Weill Medical College of Cornell University

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• Epilepsy
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Clinical Trials

Aneurysms
Stenosis
Stroke
Newly Diagnosed Brain Tumors
Recurrent Brain Tumor Studies
Spine Surgery
Movement Disorders
Epilepsy

Aneurysms

• MAPS (Matrix and Platinum Science) Trial

  A prospective randomized multi center clinical trial. Patients will be randomized to treatment with bare platinum or bio-polymer coated coils.

• Wide-Neck aneurysms: The Neuroform Stent & the Enterprise Stent System

  Clinical study of devices sued under an HDE. These two stents are small metallic mesh tube designed to keep the coils in the aneurysm sac, in intracranial wide neck aneurysms.

• Comparison of Digital Subtraction angiography vs. MRA for the detection of recurrence of intracranial aneurysms following obliteration with platinum coils.

• ONYX Liquid Embolic System for Aneurysms

  This is a study using an artificial material used to block blood flow into aneurysms. Onyx is indicated for treatment of intracranial, saccular, sidewall aneurysms that present with a wide neck and are not amenable to treat with surgical clipping. This study is under a Humanitarian Use Device.

• COCOA: Complete Occlusion of Complex Aneurysms using Pipeline™ embolization device.

• Retrospective Aneurysm Review

Stenosis

Intracranial Stenosis

• Wingspan Stent System with Gateway PTA balloon catheter (HDE)

  Intended for use in improving cerebral artery lumen diameter in patients with intracranial atherosclerotic disease, refractory to medical therapy, in intracranial arteries with greater than or equal to 50% stenosis.

• Retrospective Wingspan study

  This trial is to evaluate intracranial stenting for atherosclerotic disease in symptomatic patients with equal to or greater than 50% stenosis that received the Wingspan Stent System.

• SAMMPRIS trial (Stenting and Aggressive medical management for preventing recurrent stroke in intracranial stenosis)

Extracranial Stenosis (Carotid)

• CREST (Carotid Revascularization Endarterectomy vs. Stenting) trial

  This is a prospective, multi-centered, NIH-funded trial to compare the results of treating carotid stenosis with either carotid endarterectomy or carotid stenting.

• Capture 2

  A prospective, non-randomized multi-centered descriptive post-approval registry of carotid stents patients.

• SMART (Neuropsychological Functioning, Quality of Life and Cerebral Blood Flow in Carotid Stenting

  This is a study in which researchers at Weill Cornell want to determine if carotid stenting will increase the quality of life and cognitive functioning in patients with severe carotid stenosis (greater than or equal to 70%) due to the increase in cerebral blood flow following the procedure.

Stroke

• MR Recanalization of Stroke Clots Using Embolectomy (MR RESCUE)

  This study compares the effectiveness of the Concentric Retriever Device (CRD) to standard medical treatment and to identify people who might benefit from the device by appearance of the stroke on MRI. The trial is sponsored by the NIH and the National Institutes os Neurological Disorders and Stroke (NINDS). Patients are randomized to either embolectomy or medical treatment depending on Inclusion and Exclusion criteria, and MRI.

• IA Chemotherapy

1. Intra-arterial Chemotherapy for Retinoblastoma study is for children with newly diagnosed stage 5 Retinoblastoma, which is a cancer of the retina, the membrane of the eye. By using selective ophthalmic artery injection of Melphalan, a chemotherapeutic agent, we can directly inject into the tumor to stop growth. The standard treatment would be enucleation (removal of the eye).
2. Selective Intra-arterial Chemotherapy in the treatment strategy of Metastatic Spine melanoma

Newly Diagnosed Brain Tumors

• Prospective, Multi-center Trial of NovoTTF-100A Together With Temozolomide Compared to Temozolomide Alone in Patients with Newly Diagnosed GBM.

