Biomedical Frontiers: Winter 1995, Vol.2, No.2
Columbia's Comprehensive Epilepsy Center

At birth, Morgan Earle of Chatham, N.J., started suffering from seizures. Doctors couldn't identify their cause, but medications kept them under control. Until last April. The drugs stopped working. Four-year-old Morgan started having 100 seizures every day. She couldn't talk or eat.

In May, Comprehensive Epilepsy Center physicians, PET center radiologists, and Columbia-Presbyterian Medical Center neurosurgeons finally discovered the problem in Morgan's brain. Later in May, a 15-hour operation removed the abnormally formed region. Today, except for being a cover girl for a medical newsletter, Morgan has a typical life of someone her age and is the best student in her pre-kindergarten class.

In the New York City metropolitan area another 100,000 to 200,000 people have epilepsy. Of these, 65,000 do not have the disorder under control: Around 20,000 of these may be suitable for surgery; the other 45,000 are candidates for new epileptic drugs.

The goal of the Comprehensive Epilepsy Center at Columbia-Presbyterian Medical Center is to provide multidisciplinary diagnostic and treatment services to as many patients with uncontrollable seizures in the region as possible. It is one of five centers in the area approved by New York State to offer comprehensive epilepsy treatment. Columbia's strength-ties to Presbyterian Hospital and Neurological Institute clinical services and to the University's basic neuroscience laboratories.

The 4-year-old center serves adults and children and provides a wide range of services. Because epilepsy is group of disorders whose causes, symptoms, and consequences vary, professional staff include neurologists, pediatric neurologists, neurosurgeons, neuropsychologists, neuropsychiatrists, nurse clinicians, social workers, and EEG technologists-all with expertise in epilepsy.

The center also works with community physicians and other hospitals. "We prefer that patients get their regular care in their own communities and that we only intervene at critical points with the cooperation and approval of the referring physician," says Dr. Timothy Pedley, CEC director.

When patients are admitted to the Center's Monitoring Unit, physicians induce seizures under carefully controlled conditions to make a definitive diagnosis and develop individual plans of management. Seizure induction is necessary because patients rarely have seizures when they come for an office visit.

Services the center provides include establishing a definitive diagnosis in patients with paroxysmal symptoms of uncertain cause; diagnosing and treating psychologically based seizures; monitoring antiepileptic drugs and their metabolites in relation to seizure occurrence, other drugs, and other factors; conducting clinical trials of investigational new drugs including felbamate and topiramate; identifying patients with medically refractory seizures for surgical treatment; localizing the site of the epileptic regions in the brain; and offering a full range of rehabilitation and psychosocial services. Imaging facilities at Columbia-Presbyterian Medical Center include CT, MRI, PET, SPECT, and a new 5 Tesla MRI now under construction. CPMC is one of only two medical centers in the country to have both PET and high field MRI.

The Center admits about 225 patients each year and follows 2,750 on an outpatient basis. Dr. Pedley says, "There has been modest growth in accrual over the years, but because of the multidisciplinary and tailored nature of treatment, we can only accommodate a small increase in new patients in the future."