Nearly two million Americans suffer from epilepsy--many of them children. It is the oldest known brain disorder and was mentioned in literature 2,000 years B.C. It is not considered a single disease; the recurrent seizures that mark its presence result from sudden, temporary disturbances in the normal operation of the brain’s electrical system that may result from different causes. Epilepsy takes many forms and its severity ranges from mild to completely debilitating.

Most people with epilepsy are successfully treated with antiepileptic drugs that provide partial or complete control over seizures. But approximately 250,000 people do not respond to medication. They may experience catastrophic epileptic seizures daily, making any semblance of a normal life impossible.

The Yale Epilepsy Surgery Program provides promising options for many of these adult and pediatric patients. Internationally known for clinical excellence and innovative research, this program was one of the nation’s first and has evolved into one of the most active and advanced in the world.

Surgical Evaluation: A Multi-Phase Process
Many people with epilepsy are referred to the program at Yale by their physicians, other patients or support organizations. They begin with a complete assessment and evaluation by an epileptologist on an outpatient basis. If further evaluation is appropriate, patients undergo an intense inpatient monitoring phase to determine if there may be a way to control their seizures medically or surgically. This extensive evaluation and testing process is required to determine the part of the brain responsible for the seizures and to assess the appropriateness and impact of surgical intervention.

The patient becomes a partner in a team of finely trained specialists representing the spectrum of knowledge about epilepsy care: a neurosurgeon, adult and pediatric epileptologists, neuropsychologists, neuroradiologists, a pediatric neurosurgeon, care coordinators and others who come together to determine the best course of action. Every week this team, along with community physicians, residents and fellows, discuss all of the information available on each patient to help shape the best treatment plan.

Continual improvements in imaging technologies have fueled many neurosurgical advances. The images and functions revealed ever more clearly by MRI, PET and SPECT scans help physicians determine whether seizures are the result of focal damage caused by congenital malformations, vascular lesions, tumors or scar tissue from early disease or injury. This information is a critically important factor in evaluating different treatment options.

The evaluation process for surgical candidates may include four phases, beginning with the least invasive.

Phase one: The first evaluative phase requires approximately a week of continuous audio-visual-electroencephalogram (EEG) monitoring in Yale’s six-bed adult epilepsy unit or two-bed pediatric unit. During this time, the patterns of altered behavior and movement, along with the EEG recording during seizures, can help the epileptologists localize the source. Advanced imaging techniques such as magnetic resonance imaging (MRI), PET and SPECT scans along with neuropsychological testing are performed to determine function and pathology.

Phase two: The second phase entails performing an angiogram to study the vascular structures and WADA (intracarotid sodium amytal testing), which determines language dominance and memory assessment useful to surgical planning.

Phase three: If it is necessary to study the brain directly to pinpoint the source of the seizures, the patient may have EEG electrodes surgically implanted either on the surface or within the brain. Yale has two surgical suites equipped with stereotactic workstations that ensure precise placement of the electrodes. Mapping of critical brain functions localized by electrode stimulation may also be conducted. Following the implantation, patients undergo another phase of continual monitoring of seizure activity as inpatients.

Phase four: Using all the information collected during the prior phases, the interdisciplinary team of specialists is now able to outline for the patient and family whether surgery is possible and what the results might be. If surgery is chosen, neurosurgeons proceed to remove any lesions or damaged brain revealed by the testing process to be the focus of the seizures.

The outcomes of epilepsy surgery are very encouraging: the vast majority of patients experience either no recurrence of seizures or a greatly reduced number of less severe seizures. Extensive, long-term follow-up care and rehabilitation are provided.

World Class Care From a Team That Cares
The Yale Epilepsy program has been instrumental in developing many of what are now widely practiced surgical procedures for epilepsy, including the medial temporal lobe resection, corpus collosotomy and intraoperative or extraoperative mapping of the primary functions of the cortex. Collectively this team brings more experience than almost any other program in the world to the patients treated at Yale-New Haven Hospital.

That expertise is enriched by a very personal regard and concern for the well-being of each patient. Surgical assessment and treatment for epilepsy are not only complex medically, they are also time intensive and emotionally challenging. Patients are supported by caregivers during each step of the process, so that a very stressful experience can have the very best outcome both medically and emotionally.

Program Director
Dennis D. Spencer, M.D., is the Harvey and Kate Cushing Professor of Surgery, chairman of the Department of Neurosurgery and director of the Yale Epilepsy Surgery Program. Dr. Spencer graduated from Washington University School of Medicine and completed his neurosurgical residency at Yale. He joined the faculty after completing his residency and became the chief of neurosurgery in 1987. He is a director of the American Board of Neurosurgery.

Dr. Spencer is internationally renowned for surgical treatment of the underlying neurological diseases that cause epilepsy and for developing a now commonly used surgical approach for patients with temporal lobe epilepsy. In addition to directing the surgical arm of one of the most established epilepsy centers in the world, Dr. Spencer has assembled investigators focused on studying the neurobiology of human epileptogenic tissue in an effort to discover the underlying causes of epilepsy.

An Environment for Research and Teaching
The Yale Medical School has an international reputation for academic excellence and innovative research. This atmosphere of academic inquiry and research enhances the program’s clinical mission and provides patients with the assurance they are receiving the most current and advanced treatment available.

Faculty
Kenneth Vives, M.D.

Contact Information
Colleen Malone
Epilepsy Surgery Coordinator
203-785-4891

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Last modified: December 6, 2006 (RSM)