Epilepsy Program

Why an Accurate Diagnosis Matters

The first and most important step toward better seizure control is reaching an accurate diagnosis. While this may sound simple, seizures can look very different from one person to another. Some may resemble fainting spells, staring episodes, jerking during sleep, or unusual behaviors. Because many other conditions can mimic epilepsy, it’s essential to see a specialist rather than attempt self-diagnosis.

Our epileptologists will ask detailed questions such as:

• When did your seizures begin?

• Do you notice any warning signs before a seizure?

• What happens to you during an episode?

These answers, combined with advanced diagnostic testing, help us determine whether seizures are epileptic in nature and identify their cause, type, and origin.

• 1 in 26 people will develop epilepsy during their lifetime.

• About 3 million U.S. adults live with active epilepsy.

• The highest rates are in adults over 60, often due to stroke, tumors, or brain injury.

• Two-thirds of patients achieve seizure control with anti-seizure medications.

• One-third live with drug-resistant epilepsy, often benefiting from advanced therapies, including surgery.

• Epilepsy is linked with other conditions such as autism, multiple sclerosis, cerebral palsy, and depression.

• Up to 50,000 deaths annually in the U.S. are related to seizures or complications like SUDEP (Sudden Unexpected Death in Epilepsy).

At Hoag, our goal is to help every patient live life with fewer seizures and improved quality of life. For many, this begins with medical management—non-surgical treatment options that can effectively reduce or even eliminate seizures. More than 60% of patients achieve good seizure control with antiepileptic medications, making this the most common and effective first step in treatment.

Our epilepsy specialists take into account each patient’s specific diagnosis, health history, and lifestyle when determining the most appropriate therapies. Because medications can sometimes cause side effects or interact with other prescriptions, Hoag’s epileptologists work closely with patients and their primary care physicians to carefully manage drug therapy over time.

While primary care physicians and general neurologists play an important role, epilepsy care is most effective under the guidance of a specialist trained in seizure disorders. Epileptologists at Hoag:

• Provide precise diagnoses based on seizure type and underlying causes.

• Help patients navigate complex medication decisions.

• Manage side effects and long-term health impacts.

• Explore advanced therapies if medications alone are not successful.

With expert guidance, patients can feel confident they are receiving the most up-to-date, effective care available.

In approximately one third of patients, anticonvulsant medications cannot adequately control seizures. When seizures cannot be controlled with medication alone, Hoag offers the latest techniques in surgical intervention. Surgery can eliminate seizures in the majority of patients and reduce seizures in most of the remainder. Various testing is done to help determine where seizures are starting in the brain. This may include implantation of electrodes for intracranial monitoring. Once the location causing seizures has been determined, Hoag neurosurgeons utilize state-of-the-art neuronavigational technology and sophisticated magnetic resonance imaging techniques to precisely reach and treat the seizure areas safely.

For some patients with epilepsy or unexplained seizures, traditional tests such as MRI or routine EEG may not provide enough information to confirm a diagnosis or guide treatment. In these cases, your neurologist may recommend a stay in Hoag’s Epilepsy Monitoring Unit (EMU), a specialized inpatient program designed to capture and study seizure activity in a safe, controlled environment.

Hoag's EMU is designed with patient comfort in mind. Patients stay in private rooms that are not only equipped with the latest medical monitoring technology but also feature scenic views to enhance the healing environment. These comfortable rooms allow patients to feel relaxed during their stay, while knowing they are under constant medical supervision for safety.

You may be referred to the EMU if:

• Your seizures are difficult to diagnose.

• Your medications are not controlling your seizures.

• You may be a candidate for surgical or device-based therapies.

• Your care team needs more detailed information to tailor your treatment plan.

By recording seizures as they occur, EMU specialists can determine the type, frequency, and origin of seizures, leading to more accurate diagnosis and targeted treatment.

One of the primary goals of Hoag’s EMU is to accurately classify seizures, which is crucial for determining the most effective treatment. Many patients who have been misdiagnosed or have complex seizure types find clarity at Hoag, where the EMU team performs thorough evaluations to pinpoint the exact nature of their condition. For patients with epilepsy, the data collected helps the team refine their treatment approach, whether through adjusting medications, recommending lifestyle changes, or considering surgical interventions.

During your EMU stay, continuous monitoring provides insights that are often not possible in an outpatient setting. Outcomes may include:

• Precise diagnosis of seizure type and whether events are epileptic or non-epileptic.

• Optimization of medication therapy, ensuring the right drug at the right dose.

• Evaluation for advanced therapies, such as surgery, neurostimulation devices (e.g., RNS, VNS, DBS), or dietary interventions.

• Improved quality of life through better seizure control and reduced side effects.

At Hoag’s Level 4 Epilepsy Center, EMU patients are cared for by a multidisciplinary team, including:

• Neurologists

• Epileptologists (neurologists with advanced training in epilepsy)

• Specialized nurses trained in seizure care and safety

• Neurodiagnostic technologists who monitor EEG data 24/7

• Neurosurgeons, neuropsychologists, and radiologists who collaborate on complex cases

• Pharmacists and dietitians who provide medication and dietary support when appropriate

This team-based approach ensures that every aspect of your care is coordinated and personalized.

Hoag’s EMU is part of our comprehensive Level 4 Epilepsy Center, the highest designation awarded by the National Association of Epilepsy Centers. This recognition reflects Hoag’s expertise in:

• Complex diagnostic testing

• Advanced surgical and non-surgical therapies

• Multidisciplinary care and collaboration

• Access to clinical research and trials for patients with drug-resistant epilepsy

With state-of-the-art monitoring technology and one of the most experienced epilepsy teams in Southern California, Hoag provides patients and families with answers, options, and hope.

If you see someone having a seizure, follow this guide to keep the person safe until the seizures stop naturally and full awareness returns. If the person falls to the ground, assist them in keeping their head away from harm and injury.

• Keep calm

• Look at a clock and note the time of the seizure

• Clear the area around the person of anything hard or sharp

• Loosen ties or anything around the neck that may make breathing difficult.

• Put something flat and soft, like a folded jacket, under the head. Stay with the person until the seizure ends naturally.

• After the seizure, place the person on their side. This will help keep the airway clear.

• Be reassuring and use a calm voice as consciousness returns.

• Do not hold the person down or try to stop their movements.

• Do not try to force the mouth open with any hard implement or with fingers. A person having a seizure CANNOT swallow their tongue. Efforts to hold the tongue down can injure teeth, jaw, or your own fingers.

• Do not attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.

You don’t have to do anything if a person has brief periods of staring or shaking of the limbs. If someone has the kind of seizure that produces a dazed state and automatic behavior, the best thing to do is:

• Speak quietly and calmly in a friendly way.

• Guide the person gently away from any danger, such as a steep flight of steps, a busy highway, or a hot stove.

• Don’t grab hold of the person unless some immediate danger threatens. People having this kind of seizure are on “automatic pilot” as far as their movements are concerned. Instinct may make them struggle or lash out at the person who is trying to hold them.

• Stay with the person until full consciousness returns, and offer help as needed.

• Confusion may occur during a complex partial seizure or during the recovery period after other types of seizures. If the confusion persists, seek medical attention.

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