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Epilepsy
Epilepsy encompasses a group of disorders characterized by recurrent seizures – brief electrical disturbances in the brain that can cause a variety of symptoms such as strange sensations, changes in behavior or emotions, muscle spasms, convulsions, and a sudden loss of awareness or consciousness. About 10 percent of all people – approximately eight million Americans – may experience a seizure during their lifetime. However, only three percent of the population suffers from recurrent seizures, or epilepsy.
NewYork-Presbyterian Hospital offers state-of-the-art outpatient and inpatient care for children and adults with epilepsy at the Comprehensive Epilepsy Centers located at both NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-PresbyterianHospital/Weill Cornell Medical Center. Widely acclaimed for pioneering achievements in research and clinical innovations, the faculty and staff of our Comprehensive Epilepsy Centers include some of the world's foremost clinicians and researchers. Patients and their families benefit from the care of an experienced, compassionate, multidisciplinary team that includes epileptologists, neurologists, neurosurgeons, neuroradiologists, clinical nurse specialists, neuropsychologists and psychiatrists.
For nearly 90 years, the Neurological Institute at NewYork-Presbyterian/Columbia has been an internationally recognized center for the treatment of brain disorders. Its more than 130 faculty members are among the most renowned experts in neurology in the world, and their research provides the most innovative and up-to-date treatment opportunities anywhere. The Neurological Institute also has a proud tradition of training academic leaders and practitioners of neurology, and graduates of its educational programs can be found in medical centers throughout North America and around the world. This department is consistently ranked in the top 5 in the nation.
NewYork-Presbyterian/Weill Cornell's Comprehensive Epilepsy Center is an active branch of the internationally regarded Neurology and Neuroscience Department at NewYork-Presbyterian/Weill Cornell. Individuals and families receiving care through the Comprehensive Epilepsy Center have available to them the vast resources of one of the country's most prestigious medical and teaching institutions.
Diagnostic Innovation
Seizures occur when nerve cells discharge their electric current in an abnormal manner, much like a "short circuit." The patient may lose consciousness, and have shaking movements of all limbs, or smaller attacks – such as staring spells, unusual behavior, or movements of just one arm or leg – may occur, with just staring spells, an unusual behavior, or movements of one arm or leg. When seizures occur again and again, the patient is said to have epilepsy.
Sometimes seizures occur as an acute warning that there is an underlying problem, such as a dramatic change in blood sugar, stroke or brain tumor, that needs attention. However, in most epilepsy cases, there is no specific acute cause. Instead, perhaps a minor brain injury in the period surrounding birth or an inherited tendency toward having seizures produces the episodes. Although persons with epilepsy may have seizures frequent enough to be disabling, most people are relatively well between episodes, and lead normal lives.
At NewYork-Presbyterian Epilepsy Centers, each case of new-onset seizures is carefully investigated. We offer a full complement of advanced diagnostic tests for seizure classification and evaluation for surgical treatment, including in-patient epilepsy monitoring units, MRI, SPECT, neuropsychological tests, Wada test, and PET scanning. In addition, through the use of state-of-the-art neurodiagnostic imaging, neuopsychological testing and other means, we are able to do extensive "mapping" of the brain to ensure that any neurosurgical approach being considered will be a safe, effective and desirable option.
High-Quality Surveillance
State-of-the-art neurophysiologic monitoring is utilized by the Comprehensive Epilepsy Centers to guide patient treatment and progress in the neonatal and pediatric intensive care units, adult medical, surgical and neurological intensive care units, as well as to provide high-quality intraoperative surveillance during neurosurgery.
Therapeutic Excellence
NewYork-Presbyterian Hospital's Comprehensive Epilepsy Centers have extensive experience in working with patients with intractable (hard to treat) epilepsy, and offer state-of-the-art diagnosis and treatments for acute conditions as well as long-term management of the medical and social aspects of epilepsy. Management of epilepsy in patients where standard medications have not been effective may involve new investigational medical treatment through FDA-approved clinical trials of new antiepileptic medications not otherwise available or surgical treatment in carefully selected cases.
