Epilepsy is one of the principal chronic neurological illnesses. Affecting about 0.6% of the population, as well as being a serious health issue, it has an important associated social cost. It is defined by the appearance of two or more unprovoked and unrelated epileptic episodes, with at least 24 hours between them. The treatment for epilepsy, is essentially pharmaceutical.

When the epilepsy is refractory or resistant to the drugs, it means that two uncontrolled episodes have occurred while being treated with a minimum two or more drugs (either monotherapy or combination therapy), which have administered in the correct dose during a minimum period greater than three times longest period free of an attack during the last year, or during a complete year since the start of the treatment. This occurs in 20% to 30% of epilepsy cases. These patients are candidates for continuous video-EEG (VEEG) study, which can identify the the start of the attack, to evaluate the possibility of surgical intervention. In approximately one in every ten cases it is decided, after an exhaustive presurgical examination, that an operation would be suitable.

It should be understood that the presurgical examination is a complex process which must be performed in a hospital to be able to have access to a team that can make an proper assessment: neurophysiological, neuroradiological, neuropsychological, neuropsychiatric, and neurosurgical of patients with refractory epilepsy. The Germans Trias Hospital is accredited by the Catalan Institute of Health (ICS) to carry out these procedures.

For the candidates for the operation, the surgery can be curative (resective surgery) or palliative (callosotomy, vagal stimulation, electrical stimulation, etc.). The surgery intended as curative, attempts to eradicate epilepsy attacks and reduce the pharmacological treatment, while the palliative surgery attempts to achieve a reduction in the number, or the severity, of the epileptic attacks, to improve the quality of life for those that suffer from refractive epilepsy. In general, the surgery is curative in 70% of patients with a presurgical diagnosis.

Sleep disorder are made up of a series of illnesses which involve different medical and surgical specialities and require a multidisciplinary approach. They go beyond the boundaries of just medicine, as these disorders are not just an important health issue but a social problem, due to their ramifications in the employment, and even sometimes medicolegal sphere.

The sleep disorders unit at Germans Trias, is responsible for these illnesses. It is made up of professionals in the field of pneumology (which it leads), Neurology (Epilepsy unit), Pediatrics, Psychiatry, Otolaryngology and Maxillofacial surgery.The unit diagnoses and treats patients with:

• Insomnia
• Sleep apneas
• Noctural hyperventilation
• Excessive daytime sleepiness
• Idiopathic hypersomnia
• Restless leg syndrome and periodic leg movements during sleep.
• Cardiac arrhythmia
• Parasomnias (sleep walking, night terrors, sleep behaviour disorders REM)
• Narcolepsy, with or without cataplexy (sudden muscle weakness)

The types of diagnostic tests carried out are:

Home based tests

• Respiratory poligraph
• Automatic tritation with CPAP
• Actigraphy

Hospital Tests

• Conventional polysomnography (adults and children). Is a technique to ascertain whether there are respiratory changes (especially apneas) during sleep, by using a series of electrographic variables, such as the electroencephalogram, eye movements, airflow in the mouth and nose, or the snoring intensity, among others.
• Conventional polisomnography with CPAP tritation and non-invasive ventilation
• Multiple sleep latency tests
• Lumbar puncture for the measurement orexin hormone

The Epilepsy Unit

• Takes part in clinical research of new antiepileptic drugs for refractory epilepsy
• Carries out clinical research into epilepsy related to glial cell tumours
• Carries out multi centre studies into sleep disorders
• Studies the quality of healthcare for patients with refractory epilepsy and the impact of treatment by the unit.
• Also carries out analysis of the diagnostic efficiency of video-EEG monitoring (VEE) in health centres.
• Also performs studies of the functional prognostics of anoxic encephelopathy (by oxygen deficit)

Post graduate training

The unit accepts groups of Neurology and Neurosurgery residents in their third or fourth year of specialisation, for periods of approximately three months. The Neurology training program is divided into various areas of interest: basic epileptology, clinical epileptology (neonatal, children, adults), diagnostic tests for epilepsy, pharmacological treatments and surgical treatments.

Ongoing training

• The unit carries out fortnightly accredited sessions for resident specialists in Neurology, Pediatrics, Neurosurgery, Nuclear Medicine and Radiodiagnostics.
• They also carry out monthly inter-hospital sessions for multidisciplinary study of refractory epilepsy patients, to make consensual choices as to the best form of treatment.
• They also organise an annual refresher course in vagus nerve stimulation which is accredited by the The Catalan Council for ongoing training in the healthcare sector.