Epilepsy is a common neurological disorder that affects approximately 2.4 million Americans. The cumulative lifetime risk of epilepsy approaches 4% in individuals who live to age 80, and more than 181,000 Americans develop seizures and epilepsy every year. A significant proportion of people with epilepsy have seizures that cannot be controlled by currently available medications (i.e. refractory or intractable epilepsy). A rigorous, population-based estimate of the proportion of all epilepsy that becomes refractory is unavailable although inferences from population-based studies of remission suggest the figure, overall, may be about 20% (Rochester, MN.). People with refractory epilepsy have poorer employment status, significant limitations on their activities (e.g. driving), and disruption of all aspects of their lives due to the seizures, their consequences, and medication effects. They also experience higher mortality rates compared to the overall population. Even people with well controlled seizures and whose seizures completely remit have been found to have relatively poorer educational and social outcomes years after the resolution of their epilepsy.
My research focuses on the care and management of patients with intractable epilepsy. The goals of the research are to render these individuals seizure-free without treatment-induced adverse effects to allow the patients to become participating and productive members of society. This includes the diagnostic evaluation involving structural and functional neuroimaging, long-term EEG monitoring and intracranial EEG recordings. I have been assessing the importance of hippocampal volumetric studies and subtraction ictal SPECT co-registered to SPECT (SISCOM) in the identification of surgically remediable epileptic syndromes. Treatment options for intractable epilepsy include epilepsy surgery, vagus nerve stimulation, ketogenic diet, and investigational therapies. My colleagues and I are evaluating the safety and efficacy of electrical stimulation using responsive neurostimulation (NeuroPace, Inc.) for intractable partial epilepsy.
Finally, I am a principal investigator at Mayo Clinic in the National Institutes of Health funded study Epilepsy Phenome Genome Project (EPGP) beginning in 2007. The goal of this investigation is to understand the pathophysiology and clinical expression of idiopathic (genetic) epileptic syndromes. The Epilepsy Phenome/Genome Project (EPGP) is a large-scale, national, multi-institutional, collaborative research project aimed at advancing our understanding of the genetic basis of the most common forms of idiopathic and cryptogenic epilepsies and a subset of symptomatic epilepsy; i.e. epilepsies which are likely related to genetic predispositions or developmental anomalies rather than endogenous, acquired factors such as CNS infection, head trauma or stroke. The overall strategy of EPGP is to collect extremely detailed phenotypic information on a large population of patients with epilepsy, and to use state-of-the-art bioinformatics to identify the potential contribution of genomic and somatic variability to the epilepsy phenotype, to developmental anomalies of the central nervous system, and to the varied therapeutic response of patients treated with antiepileptic drug medication.
See my publications
- Division of Epilepsy
- Professor of Neurology
- Fellow - Clinical Fellow in Neurology Massachusetts General Hospital, Harvard University
- Resident - Neurology Harvard Medical School
- Resident - Intern, Jr. Asst. Resident and Sr. Asst Resident Duke University Medical Center, Duke University
- MD Rush Medical College