Our Mission and Goals
The Epilepsy Center at NIA was established in 2019 to provide excellent care to people with seizure disorders. It is the first center in Greece which established gestalt assessments and comprehensive management of patients with epilepsy in keeping with international standards, and through a multidisciplinary team of epileptologists, neuropsychologists and social workers. Its goal is to offer individualized care of high quality to people with Epilepsy, in order to enjoy a full and productive life. It fulfils its mission and goals through its, and activities.
Our Clinical Activities
Our clinical mission is the accurate diagnosis of seizure disorders and the provision of personalized therapy according to the best medical evidence. Accurate diagnosis of epilepsy or other transient loss of consciousness is achieved through expert clinical and laboratory assessments, by integrating electroencephalography, neuropsychology, imaging, and biochemical studies, which in turn direct personalized treatments of pharmacological, surgical, psychotherapeutic and social interventions to patients according to their needs. In keeping with our mission to serve our community, our patients and their caregivers, patients have the option to establish long-term care at our center or be referred by clinician colleagues for an expert opinion and follow with their clinician after completing our evaluation protocol and receiving recommendations.
At our clinic we evaluate adults and children with symptoms such as loss of consciousness, muscle convulsions, or transient neurocognitive disorders, or people who already carry a diagnosis of epilepsy. Each patient undergoes an evaluation by a certified epileptologist and undergoes electroencephalography by an experienced EEG technician. During the visit, recent brain imaging and blood tests are reviewed and if they are not already available, will be ordered. Furthermore, additional testing by a neuropsychologist, or other examinations such as 24h-electroencephalography or polysomnography may be required before making a definite diagnosis and recommending the best possible therapeutic course of action.
What is epilepsy and what its symptoms?
The term “Epilepsy” is derived from a Greek verb epilambanein (επιλαμβάνειν), meaning to seize, take hold of, or attack. Epilepsy therefore means “a condition of being taken over, seized, or attacked.” People in the Homeric Era used to believe that Epilepsy was induced by gods, and it is therefore a sacred disease. Hippocrates discounted the view that epilepsy is a sacred disease, stating that he did not believe that Epilepsy is any more divine or sacred than any other disease, but just as other diseases, has a nature from which it arises. Specifically, he believed epilepsy to be a disease of the brain. Today, we have proven Epilepsy to be a brain disorder, characterized by repeated unprovoked epileptic seizures that arise from an abnormal hypersynchronous and sustained neuronal excitability.
Depending on the part of the brain affected, a person can experience different types of seizures. Seizures involving the sensory part of the brain give rise to a sensation, such as numbing or tingling of a body part, or the experience of a non-existent smell or vision. If involving the motor part of the brain, involuntary movements present themselves, from persistent focal twitching to generalized muscle spasms with loss of consciousness.
Epilepsy can present at any age, but is more common in early childhood and late adulthood. Approximately 5-10% of the general population will have a single epileptic seizure during their life. In most cases, however, this won’t be associated with repeated attacks that define Epilepsy and only 1% of patients will be diagnosed with Epilepsy in the future.
There are different causes leading to Epilepsy making each person unique in their assessment and management. Some forms of epilepsy are genetically determined while others are acquired (e.g., epilepsy after traumatic brain injury or stroke), whereas others are related to pre-existing neurological disorders (e.g., Alzheimer’s disease).
Diagnosis of Epilepsy
The management of epilepsy involves 3 steps:
- Description (phenotyping) of recurrent epileptic seizures: Clinicians first ask a patient to describe what they experienced during an episode or ask observers to describe what they saw. In some cases, videos taken by bystanders are available and are very helpful. To establish an accurate diagnosis and properly classify seizures (e.g., generalized vs. focal seizures) it is important that patients provide a clear description of what they experienced before, during and after an event.
- Clinical examination and workup
- Establishing a diagnosis, providing a prognosis and recommending and pursuing treatment options
After a first seizure event, an electroencephalogram (EEG) is the first exam to be ordered. Through this test clinicians record the electrical brain activity by placing electrodes on the head. A routine EEG lasts 20-25 minutes and it is painless without side effects, other than the patient having to wash some paste from their hair. Sometimes, a longer recording is necessary that lasts at least 24 hours in the lab while the EEG is recorded together with video monitoring (VEEG). To assess if a structural brain abnormality is present that led to a seizure (e.g., brain tumor, vascular damage, or congenital malformations), a magnetic resonance imaging (MRI) brain scan is almost always recommended. In certain cases, when MRI scan is contraindicated (e.g., in a patient with older types of pacemakers), we computed tomography (CT) scans are pursued. In very special cases, a single-photon emission computed tomography (SPECT) or positron emission tomography (PET) scans may be pursued, measuring brain blood flow and metabolism. For people who are unable to be evaluated in-person at the Neurological Institute of Athens, such as in circumstances of mandated social distancing or impaired mobility, diagnostic protocols can be pursued through telemedicine tools and at-home evaluations.