  
  PI: Susan C. Pannullo, MD (212) 746-2438
  Email: scp2002@med.cornell.edu
  Funding: Novocure Ltd
  Status: Enrolling
  
  This is a study comparing the currently available treatments for subjects with Newly Diagnosed brain tumors and an investigative device NovoTTF-100A. NovoTTF-100A has shown some promises in prior studies in humans. Currently, people with Newly Diagnosed brain tumors are being treated with chemotherapeutic agents with very limited success. Previous studies in humans suggest increase time to disease progression and overall survival in brain tumor subjects treated with the new device NovoTTF-100A. This device works by sending alternating electric fields of low intensity which has shown to kill the cancer cells while not having other effects on muscle and brain tissues. Also due to the low intensity, heating is not seen. Subjects in the current trial would be assigned by chance to either the chemotherapy group or the Device group. Those assigned to the Chemotherapy group will receive the best standard of care available for their disease at the Center. If assigned to NovoTTF-100A the subject will be treated continuously for as long as their disease is stable or regressing in addition to standard therapy. Regardless of the group assigned, the subjects will be examined monthly and undergo routine laboratory examinations at the outpatient clinic. After the first progression, subjects on the device arm can continue with the investigative device in addition to alternative therapy. After the second progression subjects will return once per month for two more months for similar follow up examinations. After this follow up plan, subjects will be contacted by telephone to answer basic questions about their health status. It is our hope that this comparison will help us in developing better treatments for people affected by this terrible disease.

• PHASE I TRIAL OF SUPER-SELECTIVE INTRAARTERIAL INTRACRANIAL INFUSION OF AVASTIN (BEVACIZUMAB) FOR TREATMENT OF RELAPSED/REFRACTORY GLIOBLASTOMA MULTIFORME AND ANAPLASTIC ASTROCYTOMA.

  
  PI: John Boockvar, MD (212) 746-1996
  Email: jab2029@nyp.org
  Funding: Internal-Investigator Initiated
  Status: Enrolling
  
  Males or females, ≥18 years of age, with documented histologic diagnosis of relapsed or refractory glioblastoma multiforme (GBM), anaplastic astrocytoma (AA) or anaplastic mixed oligoastrocytoma (AOA). Subjects will be treated with a previously tested, dose and schedule of Mannitol prior to chemotherapy infusion (Mannitol 25%; 3-10 mL/s for 30seconds) in order to disrupt the blood brain barrier. Following blood brain barrier disruption the subject will receive an intracranial superselective intrarterial cathertization and infusion with Avastin¨ (Bevacizumab) starting at a dose of 2mg/kg (diluted in 150ml; n=3 subjects per dose) up to a dose of 10mg/kg over 30 minutes. Both hematologic and non-hematologic toxicity will be determined and scored according to the NCI Common Toxicity Criteria (version 2.0). Subjects will then receive the standard Intravenous administration of Avastin and CPT-11 regimen every 2 weeks after their one-time intraarterial therapy with a superselective infusion.. The subject will receive Intravenous (IV) bevacizumab 10 mg/kg and irinotecan (CPT-11) 125mg/m2 every 14 days as is standard therapy for relapsing recurring GBM. Monitoring will be conducted by post procedure CT scan (at 6-12 hours post procedure), serial history, neurological and physical examinations together with serial blood counts, prothrombin time (PT), partial thromboplastin time (PTT) and chemistries. MRI will be performed every two cycles or approximately every two months.

• PHASE I TRIAL OF SUPER-SELECTIVE INTRAARTERIAL INTRACRANIAL INFUSION OF TEMOZOLAMIDE (TEMODAR) FOR TREATMENT OF NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME AND ANAPLASTIC ASTROCYTOMA.

  
  PI: John Boockvar, MD (212) 746-1996
  Email: jab2029@nyp.org
  Funding: Internal- Investigator Initiated
  Status: Enrolling
  
