Epilepsy Program

Pickup Family Neurosciences Institute’s Epilepsy Program provides an individualized, comprehensive approach to the diagnosis, treatment, and management of epilepsy and seizure disorders. As of 2018, our program made great strides and provided access to many more patients in the community. It is now an NAEC accredited Level IV Epilepsy Center. The multidisciplinary team is dedicated to providing the most effective and least invasive treatments to help patients achieve seizure freedom and the highest possible quality of life.

A key differentiating component of the Epilepsy Program is the in-Epilepsy Monitoring Unit. Our three-bed unit offers a comfortable environment with state-of-the-art video monitoring. A control room is just steps away for quick access to patients, and is staffed 24 hours a day with EEG monitoring technicians.

Patient-related outcome metrics are a cornerstone to measuring the quality of our program, and guiding process improvement. Patients in our Epilepsy Monitoring Unit are surveyed using the Quality of Life in Epilepsy (QOLIE -10- P) assessment tool. The average patient in FY18 experienced a 772.33% improvement in Quality of Life. The longest seizure-free interval for our surgical resection patients has been 1,035 days.

EMU Quality of Life

Team

The program is led by David Millett, M.D., Ph.D., a nationally recognized specialized Epileptologist, and includes neurosurgeons Charles Liu, M.D., Ph.D, and Jonathan Russin, M.D. The program leadership includes a dedicated nurse practitioner, Suzanne Pach, R.N., who assists in the outpatient and inpatient evaluation and management of our patients; also, Sheena Dhiman, BSN, MBA, nurse navigator for the Epilepsy Program, who works closely with physicians, nurses, and EEG staff to help facilitate patient care, including appropriate referrals and resources, education of patients and staff, and coordinating programs to provide a large array of services to promote psychological and physiological wellness. We are proud to continue to attract new members to our team. Our most recent additions are James Park, D.O., Epileptologist and Dr. Vivek Mehta, M.D., Neurosurgeon. Our team cannot be successful without the care and expertise that our trained Registered Nurses and Registered EEG technologists provide.

EMU Volume

When seizure control with medication becomes challenging, advanced diagnostics including 3D imaging, functional and metabolic brain scanning and even minimally invasive brain activity mapping are used to select patients who may be candidates for focused surgical intervention that will lead to successful seizure-free life. As part of a multidisciplinary, collaborative approach to epilepsy, neurosurgeons, epileptologists, neuroradiologists, epilepsy care coordinators, EEG technologists and other health care professionals meet on a regular monthly basis to review patient-specific cases, including those being considered for surgical interventions. Patients benefit from this combined expertise and experience of the collective physicians and professionals.

A Life Regained: How Surgery Gave One Man His Life Back

Support & Education

The Epilepsy Center at Hoag offers an interactive support group for all adolescent and adult epilepsy patients. This support group functions under the direction of a licensed clinical social worker, and includes group and family discussions to help patients better understand and cope with epilepsy. This support group meets on the first Wednesday of every month from 6:30 to 8 p.m. in Pickup Family Neurosciences Institute, 3rd floor conference room.

Brain scans
(A) Axial T2 image of a 33-year-old male, showing disorganized grey matter (polymicrogyria), a common cause of focal epilepsy and (B) Co-registration of MRI axial images pre-implantation CT post-implantation of electrodes for intracranial video-EEG monitoring in a patient with drug-resistant epilepsy. Surface and deep temporal electrodes are shown.

Through a $1 million gift from philanthropists Nancy and Bill Thompson to significantly expand services to Orange County residents who have little to no options for affordable health care, Hoag collaborated with Lestonnac Free Clinic in Orange. Through this new collaboration, Hoag efficiently expanded access to outpatient services by providing comprehensive epilepsy services at the clinic and beyond, making possible an estimated 300 patient visits per year for under- or uninsured local patients.

Brain scans

David Millett, M.D., provides medical consultations and services at Lestonnac Free Clinic along with a dedicated nurse practitioner. The expanded services also include access to epilepsy surgery, vagus nerve stimulation treatment (VNS), clinical research studies and other definitive treatments to address a population that had no options for advanced care.

Clinical Research


UCB Pharma Protocol No1199: An open-label, multicenter, follow-up trial to evaluate the long-term safety and efficacy of Brivaracetam used as adjunctive treatment at a flexible dose up to 150 mg/day in subjects aged 16 years or older suffering from epilepsy. October 2013.

