Epilepsy

Patient Population
The TWH Epilepsy Program is the largest "bench-to-bedside" adult epilepsy program in Canada. We work in close relationship with the Epilepsy Program of the Hospital for Sick Children (HSC) and the Bloorview Epilepsy Program of the University of Toronto. Interactions among these programs has created the largest academic research-oriented epilepsy program in the world. The Epilepsy Clinic evaluates more than 1,800 patients annually.

Patients with newly diagnosed epilepsy, as well as those with difficult to manage seizure disorders are evaluated and followed in the ambulatory program. The clinic has a special focus on the management of health issues for women with epilepsy and a transition program has been established to acquire adult patients from HSC. A two bed Epilepsy Monitoring Unit (EMU) is the only adult program in Toronto.

Education
Patient education is an important goal of the program. Educational materials are available for patients, and regular counseling surrounding medications, women’s health issues and management options is undertaken. Physicians, research nurses, our ACNP and a volunteer from the Epilepsy Association of Toronto provide patient education opportunities.

Education of physicians at all levels of training takes place through the program. The Epilepsy Clinic is a venue for undergraduate ambulatory experience. Postgraduate trainees in neurology, neurosurgery and other programs gain experience in the management of patients with epilepsy through the EMU and ambulatory exposure. Neurosurgical trainees have the opportunity to learn operative techniques of epilepsy surgery.

Research
Seven basic science labs are examining novel approaches to understanding and treating epilepsy. Projects include:

• Identification of newly expressed genes in experimental seizure models
• Evaluating the therapeutic basis of the ketogenic diet in patients with intractable seizures
• Exploring novel ways that brain cells communicate causing synchronization and seizures
• Studying changes in ion channel distribution in epilepsy
• Studying the effect of blocking "gap junction" communication between neurons as a strategy for controlling epileptic discharges
• Evaluating the role of ovarian sex steroid hormones in the modulation and control of seizures
• Mathematical modeling of mechanisms of synchronization of the neural firing underlying seizure activity

A clinical research program includes:

• Trials of new antiepileptic medications giving the program early access to the newest pharmacological therapies
• fMRI and spectroscopy for localization of cerebral function in seizure patients
• Study of the scope and burden of depression in patients with epilepsy
• Deep brain and vagal stimulation for seizure control in patients with epilepsy
• Use of the mathematical "chaos" analysis approach for seizure prediction
• Evaluation of knowledge base for women with epilepsy surrounding specific health issues

It is hoped that these basic and clinical research approaches will lead to the development of new treatments for intractable epilepsy and strategies which will promote optimal functioning for people with epilepsy in society.