  The current standard of care for newly diagnosed GBM is chemoradiation. The chemotherapy used is Temodar by mouth starting at 75mg/m2 up to 150mg/m2. Because of the blood brain barrier (BBB) where drugs do not penetrate the blood vessel walls well to get into the brain, no one knows for sure if these oral drugs actually get into the brain after infusion. Previous studies have shown that if you want to increase your penetration of drug to the brain, that intra-carotid artery (intraarterial) delivery is superior to standard intravenous or oral delivery. Previous techniques using intra arterial (intracarotid) infusion still were non-selective as drug delivery still went to all blood vessels in the brain, so patients still had significant adverse events, such as blindness. Newer techniques in interventional neuroradiology have allowed for a more selective delivery of catheters higher up into the arterial tree where agents such as chemotherapies, can be delivered without the risk of adverse affects such as blindness. In fact, studies here at Cornell and MSKCC have developed very new and exciting super selective intraarterial delivery treatment for Pediatric Eye Tumors with little toxicity and a clinical trial of intraarterial delivery of Avastin is currently underway for GBM. Therefore, this trial will ask one simple question: Is it safe to delivery a dose of Temozolamide intrarterially using these super selective delivery techniques instead of the standard oral route of administration? This should not only increase the amount of drug that gets to the tumor but also spare the subject any adverse effects from a less selective delivery. Prior to that single dose of intraarterial Temozolamide, the subject will also receive a dose of mannitol that opens up the blood brain barrier to improve delivery of the agent to the brain. After that single dose of Mannitol and Temozolamide intrarterially, the subject will be evaluated for 4 weeks to assess for toxicity. After this point, the subject is done with the Òexperimental" aspects of the protocol. If no toxicity at this point, then the subject will go on and get their oral maintenance Temozolomide chemotherapy. In summary, this is a Phase I trial that is designed to test the safety of a single dose of intraarterial delivery of Temozolamide , prior to starting the subject's oral maintenance Temozolamide.

• A Phase III Randomized, Double-Blind Study Comparing Human Corticotrophin-Releasing Factor (hCRF) to Dexamethasone for Control of Symptoms Associated with Peritumoral Brain Edema in Patients with Primary Malignant Glioma.

  
  PI: Susan C. Pannullo, MD (212) 746-2438
  Email: scp2002@med.cornell.edu
  Funding: Celtic Pharma
  Status: Closed to enrollment

• The Effect of Meditation and Guided Imagery on Quality of Life in Brain Tumor Patients.

  
  PI: Susan C. Pannullo, MD (212) 746-2438
  Email: scp2002@med.cornell.edu
  Funding: Connecticut Brain Tumor Alliance, B.R.A.I.N. (partial)
  Status: IRB approved, awaiting completion of funding

• PHASE I TRIAL OF SUPER-SELECTIVE INTRAARTERIAL INTRACRANIAL INFUSION OF ERBITUX (CETUXIMAB) FOR TREATMENT OF RELAPSED/REFRACTORY GLIOBLASTOMA MULTIFORME AND ANAPLASTIC ASTROCYTOMA.

  
  PI: John Boockvar, MD (212) 746-1996
  Email: jab2029@nyp.org
  Funding: Internal- Investigator Initiated
  Status: Enrolling
  
  There is no current standard of care for recurring GBM after patients receive Bevacizumab (Avastin) intravenously (IV) at 10mg/kg with CPT-11 (Irinotecan). At that point, these patients are deemed treatment failures and are given another experimental treatment. Because of the blood brain barrier (BBB) where IV drugs do not penetrate the blood vessel walls well to get into the brain, no one knows for sure if these IV drugs actually get into the brain after infusion. Previous studies have shown that if you want to increase your penetration of drug to the brain, that intra-carotid artery (intraarterial) delivery is superior to standard intravenous delivery. Previous techniques using intra arterial (intracarotid) infusion still were non-selective as drug delivery still went to all blood vessels in the brain, so patients still had significant adverse events, such as blindness. Newer techniques in interventional neuroradiology have allowed for a more selective delivery of catheters higher up into the arterial tree where agents such as chemotherapies, can be delivered without the risk of adverse affects such as blindness. In fact, studies here at Cornell and MSKCC have developed very new and exciting super selective intraarterial delivery treatment for Pediatric Eye Tumors with little toxicity and a clinical trial of intraarterial delivery of Avastin is currently underway for GBM. Therefore, this trial will ask one simple question: Is it safe to delivery a dose of Cetuximab intrarterially using these super selective delivery techniques instead of the standard intravenous route of administration? This should not only increase the amount of drug that gets to the tumor but also spare the patient any adverse effects from a less selective delivery. Prior to that single dose of intraarterial Cetuximab, the patient will also receive a dose of mannitol that opens up the blood brain barrier to improve delivery of the agent to the brain. After that single dose of Mannitol and Cetuximab intrarterially, the patient will be evaluated for 4 weeks to assess for toxicity. After this point, the patient ise done with the Òexperimental" aspects of the protocol. If no toxicity at this point, then the patient will go on and get their chosen chemotherapy as determined by their treating oncologist. In summary, this is a Phase I trial that is designed to test the safety of a single dose of intraarterial delivery of Mannitol and Cetuximab , prior to starting the patients next round of chosen chemotherapy.

