Welcome to the UNM Comprehensive Epilepsy Center.  The mission of the Center is to provide state of the art medical services for individuals with seizure disorders whose seizures fail to be completely stopped by medications, and to seek cures for epilepsy through innovation in research and medical care.  The Center also provides education about seizure disorders for individuals with epilepsy and their families, as well as for health care professionals.   Physicians interested in ACGME Fellowship training in epilepsy and clinical neurophysiology should send inquiries to bfisch@salud.unm.edu.   The UNM Comprehensive Epilepsy Center is a member of the National Association of Epilepsy Centers (http://www.naec-epilepsy.org/find.htm).   

Patient referrals

Physicians and their assistants wishing to refer patients for further evaluation or specific diagnostic tests should please call:  505 272 3199.  If there is not an immediate answer, you will be contacted within 48 hours to arrange for an appointment.  In addition, please FAX patient contact and medical information to:  Attention M. Chaney, RN at 505 272 6692. 

Patients who have already been seen by a UNM CEC physician and have questions about their medical care should call 505 272 3160.  If you are experiencing a medical emergency, you should call 911 or go to the nearest emergency room.

Epilepsy precautions 

If you suffer from seizures in which you either have involuntary movements, cannot respond physically for even a few seconds, or experience any lapse in memory or awareness during the attack, then you should avoid operating heavy machinery, including driving, and should also avoid open heat sources (stovetops, boiling or extremely hot items), taking baths (always take showers to avoid possible drowning), or placing yourself in other situations that could lead to injury during attacks.  Never suddenly stop medication because that can lead to uncontrolled seizures.  There is also a risk of sudden death from seizures that is reduced by both optimal seizure control and consistent medication use.  Women of childbearing age should always take additional folic acid (4 mg per day) as a vitamin supplement (to protect the baby if they should become pregnant) and all individuals taking antiepileptic medications should take a daily Vitamin D (2000 units) and calcium supplement (800 mg) to prevent bone loss unless instructed otherwise by their physician.

Initial Clinic Visit to the Epilepsy Center

Comprehensive seizure disorder examination

The initial comprehensive clinic visit includes a thorough review of the patient’s history, previous testing and treatment, and a neurological physical examination.  The visit often lasts several hours.  The purpose of the visit is to clarify the patient’s seizure diagnosis, including whether or not they have a particular epilepsy syndrome, and to determine what optimal therapies should be undertaken.   Examinations are performed by Center physicians who are all fellowship trained subspecialists in epilepsy and clinical neurophysiology and are board certified in Neurology.   Patients are strongly advised to bring someone to the clinic visit who has witnessed their seizure or to have someone available by telephone at the time of the visit who has seen their seizure who will be available to talk to the examining physician.  Patients are also strongly advised to bring all their medications, and if they have had an EEG or MRI performed at another institution, to bring a copy of the actual study on a CD or DVD (these are easily obtained from the referring physician or hospital where the studies were performed).

Diagnostic Testing and Indications

EEG – A 2 hour test of brain electrical activity performed to help diagnose and classify seizure disorders and in some cases determine the response to treatment.

Epilepsy Inpatient video and EEG Monitoring – A typically 3 to 5 day stay in the hospital during which brain electrical activity and behavior during attacks are recorded to help confirm the presence of a seizure disorder (vs a disorder that appears to be due to seizures), classify the patient’s seizure disorder so that the optimum treatment can be selected, and in some cases, to evaluate the patient for non-medical treatments such as curative epilepsy surgery or partial treatment of seizures using Vagus Nerve Stimulation.  

 The UNM Epilepsy Monitoring Unit is a state of the art facility with private patient rooms, each with an extra bed for family members, parents, or friends who the patient may like to stay with them.  The Monitoring Unit nursing station is staffed by a dedicated nurse and a technician with 24/7 remote viewing of the patient video and EEG.  At the time of seizures, the nurse performs an examination to help locate where in the brain the seizure comes from.  This information is used in combination with the recorded EEG by the Center epilepsy physician.  

Invasive Epilepsy Monitoring and Functional Mapping – A surgical procedure in which specialized EEG electrodes are placed on or in the brain to locate a site of seizure onset  that can be safely removed to cure epilepsy and to allow for mapping brain functions to improve the safe removal of abnormal epileptic brain tissue.  As in Epilepsy Inpatient video and EEG Monitoring (see above), once the electrodes are in place, the patient’s seizures are recorded.  At the end of recording the electrodes are removed.

Genetic Testing – A blood test for the diagnosis of inherited seizure disorders or those due to genetic abnormalities.  An increasing number of seizure disorders that had previously had no apparent cause are being revealed to be defects in nerve cell functions controlled by genes.  These disorders may or may not be inherited.

