The Duke Comprehensive Epilepsy Center is expanding diagnostic and treatment resources as part of a strategic initiative to establish the center as a national leader serving patients with epilepsy.

The expansion will create a more comprehensive approach to patient care by providing additional tools and technologies to help specialists focus on the complete care of patients with epilepsy. In addition to medical and surgical therapies, the center’s team will offer mental and social health counseling.

“We will enhance our ability to serve more patients even more effectively by offering a greater scope of care to a growing region,” says Aatif M. Husain, MD, chief of the center and chief of Division of Epilepsy, Sleep and Clinical Neurophysiology within the Duke Neurology Department.

“With a larger team, we will be able to offer more comprehensive services while continuing to focus on helping patients control seizures and improve their quality of life,” he says.

From recruiting new faculty to launching new research, the new initiatives include:

• Improved imaging to enhance seizure control surgery.
• Providing more evaluations for patients who require seizure surgery by using such new diagnostic technologies as stereo electroencephalogram (EEG).
• Expanded offerings of minimally invasive laser surgery for epilepsy.
• Preparations to perform the first deep brain stimulation (DBS) surgical procedure in North Carolina for poorly controlled epilepsy. The procedure was recently approved by the FDA.
• Expanded use of responsive neural stimulator (RNS) technologies.
• More comprehensive emphasis on patients’ mental health and social circumstance with trained specialists.
• Specialized training for advanced practice providers (APP) in the care of patient with epilepsy.
• Broader telemedicine options to better serve patients who have difficulty travelling to appointments.
• Streamlined referrals within Duke Health and throughout the region.

“As we begin this new chapter, we are excited about future collaborations with many research partners within Duke Health and Duke University,” Husain says. “We are now working with individuals and teams conducting elegant research involving novel approaches to seizure control, and even examining possible cures for epilepsy,” he says.

One of the key challenges in epilepsy care is reaching patients early in the disease process. Unfortunately, Husain says, most patients who need care are not referred to a comprehensive center promptly. “Our research shows that many patients spend 10 or 12 years taking seizure medications without significant success before they find their way to our center,” he says.

Guidelines from the American Academy of Neurology recommend that a patient be referred to a comprehensive center after unsuccessful outcomes with two or three medications. This typically occurs early in the course of the disease.

“Once a patient enters our comprehensive care environment, with the advantages of an academic medical center, we start working immediately to improve their seizure control and quality of life,” he adds. “But we would like to reach them earlier in their disease to spare them many years without the comprehensive care that can change their lives.”

To improve outreach in identifying patients, the center hosts an annual patient-focused “Living with Epilepsy” symposium. The 13^th symposium will be organized in the fall of 2019. “It’s a way to reach patients through their personal support networks,” Husain says. “They become ambassadors for their own health and seek better treatment options.”