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The Epilepsy Program is devoted to the diagnosis and treatment of epilepsy and to the advancement of understanding in all aspects of the condition. The Epilepsy Clinic at the Toronto Western Hospital (TWH) provides a large outpatient facility for the evaluation of adults with epilepsy. Adult outpatients may also be evaluated and followed by epileptologists at St. Michael’s Hospital (SMH). Paediatric patients are evaluated and treated through the Paediatric Epilepsy Program at the Hospital for Sick Children.
A five-bed inpatient Epilepsy Monitoring Unit (EMU) at TWH allows for continuous video-EEG recording of patients with seizures, enabling accurate diagnosis of epilepsy (differentiating it from other conditions that may mimic epilepsy) and specific classification of the type of epilepsy. Such accurate diagnosis and classification is of prime importance in guiding appropriate treatment and counselling.
For patients with medically-refractory epilepsy who may be candidates for epilepsy surgery, the continuous video-EEG recording performed in the EMU allows for accurate localization of the brain region responsible for a patient’s seizures. The inpatient video-EEG recording is a part of the services provided by the Clinical Neurophysiology Laboratory at TWH, which also offers extensive outpatient EEG and video-EEG as well as continuous ambulatory EEG services for the evaluation of epilepsy.
State-of-the-art multimodal brain imaging is available for the evaluation of patients in the Epilepsy Program, including high resolution 3T MRI, fMRI and MEG. All patients who may be candidates for epilepsy surgery undergo formal neuropsychological testing and neuropsychiatric evaluation.
All forms of classical epilepsy surgery are performed at TWH, including implantation of depth and subdural electrodes for recording intracranial EEG in difficult cases where the site of seizure onset cannot be determined from non-invasive recordings. There is a special interest in novel neurostimulation techniques at TWH for patients with medically-refractory epilepsy who are not candidates for classical epilepsy surgery, in particular electrical deep brain stimulation. In the future, specially selected cases may be suitable for non-invasive radiosurgical treatment using the TWH Gamma Knife.
Research into all aspects of epilepsy is a major mission of the program and many members of the clinical team are active in research ranging from cellular electrophysiology to seizure prediction and EEG source localization to studies of quality-of-life in people with epilepsy. Some of these researchers have achieved national and international acclaim and many work together with a large number of interdisciplinary collaborators both within the University of Toronto system and beyond to further the basic understanding of epilepsy.
Another goal of the Epilepsy Program is to constantly strive to raise awareness of epilepsy in society. Relatedly, we hope to increasingly bring knowledge of epilepsy and epilepsy care to the community, and at the same time improve access to specialized centres such as ours to facilitate accurate diagnosis and optimal treatment for all patients.
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