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Annual Course | Controversies in the Management of Difficult Epilepsies

The annual course will cover controversies in the management of difficult epilepsies. The day will be organized in a series of case presentations, debates, and didactic lectures covering a wide variety of difficult clinical decisions, with direct impact on patient care. Our experts will cover pragmatic questions including the indications to obtain tests such as EEG or seizure medication blood levels, when to initiate and stop anti-seizure medications, and how to manage driving restrictions in adults with epilepsy. A surgical portion will evaluate the indications for the different invasive EEG techniques (intraoperative electrocorticography, subdural electrodes, and stereo-EEG). Future directions and innovative treatment and diagnostic modalities will be discussed in the last portion of the day. The overall purpose of the course is to provide our learners with practical knowledge that can facilitate and advance their day to day practice.

Learning Objectives

Following participation in this activity, learners will be able to:
  • Develop a rational process for the outpatient follow-up of patients with epilepsy
  • Review a comprehensive picture of the current state of knowledge for seizure medication management after epilepsy surgery
  • Discuss the indications for the different types of invasive EEG
  • Examine potential role of innovative technology in the fields of genetics and language mapping in patients with epilepsy


Chair: Lara E. Jehi, MD
Introduction: Lara E. Jehi, MD
I. Management Decision Challenges in Epilepsy (Moderator Lara E. Jehi, MD)
8:50 AM Case: An Adult with History of Depression Presenting with Recurrent Convulsions: Tracy A. Milligan, MD
8:55 AM Debate: It Is Appropriate to Start Treating Epilepsy Based on Clinical Suspicion Alone vs.: We Should Always Strive to Confirm Diagnosis of Epilepsy Before Starting Medications: Elson L. So, MD, and W. Curt LaFrance, Jr., MD, MPH
9:20 AM Lecture: When Should We Obtain a Routine EEG while managing Managing an Adult with Epilepsy? William O. Tatum, DO
9:40 AM Lecture: Does Epilepsy Surgery Improve Developmental Outcomes in Children with Epileptic Encephalopathy and Few or No Seizures? Kevin E. Chapman, MD
10:00 AM Lecture: When Should We Measure Antiepileptic Blood Levels? Lynn Liu, MD
10:20 AM Break
II. How to Start and How to Withdraw Antiepileptic Medications (Moderator: Kimberly Pargeon, MD, MA)
10:35 AM Case: Adult with Status Epilepticus Following Brain Tumor Resection: Juan G. Ochoa, MD
10:40 AM Lecture: When to Start and Stop Antiepileptic Medications in Adults with Acute Symptomatic Seizures: Stephen Hantus, MD
11:05 AM Debate: Newer AEDs for Children with Catastrophic Epilepsy Are Expensive but Worthwhile vs. Traditional AEDs Are Equally as Beneficial and Should Be Tried First in Pediatric Epilepsy Population: Elaine C. Wirrell, MD, and Yu-Tze Ng, MD
11:30 AM Debate: Medication Withdrawal after Epilepsy Surgery: It Should Always Be Attempted in Patients Who Are Seizure Free vs. There Are Several Situations where Medications Should Never Be Withdrawn: Sarah Aminoff Kelley, MD, and Samuel Wiebe, MD
11:55 AM Lecture: Should Patients Stop Driving when AEDs Are Withdrawn? Joseph I. Sirven, MD
12:05 PM– 2:00 PM Lunch Break
III. Choosing a Surgical Approach (Moderator Lara E. Jehi, MD)
2:00 PM Debate: If Epilepsy Surgery Is Considered in a Patient with a Normal MRI, an Invasive EEG Evaluation SHOULD Be Done vs. Invasive EEG Is Not Always Necessary in Patients with a Normal Brain MRI: Sumeet Vadera, MD, and Michael R. Sperling, MD
2:25 –PM Lecture: Indications for Subdural Electrodes Evaluation: Stephan Schuele, MD, MPH
2:45 PM Lecture: Indications for Stereo EEG Evaluation: Patrick Chauvel, MD
3:05 PM Lecture: Indications for Intraoperative ECoG: Andre Palmini, MD, PhD
3:20 PM Panel Discussion: See the Counterpoint: Stephan Schuele, MD, MPH, Patrick Chauvel, MD, and Andre Palmini, MD, PhD
3:30 PM Break
IV. Looking to the Future (Moderator: Jeremy Moeller, MD, MSc)
3:45 PM Debate: Advances in Our Diagnostic Technology Are Improving Our Epilepsy Surgery Outcomes vs. Doing More Tests Is Increasing Cost but Not Necessarily Influencing Our Outcomes: Edward Chang, MD, PhD, and Nathalie Jetté, MD, MSc, FRCPC
4:10 PM Lecture: The Future of Language Mapping in Epilepsy Surgery: Nathan E. Crone, MD
4:30 PM Lecture: The Role of Epilepsy Surgery in Genetic Epilepsies: Kees Braun, MD, PhD
4:50 PM Lecture: Treatments: We Can Predict Anything but the Future: Robert S. Fisher, MD, PhD
5:10 PM Course Wrap-up: Lara E. Jehi, MD

Target Audience

Adult neurologists/clinicians (MD/DO), clinical trainee students/fellows, allied health professionals/advance practice providers, neurosurgeons, pediatric neurologists/clinicians (MD/DO)

Program Purpose

Knowledge, competence, performance

Career Stage

Early, mid-career, established