• PHASE I/II TRIAL OF INTRAVENTRICULAR BEVACIZUMAB (AVASTIN) FOR TREATMENT OF LEPTOMENINGEAL METASTASIC DISEASE (NEOPLASTIC MENINGITIS).

  
  PI: John Boockvar, MD (212) 746-1996
  Email: jab2029@nyp.org
  Funding: Internal- Investigator Initiated
  Status: Pending IRB

• PHASE I TRIAL OF SUPER-SELECTIVE INTRAARTERIAL INTRACRANIAL INFUSION OF AVASTIN (BEVACIZUMAB) FOR TREATMENT OF VESTIBUAR SCHWANNOMA

  
  PI: John Boockvar, MD (212) 746-1996
  Email: jab2029@nyp.org
  Funding: Internal- Investigator Initiated
  Status: Pending IRB
  
  This trial will ask one simple question: Is it safe to deliver a subject's first dose of Avastin intrarterially using these super selective delivery techniques instead of the standard intravenous route of administration? This should not only increase the amount of drug that gets to the VS but also spare the subjectt any adverse effects from a less selective delivery. During that single dose of intraarterial Avastin, the subject will also receive a dose of mannitol that opens up the blood brain barrier to improve delivery of the agent to the brain. After that single dose of Mannitol and Avastin intrarterially, the subject will be evaluated for 4 weeks to assess for toxicity. If no toxicity, then the subject will go on and get MRI of the brain every two months to assess for response up to 12 months. After this he/she is done with the "experimental" aspects of the protocol. This is a Phase I trial that is designed to test the safety of the single dose intraarterial delivery of Avastin and Mannitol.

• Treatment of Newly Diagnosed, High-Grade, Malignant Glioma with Polifeprosan 20 Containing Carmustine Implant (Gliadel® Wafer) Using MR Spectroscopy (MRS) Data as a Primary Indicator of Therapeutic Response.

  
  PI: Susan C. Pannullo, MD (212) 746-2438
  Email: scp2002@med.cornell.edu
  Status: Enrolling
  
  The purpose of this research protocol is to examine the changes that occur on contrast enhanced MRI with MRS in patients given Gliadel® wafers, to determine if MRI with MRS can predict whether the tumor will respond to the therapy or not.

• A Phase II, Multicenter, Exploratory Study, Evaluating the Treatment Effect of Surgery Plus Gliadel Wafer in Patients with Metastatic Brain Cancer.

  
  PI: Susan C. Pannullo, MD (212) 746-2438
  Email: scp2002@med.cornell.edu
  Status: Enrolling
  
  The primary objective is to evaluate the effect of the surgical intervention and insertion of Gliadel wafers on the neurocognitive functioning in patients with metastatic brain cancer. Additional objectives include: evaluating the local recurrence rate of metastatic brain tumors, evaluating correlative science in metastatic lesions to the brain, determining the rate of neurological death defined as death attributable to the progression of neurological disease, determining the clinical significance (if any) of locally recurrent brain metastasis at the time of their occurrence (mass effect, cognitive functioning other symptoms) post treatment, and determining the time to and severity of neurocognitive decline in patients treated with Gliadel.

• A Phase III Randomized Study of the Neuradiab in combination with External Beam Radiation and Temozolomide versus External Beam Radiation and Temozolomide in patients with newly diagnosed Glioblastoma Multiforme.