Publications, Lectures, Book Chapters

BIBLIOGRAPHY

(*indicates senior/corresponding author):

PEER REVIEWED


The Weekend Effect on Morbidity and Mortality Among Pediatric Epilepsy Admissions. Wen T, Kramer DR, Sirot S, Ho L, Moalem AS, Cen SY, Millett D, Heck C, Robison RA, Mack WJ, Liu CY. Pediatr Neurol. 2017 Sep;74:24-31.


Characterization of electrocorticogram high-gamma signal in response to varying upper extremity movement velocity. Wang PT, McCrimmon CM, King CE, Shaw SJ, Millett DE, Gong H, Chui LA, Liu CY, Nenadic Z, Do AH. Brain Struct Funct. 2017 May 18.


Potentially preventable complications in epilepsy admissions: The “weekend effect”. Ho L, Kramer DR, Wen T, Moalem AS, Millett D, Heck CN, Mack WJ, Liu CY. Epilepsy Behav. 2017 May;70(Pt A):50.


Unstable periodic orbits in human epileptic hippocampal slices. Pen-Ning Yu, Min-Chi Hsiao, Dong Song, Liu CY, Heck CN, Millett D, Berger TW. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:5800-3.


A testbed to explore the optimal electrical stimulation parameters for suppressing inter-ictal spikes in human hippocampal slices. Min-Chi Hsiao, Pen-Ning Yu, Dong Song, Liu CY, Heck CN, Millett D, Berger TW. Conf Proc IEEE Eng Med Biol Soc. 2014;2014:5792-5.


An in vitro seizure model from human hippocampal slices using multi-electrode arrays. Hsiao MC, Yu PN, Song D, Liu CY, Heck CN, Millett D, Berger TW. J Neurosci Methods. 2015 Apr 15;244:154-63.


Sensitivity and specificity of upper extremity movements decoded from electrocorticogram. Do AH, Wang PT, King CE, Schombs A, Lin JJ, Sazgar M, Hsu FP, Shaw SJ, Millett DE, Liu CY, Szymanska AA, Chui LA, Nenadic Z. Conf Proc IEEE Eng Med Biol Soc. 2013;2013:5618-21.


Liu C, Russin J, Heck C, Kawata K, Adiga R, Yen W, Lambert J, Stear B, Law M, Marquez Y, Crino P, Millett D, Langford D. Dysregulation of PINCH signaling in mesial temporal epilepsy.
J Clin Neurosci 2017:43-52.


Hsiao MO, Yu PN, Song D, Liu CY, Heck CN, Millett D, Berger TW. Spatio-temporal inter-ictal activity recorded from human epileptic hippocampal slices. Conf Proc IEEE Eng Med Biol Soc. 2012 Aug;2012:5166-9.


Shaw S, Kim P, and Millett D. “Status Epilepticus Amauroticus Revisited: Ictal and Peri-ictal Homonymous Hemianopia,” Arch Neurol 69: 1504-1507, 2012.

ABSTRACTS


Po T. Wang*, Christine E. King, Colin McCrimmon, Susan J. Shaw, David Millett, Charles Y. Liu, Luis A. Chui, Zoran Nenadic, An H. Do. “Electrocorticogram Encoding of Upper Extremity Movement Duration.” 36th Annual International IEEE EMBS Conference, Chicago, IL, August 26-30, 2014.


Pen-Ning Yu*, Min-Chi Hsiao, Dong Song, Charles Y. Liu, Christi N. Heck, David Millett, Theodore Berger. “Unstable Periodic Orbits in Human Epileptic Hippocampal Slices.” 36th Annual International IEEE EMBS Conference, Chicago, IL, August 26-30, 2014.


Min-Chi Hsiao, Pen-Ning Yu, Dong Song, Charles Y. Liu, Christi N. Heck, David Millett, Theodore Berger. “A Testbed to Explore the Optimal Electrical Stimulation Parameters for Suppressing Inter-Ictal Spikes in Human Hippocampal Slices.” 36th Annual International IEEE EMBS Conference, Chicago, IL, August 26-30, 2014.

CHAPTERS


Millett D, Coutin-Churchman P, Stern J. “Basic Principles of Electroencephalography.” In Toga A. Brain mapping: An Encyclopedic Reference. Elsevier Press, 2015: pp. 75-80.


Millett D and Stern J. “Fundamentals of EEG.” In Stern J and Sirven J (Eds), Atlas of Video-EEG Monitoring, McGraw-Hill, 2011.

To learn more, visit the Epilepsy Program section or call 949-764-6066.