CCE Seizure Disorders: New York University

New York University Comprehensive Epilepsy Center
New York City, New York

In its 20-year quest to get to the root of seizure disorders, the New York University Comprehensive Epilepsy Center has accumulated a wealth of clinical and research knowledge.

Orrin Devinsky, MD, the center's director, says there is still much ground to explore in the treatment of seizure disorders, which are various and complex. Of the 3 million people in the United States with epilepsy, one-third suffers from seizures that cannot be controlled by medication, he says.

Founded in 1989, the NYU Comprehensive Epilepsy Center has quickly assumed an influential role in the field. For example, NYU is one of two leading investigators in the Epilepsy Phenome/Genome Project. Led by Reuben Kuzniecky, MD, director of research in the center's Department of Neurology, the five-year, $21 million study will recruit 4,000 patients and is touted as the first and largest research study of its kind to examine what causes epilepsy, why people respond differently to medications, and why some families include several people with seizures.

Like other researchers, Devinsky and his team are investigating new antiepileptic drugs (AEDs). Because AEDs can cause severe side effects including weight loss, dizziness, anemia, osteoporosis, and mental disturbances, the center is also active in the development of nondrug treatments and unique drug delivery systems.

Tuberous sclerosis surgery

For example, the center offers a surgical strategy consisting of consecutive procedures performed over a 10-day period during the same hospital admission. The strategy has been successful for treating children with tuberous sclerosis and during the past decade, about 100 cases have been treated at NYU. During the first procedure, an electrode grid is implanted that will continuously monitor seizure activity over the next several days. The result is a map of seizure foci which the surgeon uses to guide resection during the second procedure. A third procedure is performed to remove any residual seizure-causing tissue.

Drug delivery developments

The Comprehensive Epilepsy Center is developing new strategies to better assist seizure sufferers. One involves an investigational nasal spray that may be used to stop acute seizures before they begin. Devinsky says this would be a welcomed advance because currently, drugs for acute seizures are usually administered rectally.

Scientists at NYU are also conducting early clinical trials with an implantable intracranial drug delivery pump connected to an electrode that, when enacted, delivers the medication directly to the seizure foci.

"Right now, all of the medications that are given, whether they're given orally or potentially nasally or intravenously, they all go through the systemic circulation," Devinsky says. "If your brain has 50 million brain cells, then they go to all 50 million cells, when the seizures may only come from 2 million of those cells."

Direct drug delivery would also reduce the incidence and severity of AED side effects, he says.

Incorporating research into patient care

Research at the Comprehensive Epilepsy Center extends to seizure disorder etiology.

One targeted research area is the role inflammation may have in the development of epilepsy. Jacqueline French, MD, director of the Clinical Trials Consortium at the NYU center, says that seizures normally cause inflammation in the brain. In turn, animal research has shown that such inflammation can perpetuate more seizures.

"This might be a strategy for future treatment by attacking a piece of the pathology rather than just adding a blanket over the brain, which many antiepileptic drugs do," French says.

NYU has an extensive, comprehensive program that includes neuropsychological services, complex neurodiagnostic monitoring, social services, recreational therapies, and a broad range of surgical interventions. The staff includes 16 epileptologists, three neuropsychologists, and two neurosurgeons.

Devinsky says the center excelsin transitional research and its ability to convert theory to real results. But the most effective results come from interacting with individual patients, he says.

"Everything said and done about research and fine clinical care, is that it ultimately boils down to the individual person and I think the ability to get into individual cases in detail, to understand life experience and how epilepsy has impacted an individual child or adult is the challenge that we try to face," says Devinsky.

From his pediatric neurology practice in New Jersey, Richard Sultan, DO, has referred more than 100 difficult pediatric seizure cases to NYU primarily because he trusts Devinsky and NYU's program.

He values the regular feedback from NYU physicians on every case he refers. "You always feel like you're part of the decision making process," Sultan says. "You don't feel like you're losing sight of your patient."