  
  PI: Susan C. Pannullo, MD (212) 746-2438
  Email: scp2002@med.cornell.edu
  Status: Closed
  
  To determine whether the addition of Neuradiab to a standard regimen of surgery, radiation and chemotherapy will result in significant improvement in overall median survival in subjects with newly diagnosed Glioblastoma multiforme (GBM). The secondary objectives include progression-free survival rates and safety evaluation.

• A Phase II/III Randomized Study of CDX-110 with Radiation and Temozolomide in Patients with Newly Diagnosed Glioblastoma Multiforme.

  
  PI: Theodore H. Schwartz, MD (212) 746-5620
  Email: schwarh@med.cornell.edu
  Status: Closed to Enrollment
  
  This study is an open-label, randomized, controlled, 2-arm, 2:1 (vaccine-CDX-110: control), multicenter evaluation of CDX-110 in patients newly diagnosed with glioblastoma multiforme (GBM). The study is designed as a Phase II/III study and will be conducted in two stages. The primary objective of Phase II is to evaluate the clinical activity of CDX-110, defined as an increase in progression-free survival (PFS) at 6 months from study day 0 for the CDX-110 treated patients as compared to the control patients. Other objectives Phase II include: establishing the safety and tolerability profile(s) of the CDX-110 vaccination schedule in these patients, and assessing humoral and cellular immune responses during different stages of therapy to explore the overall immunogenicity of the vaccine as well as any interactions with steroid dosing and maintenance temozolomide. If adequate PFS benefit is observed in patients during Phase II, the study will continue to Phase III. The primary objective for Phase III is to evaluate the clinical efficacy of CDX-110 by assessing median overall survival. Secondary objectives for Phase III include assessing progression-free survival and establishing the safety and tolerability profile(s) of the CDX-110 vaccination schedule(s) in these patients.

• Phase II Trial of Continuous Dose Temozolomide in Patients with Newly Diagnosed Anaplastic Oligodendroglioma and Mixed Oligoastrocytoma (Multicenter Trial with Cleveland Clinic) 2003-2005

  
  PI: Susan C. Pannullo, MD (212) 746-2438
  Email: scp2002@med.cornell.edu
  Status: Closed to enrollment
  
  The primary objective of this trial is to determine if the drug, Temozolomide, is effective for the treatment of anaplastic oligodendroglioma and mixed Oligoastrocytoma brain tumors. Temozolomide is approved for the treatment of anaplastic astrocytoma, a similar brain tumor and is commercially available. It is usually given by mouth for 5 days in a row, on a monthly basis. Studies show that this drug may have fewer side effects associated with it than other types of therapies available to treat this disease. The purpose of this study is to see if these tumors respond to a different way of giving the drug and to measure how long the response lasts. Another goal of the study is to see if radiation therapy, the usual way of treating this type of tumor, can be delayed because of the way patients might respond to the Temozolomide. The secondary objective is to assess the quality of life in this patient population using validated quality of life instruments.

Recurrent Brain Tumor Studies

• Superselective Intraarterial Cerebral Infusion of Bevacizumab (Avastin) for recurrent Malignant Glioma.

  
  Principle Investigator: John A. Boockvar, MD; Howard Riina, MD
  Email: jab2029@nyp.org
  Status: Enrolling
  
  This trial is a Phase I trial designed to test the hypothesis that selective intraarterial infusion of Avastin (an antibody to VEGF) directly into the brain tumor is not only safe but effective in the treatment of either Glioblastoma Multiforme and Anaplastic Astrocytoma. Prior to starting standard intravenous (IV) Avastin, a patient will get a dose of Intraarterial Avastin directly into the brain at the tumor location. This is done via a cerebral angiogram using Interventional Neuroradiology. More information on the trial is available at ClinicalTrials.gov at http://clinicaltrials.gov/ct2/show/NCT00968240.

• Superselective Intraarterial Cerebral Infusion of Cetuximab (Erbitux) for recurrent Malignant Glioma.