Biological Screening – Blood tests for medical disorders (for example, abnormalities of the immune system, blood levels of sodium, calcium or magnesium, hormonal disorders, liver disorders or other medical conditions that can cause seizures).

3 Tesla MRI – A 1 to 2 hour test that provides a picture of the brain based on the magnetic activity of brain molecules.   3 Tesla is the strongest medically approved (FDA approved) MRI available.  It provides more detailed anatomy of the brain and improved diagnosis of brain abnormalities that can cause seizures compared to other MRI’s in the state of New Mexico.  The MRI at UNM is also performed in a special way (MRI epilepsy protocol sequences) for patients who are being evaluated for a seizure disorder. 

MEG – A 4 to 5 hour test that measures brain magnetic activity.  MEG is not a widely available test in the United States but it has been shown to provide more accurate determination of the area of the brain that is involved in epilepsy than EEG or other tests.  It also shows where various areas are located in the brain that control language, movement, and feeling in the hands, feet and face.  It is useful for planning for possible epilepsy surgery and for planning surgeries to remove abnormal brain areas such as vascular malformations (e.g., cavernous malformations, arteriovenous malformations) or tumors.  The MEG instrument used by UNM is the most up to date system available in the world.

PET – A 3 hour test that provides a picture of brain cell activity (PET stands for positron emission tomography).  Between seizures the part of the brain where the patient’s seizures come from often appears as an area of reduced brain cell activity.  This helps guide medical treatment and especially possible surgical planning.

Wada Testing – an in hospital test that does not require an overnight stay that is performed as part of a presurgical evaluation to determine if it is safe to perform epilepsy surgery.  The Wada test involves a cerebral angiogram during which memory  and language testing is performed.  The test requires the insertion of a catheter (small tube) into an artery (femoral artery) at the top of the right leg.  After the procedure it is generally recommended that the patient remain in bed for 4 to 6 hours before going home. 

Neuropsychological Testing – a clinic test lasting approximately 4 hours in which the patient’s memory and thinking is tested.  This provides information about cognitive ability and what part or parts of the brain may be affected by epilepsy.  It is routinely performed prior to epilepsy surgery.

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.

Research  Medication Trials

The Epilepsy Center usually has one or more ongoing research studies testing promising antiepileptic medications.  Eligible patients will be made aware of these trials and if they qualify and are interested, they will be offered to participate.

UNM Epilepsy Center Staff

Bruce Fisch, MD

Medical Director

Epilepsy Nurse Coordinator

Mona Chaney, RN

Neurology

Madeleine Grigg-Damberger, MD

Adult and Pediatric Epilepsy

Jose Padin, MD

Adult and Pediatric Epilepsy

Glenn Fenton, MD

Pediatric Epilepsy

Jennifer Vickers, MD

Pediatric  Epilepsy

Neurosurgery

Erich Marchand, MD

Surgical Director

Martina Stippler, MD

Neuropsychology

Richard Campbell, Ph.D.

Rex Jung, Ph.D.

John King, Ph.D.

Neuroradiology

Blaine Hart, MD

Frederick Rupp, MD

Fellows

Emmanuel Martinez, MD

Flenny Thomas, MD

Tony Lee, MD

Neurodiagnostic Laboratory

Rose Mills, REEGT, Director

Tom Murphy, REEGT, Supervisor

Paul Brooks, REEGT

Larry Davis, CEEGT

Carol Finley, REEGT

Jodi Gallegos, REEGT

Milton Gallegos

Ritu Jain, REEGT

Karen Lofgren, REEGT

Carolyn Sadeki, REEGT

Sonji Crouthers, Administrator

Donations

Making a gift in support of the UNM Comprehensive Epilepsy Center

The UNM Comprehensive Epilepsy Center encourages donations for the purpose of supporting the overall mission of the Center in furthering the advancement of patient care, research, and education in epilepsy and seizure disorders.  In accordance with University policy, all private gifts are received through the UNM Foundation, which has the responsibility for managing contributions to all UNM programs. Gifts to the UNM Foundation are tax-deductible. Checks should be made out to the: "University of New Mexico Foundation" and indicate the program,  “UNM Comprehensive Epilepsy Center”, in the memo section. You can mail your check to:  Epilepsy Center Director, Department of Neurology, MSC 10 5620, 1 University of New Mexico, Albuquerque, NM 87131-0001 and enclose a brief note indicating that “This is an unrestricted donation to be used by the director of the UNM Comprehensive Epilepsy Center.