyle. For some patients, medication may be the most effective approach. Others may benefit from surgical evaluation, laser-based treatment or neurostimulation.
Treatment options may include:
Medical Management
There are more than 25 different anti-seizure medications available to treat seizures. Finding the right fit requires a personalized approach.
- Personalized Selection: Your exact prescription depends heavily on your specific seizure type, which is why a thorough epilepsy evaluation is essential.
- Individual Factors: Your doctor will also consider your age, weight, gender, general health, and known drug sensitivities.
- The Titration Process: Medications are usually started at a low dose and gradually increased over time to minimize side effects.
- Critical Safety Guidelines:
- Take your medication exactly as directed by your doctor.
- Never suddenly change your dose or stop taking your medication without consulting your doctor first.
- Take your medication exactly as directed by your doctor.
- Side Effects: Any medication can cause side effects or interact with other drugs.
- Common side effects: Drowsiness, dizziness, blurry vision, and double vision. These often resolve spontaneously as your body adjusts.
- Action plan: If you experience any side effects, call your doctor immediately. Keep in mind that finding the perfect medication and dosage can take time.
Surgical Management
When medications alone cannot control seizures, several surgical options may be considered. Learn about Drug-Resistant Epilepsy Treatment.
Clinical Trials
BIDMC researchers are advancing the future of epilepsy care through innovative clinical trials and translational research. Learn more about clinical trials at BIDMC.
BIDMC offers focused programs and consultations to meet the needs of specific patient groups, including:
First Seizure Program
A first seizure can be frightening and confusing. Our First Seizure Program provides timely evaluation, diagnostic testing, and guidance to help patients understand what happened, whether additional treatment is needed, and what steps to take next.
Women’s Epilepsy Program
Our Women’s Epilepsy Program provides specialized care for women with epilepsy across life stages, including counseling related to contraception, hormones, pregnancy, medication safety and seizure management.
Epilepsy Care for Older Adults
We also provide consultations for seizures in older adults, including evaluation of new-onset seizures, medication considerations and epilepsy care in the context of other neurological or medical conditions.
Advanced Care Programs for Drug-Resistant Epilepsy
When seizures continue despite medications, specialized evaluation may identify additional treatment options for drug-resistant epilepsy
Our multidisciplinary team offers advanced testing, surgical evaluation, neurostimulation therapies and personalized treatment planning.
Living with epilepsy affects more than medical care alone. Our team provides education, counseling and support for patients and families so they can better understand the condition, make informed decisions and manage day-to-day life with greater confidence.
Education and support may include:
- Seizure first aid
- Seizure emergency plans
- Medication adherence
- Medication interactions
- Possible medication side effects, including effects on memory, mood, thinking, weight and bone health
- Seizure safety, including driving guidance
- Seizure triggers
- Seizure types and epilepsy syndromes
- Prognosis and long-term management
- Tools to track and manage seizures
- Women’s health counseling, including contraception, hormones and pregnancy
Our epilepsy nurse specialists, along with affiliated psychiatry and neuropsychology experts, play an important role in patient education, counseling and support. Patients and families are also encouraged to visit our dedicated epilepsy resource room for additional information and guidance.
BIDMC welcomes patient referrals for adults with epilepsy, seizure disorders, first-time seizures and drug-resistant epilepsy. Our team works closely with referring providers to support timely evaluation, advanced diagnostic testing and personalized treatment planning.
Patients may be referred for:
- First seizure evaluation
- Ongoing epilepsy care
- Second opinions for complex seizure disorders
- Surgical epilepsy consultation
- Advanced EEG monitoring
- Drug-resistant epilepsy evaluation
Advancing Care, Research & Education
Department of Neurology
The Department of Neurology offers exceptional patient care, education opportunities and research programs.
Neurology Research
Our top-tier research programs and laboratories work to advance the knowledge and treatment of neurological disorders.
Neurology Education
Our team offers comprehensive education and training programs for healthcare professionals, including fellowships and residencies.
Epilepsy Center Designation
The National Association of Epilepsy Centers has designated BIDMC’s Comprehensive Epilepsy Program as a Level 4 Epilepsy Center, demonstrating our ability to provide complex care and a range of services.
