Anyone who has experienced an epileptic seizure should be evaluated by a specialist in neurology. The neurologist will conduct a clinical examination, recommend additional diagnostic tests, and based on the results, initiate an appropriate treatment plan.
Is this your first visit with us? We’re here to help guide you through the next steps.
To determine the most appropriate treatment for each patient, several additional diagnostic tests are necessary to clarify the cause and characteristics of epilepsy. All patients under the care of our Epilepsy Center undergo basic evaluations, which always include an EEG and MRI. If your epileptologist begins considering surgical treatment, the first essential step is to rule out pseudoresistance—a situation where seizures persist for reasons other than true drug resistance. In nearly half of these cases, the cause of ongoing seizures is an incorrect diagnosis.
Once true drug resistance is confirmed, the patient undergoes a comprehensive two-week diagnostic hospitalization at our center. During this stay, we complete a series of non-invasive presurgical tests, which typically include:
Video-EEG monitoring
High-resolution brain MRI using an epilepsy-specific protocol
Comprehensive neuropsychological evaluation
In most cases, we also perform PET imaging of the brain on an outpatient basis.
In patients with non-lesional epilepsy—those whose MRI shows no obvious abnormality—additional advanced testing is necessary. This may include:
SISCOM (Subtraction Ictal SPECT Coregistered to MRI)
SPM-PET (Statistical Parametric Mapping of PET data)
Stereo-EEG (SEEG) — an invasive video-EEG investigation using depth electrodes
Only after all necessary diagnostic procedures have been completed and thoroughly reviewed, a multidisciplinary surgical team meets to evaluate the findings and decide whether epilepsy surgery is a suitable and safe option.
For the vast majority of patients with epilepsy, treatment requires the use of medication. These medications are commonly referred to as antiseizure medications (ASMs), a term now preferred over the older “antiepileptics” because currently available drugs do not cure epilepsy—they only help prevent seizures.
The general approach to starting treatment with ASMs follows these principles:
Treatment is initiated after a thorough evaluation of the seizure’s origin. Medications are prescribed only when the seizure is clearly epileptic in nature, or when there is reasonable suspicion of epilepsy. In uncertain cases, doctors may proceed with a “therapeutic trial” using a broad-spectrum ASM at appropriate doses.
Monotherapy is the first step. Treatment begins with a single first-line ASM, started at a low dose and gradually increased to the maximum tolerated dose (MTD)—the highest dose that does not produce unacceptable side effects. This approach leads to complete seizure control in approximately 50% of patients.
If the first medication is ineffective, it is usually replaced with a different ASM. This change brings seizure freedom to an additional 13% of patients.
In cases where seizures persist, a second medication is added to the initial one, moving to combination therapy.
If seizure freedom is not achieved after trying two appropriately chosen, correctly dosed, and consistently used ASMs—along with adherence to all lifestyle recommendations—the likelihood of reaching long-term remission with additional medication becomes significantly lower. At this point, the patient meets the criteria for drug-resistant epilepsy.
Despite advances in pharmacological treatment, long-term seizure freedom remains unachievable in 20–30% of patients with epilepsy, even when they adhere strictly to lifestyle recommendations and take antiepileptic medications correctly. In such cases, surgical treatment becomes a viable therapeutic option.
Epilepsy surgery is currently considered an effective and safe approach for many patients with drug-resistant epilepsy. In a significant proportion of these individuals, seizures can be eliminated entirely or at least substantially reduced in frequency.
Key criteria for considering epilepsy surgery include:
Proven diagnosis of drug-resistant epilepsy
Expected improvement in quality of life due to seizure reduction or elimination
Surgical risks are outweighed by anticipated benefits
Strong motivation from the patient (or, in pediatric cases, from the child’s caregivers)
Whether surgery is indicated—and which surgical procedure is most appropriate—must be carefully evaluated on a case-by-case basis by a specialized interdisciplinary team.
The final decision regarding surgery is made by the center’s surgical board only after comprehensive diagnostic evaluations and multidisciplinary assessment.
Resective surgery(curative surgery), where the brain area responsible for seizure onset (epileptogenic zone) is removed, offers the best chance for complete seizure freedom and, essentially, a cure. Unfortunately, this outcome is not possible for all patients.
Resection is not feasible if the epileptogenic zone overlaps with eloquent cortex—brain regions responsible for essential functions like movement, sensation, speech, or vision. It is also typically not an option for patients with multifocal epilepsy (multiple seizure foci), idiopathic generalized epilepsy, or most developmental epileptic encephalopathies such as Dravet syndrome or Lennox-Gastaut syndrome.
Neurostimulation therapies, such as Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation of the anterior thalamic nuclei (DBS-ANT), are considered alternatives when resective surgery is not appropriate. Though seizure freedom is not the primary expected outcome of neurostimulation, complete seizure elimination is seen in approximately 5% of VNS or DBS-treated patients, and a >90% seizure reduction in about 10%. Additionally, 50–60% of patients typically experience a significant (>50%) reduction in seizure frequency.
It is crucial to note that neurostimulation should only be considered when curative surgery is not an option, as resective procedures remain the first-line surgical treatment for suitable candidates.
Any adult patient with epilepsy who continues to experience seizures despite appropriate treatment for two years should be referred to one of the accredited Centers of Highly Specialized Care (CVSP) for pharmacoresistant epilepsy. In the Czech Republic, these centers include our Brno Epilepsy Center (St. Anne’s University Hospital / Brno University Hospital) and the Motol University Hospital or Na Homolce Hospital in Prague.
For children with pharmacoresistant epilepsy, timely intervention is even more critical and should not be delayed.
First Contact with the Brno Epilepsy Center
Your first contact with the Brno Epilepsy Center may involve a consultation at the epilepsy outpatient clinic or direct admission to the hospital ward, as referred by your neurologist.
In either case, please bring your medical records and the results/images of all recent imaging examinations you have undergone.
The initial outpatient consultation typically lasts about one hour. During this visit, the doctor will take a detailed personal and family medical history, including questions about your mother’s pregnancy, as well as any neurological or psychiatric conditions that may be present in your family. This comprehensive assessment helps guide further diagnostic and treatment decisions.
The doctor will also conduct a thorough review of your epilepsy history, including the type, frequency, and duration of your seizures, your current and previous treatments, known seizure triggers, and any sensations or symptoms you experience before or after a seizure.
You may be asked to describe or demonstrate what your seizures look like, or to show a video recording of a previous seizure—for example, a recording made on a mobile phone, if available.
To help the medical team form the most complete picture, it is highly recommended that you bring along a family member, caregiver, or someone who has witnessed your seizures to the first appointment. Keeping a seizure diary is also very helpful.
Based on the findings from this initial consultation, your doctor may recommend further outpatient testing, adjust your medication, or schedule a hospital admission for more in-depth evaluation.
Need to schedule a follow-up appointment or running out of medication?
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