  
  Principle Investigator: John A. Boockvar, MD
  Email: jab2029@nyp.org
  Status: Pending IRB Approvel
  
  This trial is a Phase I trial designed to test the hypothesis that selective intraarterial infusion of Cetuximab directly into the brain tumor is not only safe but effective in the treatment of either Glioblastoma Multiforme and Anaplastic Astrocytoma. Prior to starting there next round of chemotherapy, a patient will get a dose of Intraarterial Cetuximab directly into the brain at the tumor location. This is done via a cerebral angiogram using Interventional Neuroradiology. More information on the trial is available at ClinicalTrials.gov.

• Intrathecal Infusion of Bevacizumab (Avastin) for Neoplastic Meningitis (Leptomeningeal Disease)

  
  Principle Investigator: John A. Boockvar, MD
  Email: jab2029@nyp.org
  Status: Pending
  
  This trial is a Phase I trial designed to test the hypothesis that Intrathecal infusion of Avastin (an antibody to VEGF) directly into the spinal fluid via an Ommaya Reservoir is not only safe but effective in the treatment of either Neoplastic Meningitis or Leptomeningeal spread of cancer. Prior to starting standard chemotherapy, a patient will get a dose of Intrathecal Avastin directly into the spinal fluid via an Ommaya Reservoir. More information on the trial is available at ClinicalTrials.gov.

• Phase I/II Trial of Erlotinib (Tarceva, OSI-774) for Treatment of Relapsed/Refractory Glioblastoma Multiforme and Anaplastic Astrocytoma Description

  
  Principal Investigator: John Boockvar, MD
  Email: jab2029@nyp.org
  Status: Enrolling
  
  This study investigates the use of the drug, Erlotinib (Tarceva), in the treatment of recurrent glioblastoma and anaplastic astrocytoma. Erlotinib belongs to a class of drugs called epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors. Erlotinib is approved for treatment of non-small cell lung cancer. A percentage of malignant brain tumors, such as glioblastoma multiforme and anaplastic astrocytoma, express EGFR and therefore, by inhibiting this receptor, we predict that we may be able to slow or arrest the growth of tumor. Previous studies using Erlotinib for malignant brain tumors have been performed at other institutions. Results of these studies indicate that Erlotinib is safe to use in patients with brain tumors and may also have anti-tumor effects. The specific objective is to determine the safety and effectiveness (rate of response and patient survival time) to oral Erlotinib in patients with and without the EGFRvIII and PTEN brain tumor mutation and to assess quality of life and survival.

• A Prospective, Multi-Center Trial of NovoTTF-100A Compared to Best Standard of Care in Patients with Progressive or Recurrent GBM.

  
  Principal Investigator: Susan C. Pannullo, MD
  Email: jab2029@nyp.org
  Status: Closed to Enrollment
  
  This is a study comparing the currently available treatments for subjects with recurring brain tumors and an investigative device NovoTTF-100A. NovoTTF-100A has shown some promise in prior studies in humans. Previous studies in humans suggest increased time to disease progression and overall survival in brain tumor subjects treated with the new device NovoTTF-100A. This device works by sending alternating electric fields of low intensity which has shown to kill the cancer cells while not having other effects on muscle and brain tissues. Subjects in the current trial would be assigned by chance to either the Chemotherapy group or the Device group. Those assigned to the Chemotherapy group will receive the best standard of care available for their disease at the Center. If assigned to NovoTTF-100A the subject will be treated continuously for as long as their disease is stable or regressing. Regardless of the group assigned, the subjects will be examined monthly and undergo routine laboratory examinations at the outpatient clinic. After progression, subjects will return once per month for two more months for similar follow up examinations. After this follow up plan, subjects will be contacted by telephone to answer basic questions about their health status.

Spine Surgery

Minimally invasive spinal fusion using transforaminal interbody fusion with unilateral pedicle screws and BMP for the treatment of single level degenerative disc disease. This study, led by Dr. John A. Boockvar, Assistant Professor of Neurosurgery, seeks to evaluate the clinical outcomes in patients who undergo this procedure. The outcome parameters studied include clinical outcome, fusion rates, hospital stay, operative time, complications, and economic costs.

