Our Level 4 comprehensive Epilepsy program serves patients with seizures, especially when there are difficult diagnostic questions, and/or the seizures are refractory to treatment with medications. Patients may be referred for consultation on diagnosis and management, or directly to the EEG laboratory for ambulatory EEG or video EEG monitoring.
Mechanisms of sensory coding in the olfactory system; seizure mechanisms in hippocampal slices; optical imaging techniques.
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Determination of the Functional Status of the Human Olfactory Epithelium with Optical Electrophysiological Techniques. With D. Kurtz, T. White, P. Emko and D. Leopold.
One theme central to our work is understanding olfactory dysfunction at both more central and peripheral levels. To this end, psychophysical instruments and MR imaging techniques will be developed. Unfortunately, evaluation of olfactory dysfunction at the site of initial transduction at the mucosal level is by inference only. Currently, we evaluate the mucosa with olfactory biopsies and through direct visualization with endoscopy. Olfactory biopsies provide limited information because of their inherent nature of sampling a small area of the mucosa that may not reflect the over-all pathology. Traditional endoscopy may reveal gross anatomical features, but tells nothing of function. A technique that could monitor the initial olfactory transduction events across a large portion of the mucosa may shed light on both basic mechanisms of olfactory function and dysfunction. Functional optical imaging, coupled with video technology, offers such a possibility. The major objective is, therefore, to develop a high resolution, odor induced, functional map of in vivo human olfactory mucosa using an intrinsic reflection signal. Besides shedding light on olfactory function and dysfunction, functional imaging of the olfactory mucosa will help direct olfactory biopsies and guide surgery for patients with phantosmia.
Determination of Olfactory Coding Mechanisms Using Optical Recording Techniques. With M. Mozell, S. Youngentob and D. Hornung.
The aim of our project is to test the hypothesis that odorant-specific mucosal activity patterns are projected to the bulb and to behavior in some orderly fashion and so serve as the basis for olfactory discrimination. The overall strategy is first to document conditions that vary the mucosal activity patterns and then, using these conditions, determine: 1) how these changes in the mucosal patterns project, if at all, as activity changes in the bulb, and 2) how these changes in activity patterns at both the mucosal and bulbar levels affect, if at all, the animal''s ability to discriminate behaviorally among the odorants. Four different approaches will be used to change the spatial activity patterns across the mucosa.
One approach will be to mix two odorants in stepwise proportions expecting the mucosal activity pattern to change from that given by one odorant alone to that given by the other odorant alone. In a second approach a given odorant''s mucosal activity pattern will be altered by adapting the receptors to the same and different odorants. In the third approach, odorants in homologous series will be presented in systematic increments expecting the mucosal activity patterns to change. In the final approach, a given odorant''s mucosal activity pattern will be altered by changing the odorant''s flow rate, flow path and flow direction through the nasal cavity. These various alterations in mucosal patterns were chosen so as to give a comprehensive evaluation of whether the odorant-specific activity patterns at the mucosa and the bulb are related in some systematic fashion to each other and to determine, at long last, whether these activity patterns play a significant role in the neural encoding of different odorants. A breakdown in this coding process could likely play a pivotal role in a number of human olfactory dysfunctions.
Kent, P.F., Mozell, M.M., Youngentob, S.L.., Yurco, P.J. Mucosal activity patterns as a basis for olfactory discrimination: comparing behavior and optical recordings. Brain Res; 981(1-2):1-11, 2003 Aug 15.
White, T.L, Kent, P.F., Kurtz,D.B., and Emko, E. Gabapentin (Neurotin) as an Effective Treatment for Burning Mouth Syndrome. Archives of Otolaryngology-Head & Neck Surgery. 2004 Jun;130(6):786-8.
At the Epilepsy Monitoring Unit at University Hospital we perform video-EEG monitoring where a patient's behavior and EEG are recorded simultaneously. This is essential for localizing the origin of seizure discharges in the brain in patients being evaluated for neurosurgical removal of epileptic foci. It is also indispensable for evaluating the type of epileptic seizures to ensure proper treatment, and in identifying non epileptic seizures.
The program provides the full range of surgical interventions including localization and removal of the epileptic focus, multiple subpial transection for foci in essential brain areas, as well as vagus nerve stimulation, when resective surgery is not an option. Patients who meet the criteria for surgical therapy, and wish to have it, are evaluated by our program's adult and pediatric epilepsy neurosurgeons.
Program physicians also participate in experimental trials of new drugs and treatments; such as the gamma knife. Patients are seen at the University Health Care Center, a few blocks from University Hospital.