Yale Epilepsy Surgery Program
Dennis D. Spencer, M.D.
Chairman, Neurosurgery, Epilepsy Surgery
Mission
This program is designed to provide comprehensive and innovative clinical care for patients suffering from medically intractable epilepsy. Research in epilepsy directed by this program is interdisciplinary and will expand on a theme that correlates basic clinical and laboratory studies emphasizing the pathogenesis of the diseases responsible for chronic seizure disorders. The goals for education are to instill in our medical students, residents and fellows the translational nature of this research to patient care and the importance of teamwork effort.
Clinical Care
The epilepsy surgery program is internationally recognized as a leader in the implementation of innovative surgery for the treatment of patients with intracerebral diseases associated with medically intractable epilepsy.
The clinical program is multidisciplinary consisting of neurosurgery, neurology, neuropsychology, neuroradiology and neuropathology utilizing out patient facilities, a six bed epilepsy monitoring unit and a technologically advanced and computerized OR suite. Patients worldwide are evaluated in phases of an increasingly invasive nature in order to precisely determine concordance of electrophysiology, cognitive testing, history, physical and neurological examination with advanced imaging using MRI, SPECT and PET techniques.
A state of the art operating room suite contains advanced digitized imaging, computerized stereotaxy and sophisticated electrophysiology in order to perform optimal yet safe resections and to place intracranial electrodes for those patients who need invasive electrophysiological confirmation of an epileptogenic region. The Yale program has been instrumental in developing many of the currently widely accepted surgical procedures for epilepsy including the medial temporal lobe resection, corpus collosotomy and intraoperative or extraoperative mapping of primary cortex such as motor, sensory and language function.
The comprehensive nature of the program is emphasized by a pharmacology arm directed by neurology providing clinical trials of all new anticonvulsants presently being studied in the United States.
A highly skilled and empathetic clinical nurse coordinating team provides easy patient access, short response times and invaluable assistance in moving through the program and most importantly close follow up care.
Research
The Yale Epilepsy Surgery Program investigates the pathogenesis of epilepsy using a similar interdisciplinary model. Clinical and basic scientists from the departments of Medicine (neuroendocrinology), Neurosurgery, Psychiatry, Pediatrics, Neurobiology, Radiology, Cell Biology, Obstetrics, and Gynecology, and the Howard Hughs Center for molecular medicine, are studying the molecular, cellular, animal model and human biology of epilepsy pathogenesis. A major research emphasis of the program has been the neurobiological study of human tissue resected for the cure of epileptic conditions. This tissue is submitted to in vitro slice electrophysiology, immunohistochemistry, culture, and molecular studies by investigators primarily within neurosurgery, but including scientists in all the departments listed above. The characteristics of this tissue represent the wide variety of diseases responsible for epilepsy and the results of these studies are correlated with both animal models and human in vivo studies performed in the clinical arm of the program in order to provide feedback for innovative patient care or the development of more appropriate animal models of epilepsy. A weekly Clinical Basic Science Correlations (CBC) conference is held to formalize and assist the integration of this data.
We are presently emphasizing the molecular genetics of various substrates underlying the epilepsies, and on correlating the human slice electrophysiology with in vivo clinical depth electrode studies. Tremendous advances are also being made in functional and spectroscopic MR with the aim not only to correlate MR derived function such as motor, sensory, and language, but also to use these techniques in identifying ictal and interictal epileptogenic regions.
Education
A critical and parallel theme of this program is to train our medical students, residents and fellows the discipline of translational research and patient care. The program emphasizes critical problem solving not only in day to day patient care, but in research projects designed to provide an analysis of how research today will direct new methods of patient care tomorrow.
The Yale Epilepsy Surgery Program can be reached at 203-785-4891
or email to dennis.spencer@yale.edu
Neurosurgery Faculty/Program Menu
Department of Neurosurgery address and phone number
http://info.yale.med.edu/neurosurgery/episurg.html
credits