Specialty Therapeutic Protocols
Therapeutic protocols at the Epilepsy Center follow a multidisciplinary approach, with pharmacological, psychotherapeutic, technological, and social interventions, because for most patients there are multiple factors contributing to symptoms and placing them at risk for worse future outcomes. Such comprehensive protocols maximize benefit and minimize cost by assessing both the person and the environment they live in.
Not all epileptic seizures need to be treated. In many cases treating the underlying condition will sufficiently lead to improvement in seizure frequency and severity. Even more, certain epileptic syndromes have tend to be self-limited and resolve after a certain age (e.g., idiopathic epileptic syndrome of childhood). In these cases a close follow up may be the only necessary intervention to be pursued. In the end, the decision on what therapeutic approaches to pursue are decided during discussions between the patient and their Epilepsy specialist, considering patient needs while respecting their autonomy.
The therapeutic protocols in epilepsy include medications, non-pharmacological non-invasive treatments, and surgical interventions.
The most common treatment of epilepsy is through the use of anti-epileptic drugs (AED), with a goal of decreasing seizure frequency and severity while achieving the least possible side effects. These medications protect the brain from having recurrent seizures by changing how certain chemicals affect brain cell activity. AED don't cure epilepsy, but can prevent seizures from happening. In general, AED control seizures in approximately 70% of people.
The choice of AED depends on the type of epilepsy a person has. Unfortunately, with the exception of certain epileptic syndromes, one cannot predict which AED will prove most effective for a specific person. As a result, patients may have to switch between AED, or even pursue a combination of AED, if seizures are not well controlled. Only 50% of epileptic patients will achieve seizure control after the first medication tried.
In certain cases Epilepsy treatment can be pursued through medical devices, such as a Vagus Nerve Stimulator (VNS). A VNS is a small electrical device, similar to a cardiac pacemaker, which is placed under the skin of the patient’s chest and it delivers specific electrical activity to a nerve at the neck, called the Vagus nerve. The exact mechanism of VNS action is not completely known, though research indicates it improves seizure control by changing electrical brain signals. In general, VNS doesn't stop seizures from recurring completely, but it makes them less severe and less frequent.
Another common non-pharmacological treatment is the ketogenic diet. A ketogenic diet is a diet high in fat and low in carbohydrates and protein. It is effective in certain types of epilepsy, mainly childhood epileptic encephalopathies. In children, it's thought it decreases seizure frequency by changing the levels of certain chemicals in the brain. It should only be used under the supervision of an Epilepsy specialist while coordinating with a dietitian.
Surgery is reserved for drug-resistant epilepsy cases or if epilepsy is caused by a localized brain lesion, such as a brain tumor. Epilepsy surgery requires detailed pre-surgical evaluation by a multidisciplinary team consisting of epileptologists, neurosurgeons, neuropsychologists, and neuroimaging specialists.
An important step in the treatment of all types of epilepsy is the identification and avoidance of triggering factors. For example, increased alcohol consumption, sleep deprivation, uncontrollable stress are known conditions to provoke seizures. Avoiding them will lead to a better control of epilepsy.
Our Research Activities
Our research goals complement and serve our clinical mission, establishing comprehensive and fast diagnostic protocols, and validating multidimensional therapeutic protocols that decrease seizures, but also help cognitive, sleep and social aspects of daily life
Our Educational Activities
Education is the third core activity at the Epilepsy Center through which we aim to inform clinicians, scientists, patients and the general public on the best clinical practices and latest research advances in the field of Epilepsy and Seizure Disorders from our center and worldwide.
Education to Specialist Clinicians and Scientists
Our members regularly give educational and scientific talks at international and national conferences and fellowship training curricula targeted to the needs of colleague clinicians and scientists. Within the NIA, we organize annual workshops and conferences, quarterly grand rounds, weekly journal club and patient review meetings
Education to Patients, Caregivers, and the General Public
Our team of experts informs patients with seizure disorders, their caregivers, and the public at large on the latest research and best clinical practices in Epilepsy through talks and educational material in order to improve the quality of life of people with Epilepsy and, at the same time, combat the stigma for those carrying the diagnosis through improved public health education.