Children and adults with hard-to-manage seizures may be considered for epilepsy surgery if seizures remain uncontrolled after treatment with three or more anti-epileptic medications. In resective surgery, a team of epilepsy specialists works to identify the specific area or part of the brain where seizures are generated, then remove that area if possible. The first step involves an extensive evaluation to localize the seizures to determine whether the seizures begin in one small part of the brain that might be treated surgically. Then we must predict whether surgery will result in any major problems with speaking, understanding, or other abilities. Multiple subpial transection surgery does not remove the areas of the brain in which seizures originate, but rather interrupts the neuro pathway of the seizure, preventing it from spreading.
A promising experimental treatment for patients, called vagus nerve stimulation, involves placing a small pacemaker under the skin near the vagus nerve in the side of the neck to regulate the electrical activity in the brain and in this way reduce the frequency and severity of seizures. NewYork-Presbyterian Hospital has developed a strong expertise in VNS, having employed this technique to treat more patients with severe epilepsy than any other epilepsy center in the world.
Management of Epilepsy in Children
Many cases of childhood epilepsy are well-controlled and have a good outcome. Some children have a more difficult time, and the combination of seizures, medication effects and behavioral or learning problems requires a multidisciplinary effort where family needs are recognized as well.
Whether seen as out-patient or in-patient, each child receives expert medical attention with an emphasis on developmental needs. Children requiring hospitalization for monitoring, medication adjustment or surgical management are housed in a two bedded room on constant video-camera surveillance; parents are encouraged to stay overnight.
Children with hard-to-manage seizures may be considered for epilepsy surgery when treatment with anti-epileptic medication fails. Neurosurgical intervention, even at an early age, can sometimes end frequent, uncontrollable seizures, allowing children to maximize their potential. Epilepsy surgery in children serves to remove the source of the seizures, or in some cases, to disrupt pathways which spread seizures.
Hormonal Influences on Epilepsy, Mood and Behavior
Neuroendocrinology is the study of how hormones interact with the brain. At the Neuroendocrine Division of the Comprehensive Epilepsy Center at NewYork-Presbyterian/Weill Cornell, we have particular interest in the relationships between the reproductive steroid hormones, epilepsy and behavior. Insight into the complex interactions between the reproductive steroid hormones (estradiol, progesterone and testosterone) and issues such as seizure exacerbation, mood disturbances, altered libido and fertility leads to new treatment approaches sensitive to the needs of adolescents and adults with epilepsy, migraine and other neurologic conditions.
Reproductive endocrine disorders are more common among women and men with temporal lobe epilepsy than in the general population. The temporal lobe of the brain provides important feedback to endocrine centers in the brain, therefore indirectly influencing the secretion of important chemical messengers. In some individuals with temporal lobe epilepsy, disruption of temporal lobe function may impact on this hormonal feedback system. Symptoms experienced by affected individuals, such as amenorrhea and infertility in women, and diminished libido and potency in men, can be effectively treated both by controlling seizures and by normalizing the hormonal environment.
Research
NewYork-Presbyterian Hospital's Comprehensive Epilepsy Centers are also renowned for their excellence in epilepsy research. Research conducted at these centers, with a special focus on epilepsy in children and women, has advanced our understanding of the causes, consequences, and treatment of epilepsy, including the use of many new anti-seizure medications and the effects of epilepsy and its treatment on mood. In addition, the Comprehensive Epilepsy Centers train future leaders in epilepsy research through national and international epilepsy fellowships.
The Comprehensive Epilepsy Center of NewYork-Presbyterian/Weill Cornell actively pursues research interests including new approaches to the management of status epilepticus, and the effects of epilepsy on mood and memory. The Center offers clinical trials for several new anti-convulsants, as well as new techniques such as vagus nerve stimulation. In addition, researchers at NewYork-Presbyterian/Weill Cornell are conducting investigational trials of two methods of brain stimulation for epilepsy: stimulation of the anterior nucleus of the thalamus, and the responsive brain stimulator.
