The Duke Comprehensive Epilepsy Center (DCEC) has built a dynamic multidisciplinary team with the expertise and resources to treat the full range of epilepsy cases in both adult and pediatric populations. This includes advanced surgical techniques and the latest evidence-based approaches that support the best clinical outcomes possible for patients. The team of adult and pediatric epileptologists, neurosurgeons, psychologists, advanced practice providers, epilepsy nurses, and neurodiagnostic technologists works closely to coordinate patients’ care in a streamlined and efficient process. 

“20 years ago, we had a limited number of surgical solutions for epilepsy; today, we have many that range from minimally invasive neuromodulation to resections,” says Birgit Frauscher, MD, PhD, epileptologist and director of the Duke Comprehensive Epilepsy Center. She adds, “Nowadays, most patients who are not responsive to medications are surgical candidates. We couldn’t say that even 10 years ago.”

Frauscher and her team use stereoelectroencephalography (sEEG) through a minimally invasive procedure to monitor deep structures of the brain with electrodes that can more precisely reveal the source of epileptic seizures. Then, neurosurgeons can more accurately resect only the parts of the brain necessary or better target neuromodulation if indicated. “Patients benefit from this approach because we can do more conservative and targeted surgical interventions, resulting in better seizure control and less functional compromise,” says Frauscher. 

Additionally, the team is involved in extensive lab research to quantify objective markers that predict surgical success. Frauscher says, “Quantitative measures using sEEG better pinpoint just the areas that need intervention and inform our collaboration with neurosurgeons to develop a personalized surgical plan for each patient.”

Neuromodulation has increased surgical options for adult patients with epilepsy who have widespread impairments or those affecting the motor or language cortex, where resections would result in severe functional deficits. “Neuromodulation is a great option for many patients. It’s a minimally invasive procedure and can reduce seizure frequency substantially (up to 80% of patients have a ≥50% reduction in seizure frequency) with minimal side effects,” says Frauscher. 

DCEC experts have the unique expertise to provide long-term monitoring and care for patients with a neuromodulation device. Frauscher explains, “The device needs some adjusting. Our clinic brings together experts in various subspecialties to regularly monitor patients and fine-tune the stimulation settings to deliver the most optimal results.” 

Duke experts offer neuromodulation evaluation and care at multiple locations in Durham, Raleigh, and a new location in Cary, expanding access to care for more people in their local communities. According to Frauscher, surgical techniques and technology are evolving rapidly, expanding options for patients that might not have been surgical candidates in the past. “It’s worthwhile for patients to know their options today because our capabilities are constantly evolving.”

Frauscher and her team are actively exploring the latest translational research to improve epilepsy care and surgical outcomes. “One body of work we’re studying involves trying to identify new biomarkers that help us deliver precision medicine and predict surgical outcomes. This modeling also accounts for patients’ subjective goals. Seizure reduction might be a clinical goal, but we account for patients’ personal wishes so we can treat them holistically,” she says. “With AI and the ability to aggregate big data, we can collect and quickly interpret more clinical data points. We’re at the forefront of emerging insights and technologies that translate into the best possible care for our patients.”