Movement Disorders

Gene Therapy

The Department is conducting the first-ever cinical trial involving gene therapy to treat Parkinson's Disease. This promising technology has the potential to revolutionize our approach to treating a whole range of neurological disorders. Principal Investigator: Michael G. Kaplitt, M.D., Ph.D.

Deep Brain Stimulation (DBS)

We are also conducting a series of clinical trials in order to expand the medical benefits of Deep Brain Stimulation (DBS) to a greater variety of neurological disorders. The Department's Laboratory of Molecular Neurosurgery actively investigates the effects of DBS on brain cell biology and is developing molecular techniques to improve our understanding and treatment of neurodegenerative disorders. Principal Investigator: Michael G. Kaplitt, M.D., Ph.D.

Epilepsy

At the Comprehensive Epilepsy Center, not only are we dedicated the treatment of epilepsy using the latest state-of-the-art medication and surgical techniques, but we have several NIH- and privately-funded laboratories pursuing novel treatments and increasing our understanding of the pathophysiology of epilepsy.

Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy

The thalamus makes electrical connections with many parts of the brain, and stimulation there may oppose a patient's epilepsy and reduce seizures. Thalamic stimulation is already in use to treat tremor and stimulation of a nearby brain region, the subthalamic nucleus, is now being used to treat Parkinson's disease. For stimulation of the anterior nucleus of the thalamus, the stimulating electrodes are surgically placed through dime-sized holes in the top of the skull, and are connected to a battery pack in the chest by thin wires that run under the skin. Patients with brain stimulators still take antiepileptic medications. However, rather than coming to their doctor for medication prescription changes, patients in the stimulation of the anterior nucleus of the thalamus study come to get their stimulator settings reprogrammed with a magnetic device that the treating doctor uses to send information through the skin.

Responsive Brain Stimulation for Epilepsy

Responsive brain stimulation functions by delivering a counter-shock to the seizure source in the brain at the moment a seizure starts. This is thought to interrupt the seizure and stop it before it spreads and becomes severe. The responsive brain stimulator employs a small battery-operated computer that is surgically implanted in the skull to detect the abnormal brain electrical activity that represents a seizure. This tiny computer is connected with thin wires to an electrode implanted in the brain at the seizure source. When the device detects a seizure, it immediately sends a counter-shock to block it. Patients with brain stimulators still take antiepileptic medications. However, rather than coming to their doctor for medication prescription changes, patients in the responsive brain stimulator study come to get their stimulator settings reprogrammed with a magnetic device that the treating doctor uses to send information through the skin. For more information on stimulation of the anterior nucleus of the thalamus, the responsive brain stimulator study, or other new epilepsy treatments available at New-York Presbyterian Hospital/Weill Cornell Medical Center, please contact the Comprehensive Epilepsy Center.

Optical imaging of intrinsic signals in vivo

In the past few years, researchers have learned that neuronal activity can be recorded optically by measuring small changes in the reflectance of light on the surface of the brain. Using this technique, Dr. Theodore Schwartz has pioneered the ability to monitor the initiation and spread of epilepsy on the surface of the brain with a sensitive camera. These "epilepsy movies" provide the ability to map an epileptic focus with incredible spatial and temporal resolution. Researchers at Weill Medical College are currently using these techniques in the laboratory to provide a greater understanding of epilepsy and implement novel techniques that may someday offer a cure for more patients with epilepsy. The use of optical imaging techniques in humans is another exciting project, which we are undertaking to map epileptic foci in the operating room prior to epilepsy surgery. Human epilepsy movies will demonstrate epileptic foci with greater resolution than is currently available and increase the efficacy of our surgical treatments.

Optical imaging of calcium dynamic in vitro

In collaboration with Dr. Rafael Yuste at Columbia University, Dr. Schwartz's laboratory is using fluorescence imaging to monitor small changes in calcium concentration in hundreds of cells simultaneously during epileptic events. With this technique, investigators can monitor the exact cells where a seizure begins and where they spread and then identify and characterize these cells. Novel therapies based on cell-specific markers and immunotoxins can then be developed to treat epilepsy.