Society of Pediatric Neurosurgeons, also developed the current 2014 Highlights — • Participated in trials leading to FDA approval of responsive neurostimulator (RNS) devices, and performed the nation’s first post-approval RNS implantation • Nature publication showing that speech processing involves bilateral brain activity • American Journal of Human Genetics report showing that genetic mutations related to synapse function are linked to severe childhood epilepsies • Forming a Rare Epilepsy Network aimed at expediting research into the rare epilepsies, in partnership with the Epilepsy Foundation and other patient advocacy groups • Awarded a five-year CDC grant to establish a Managing Epilepsy Well Network Collaborating Center • One of 15 institutions across the U.S. and the United Kingdom collaborating to study the causes of Sudden Unexpected Death in Epilepsy (SUDEP) as part of the NIH-funded Center for SUDEP Research PAGE 20 NYU LANGONE MEDICAL CENTER / NEUROLOGY AND NEUROSURGERY / 2014 state-of-the-art approach to tuberous sclerosis surgery, in which the brain’s epileptic regions are mapped with electrodes prior to surgical excision. Dr. Doyle is one of the nation’s most experienced surgeons at brain resection in adult patients, and has also been a leader in utilizing both responsive neurostimulation and the vagus nerve stimulator—an implantable device that can reduce seizure activity by transmitting electrical signals to the brain indirectly via the vagus nerve in the neck. COLLABORATIVE APPROACH CEC clinicians and researchers are also using innovative neuroimaging techniques to pinpoint epileptic regions prior to surgery, including combining the results of subtraction SPECT scans, MRI and PET imaging, and magnetoencephalography, and using enhanced computer analysis of MRI images to identify areas of gray-white blurring in the brain. An interdisciplinary conference of two dozen or more medical professionals meets on a regular basis to carefully review each patient’s imaging results. “Most of our senior members have been working together for 15 or 20 years—we have a seasoned team with many strengths,” says Dr. Devinsky. “Besides doing a great job on the relatively simple cases, we’ve been very effective at finding new treatment modalities for patients who have run through existing therapies.” As treatments evolve, he adds, the center is increasingly finding that they can bring about significant improvement even when a patient’s epilepsy is not completely cured. “If we can reduce a young person’s seizures by 80 percent,” observes Dr. Devinsky, “that translates into a dramatically reduced seizure burden over the next 10 or 20 years.” NYU Langone recently published research showing that a thin sheet of electrode-containing material, spread over the surface of the brain, can effectively detect specific neuronal electrical activity both on and below the brain’s surface. The technology, called NeuroGrid, was designed and manufactured by Dion Khodagholy, PhD, a postdoctoral fellow at NYU Langone. It uses a thin, flexible sheet of biocompatible material containing gold, platinum, and a conducting polymer called PEDOT:PSS, which conforms to the contours of the brain. Because it remains on the brain surface, the technology enables physicians to accurately measure and map action potentials across a much larger number of neurons than the traditional approach of implanting electrodes into the brain. The recent study was conducted with CEC investigators, who successfully used the NeuroGrid to assess neuronal activity in two patients undergoing epilepsy surgery. NEUROGRID TECHNOLOGY PROVIDES ENHANCED MAPPING OF BRAIN NEURON ACTIVITY NYU LANGONE MEDICAL CENTER / NEUROLOGY AND NEUROSURGERY / 2014 PAGE 21 CLINICAL CARE Treatment-Resistant Epilepsy The CEC has particular expertise in caring for the most difficult-to-control cases of epilepsy, combining extraordinary resources in neurodiagnostics (from genetics to novel computer-assisted MRI techniques) and neurotherapeutics, both clinically and in cutting-edge research to advance epilepsy care. A broad expertise in antiepileptic drug therapies, new drug trials, dietary therapy, surgically implanted devices, and surgical therapy, combined with an individualized approach to patient care and access to an outstanding collaborative team, make the CEC especially effective in these challenging cases. SPECIALTY AREAS IN EPILEPSY TREATMENT Dravet Syndrome The Dravet Center, directed by pediatric neurologist Judith Bluvstein, MD, assistant professor of neurology, provides comprehensive care for children with Dravet syndrome, including inpatient monitoring if needed, as well as a ketogenic diet program. The center is also part of a collaborative network of Dravet centers whose goals include developing and optimizing a standard of care for Dravet syndrome and pursuing basic science and clinical research on the condition. Tuberous Sclerosis (TS) The Tuberous Sclerosis Center—whose staff includes Dr. Devinsky and Kimberly Menzer, RN, NP, senior staff nurse—provides comprehensive interdisciplinary medical and surgical care for children and adults with TS. Dr. Weiner pioneered the multistage invasive monitoring technique for TS and is an expert in its surgical treatment. CEC