Inauguration of State-of-the-Art 12-Bed Epilepsy Monitoring Unit at Oishei Children’s Hospital

With the move to Oishei Children's Hospital on the Buffalo Niagara Medical Campus, the Epilepsy Monitoring Unit (EMU) has expanded to 12 large, spacious rooms dedicated to patients with epilepsy. The EMU is located on the 12th floor and boasts beautiful views of lake Erie and the Buffalo skyline.  Rooms feature an additional bed for caregivers and two televisions - one for the patient and one for the caregiver.  

Expansion of Epilepsy Surgery Program

Jonathan Riley, MD has joined the faculty of UBMD Neurosurgery, spearheading the functional neurosurgery and adult epilepsy program. Dr. Riley has vast experience with novel procedures in epilepsy surgery, including stereotactic placement of s EEG electrodes for presurgcial evaluation of epilepsy surgery, placement of subdural electrodes, implantation of RNS (NeuroPace) and laser guided ablation therapy. These procedures have already begun at Kaleida Health. Many patients with refractory epilepsy are not candidates for these procedures. 

SEEG (Stereotactic EEG)

Over the last years, a novel diagnostic technique of stereotactic EEG (SEEG) evaluation for patients with refractory epilepsy has been in place in advanced comprehensive epilepsy centers.  The procedure is typically performed after the patient completes a comprehensive evaluation including video EEG monitoring, high resolution brain MRI, neuropsychological testing and PET scan.  In many such cases, the epileptogenic regions remain uncertain and additional evaluation is needed to allow for epilepsy surgery. The placement of SEEG electrodes is well tolerated and has a low rate of complications.  This technique is also more accurate as it allows recording on the surface as well as of on deep structures of the brain. The SEEG procedure consist of placements of stereotactic EEG electrodes in different brain regions.  The placement of these electrodes can be performed by using  a robotic arm or under a stereotactic frame. About 10-20 such electrodes are placed at different brain regions.

The results of SEEG evaluation will allow in the majority of cases, to pursue epilepsy surgery: whether craniotomy for cortical resection, laser guided ablation, NeuroPace implantation or VNS.

We have identified many patients that are candidates for this procedure within our program, and we believe there are many such patients in the community that can be referred for SEEG evaluation and that could benefit from SEEG.

Click here for more information on SEEG. 

Laser Ablation

laser ablationKaleida Health is pleased to offer our epilepsy patients the leading technologic advancements in epilepsy surgery, including Visualase. Visualase is a laser therapy that can be utilized in patients who have a localized abnormality in the brain suspected as the source of their seizure activity. The laser is introduced through a very small incision making it minimally invasive. Using real time MRI scanning to monitor the procedure, the laser is able to heat and destroy the targeted brain tissue and minimize the risk to the surrounding healthy brain tissue. Over 1,000 procedures have been performed nationwide with encouraging initial results for conditions such as mesial temporal sclerosis, cortical dyplasias, tuberous sclerosis, hypothalamic hamartomas and more. This minimally invasive technique typically allows for shorter hospital stays, lower infectious risks, minimal cosmetic changes and quicker recovery times for those who are candidates. Dr. Renee Reynolds, Pediatric Neurosurgeon at Oishei Children’s Hospital has expertise in Visualase and has performed several laser ablations on patients throughout Western New York.

NeuroPace (RNS)

Some patients with focal epilepsy and refractory seizures cannot undergo epilepsy surgery when the seizure focus is located adjacent to important cortical function, such as speech and language. Performing surgeries in such cases would cause unwanted neurological deficits. Other patients may have epilepsy arising from both temporal lobes (bi-temporal epilepsy), and cannot benefit from surgery. In such cases, an additional option to relieve seizures consist of placement of NeuroPace leads adjacent to a seizure focus and a pacemaker-like device in the skull. When a seizure is recognized, the pacemaker will be activated and “fire back” at the seizure focus, and by this abort the seizure.

Click here for more information on NeuroPace.

Components and programming of the NeuroPace RNS.
Thomas, George P. and Jobst, Barbara C.  Medical Devices: Evidence and Research. Critical review of the responsive neurostimulator system for epilepsy.  2015; 8: 405–411.

Components and programming of the NeuroPace RNS.

Notes: (A) The RNS on skull X-ray. (B) Example of a bilateral hippocampal implantation. (C) Interrogation of the device with the wireless wand and the programmer. (D) ECoG and time-frequency analysis from the device with detection of an epileptic seizure and stimulation delivered (vertical lines).

Abbreviations: ECoG, electrocorticogram; FFT, fast Fourier transform; RNS, responsive neurostimulator.

 

RNS stimulator with depth and surface electrodes.
Thomas, George P. and Jobst, Barbara C.  Medical Devices: Evidence and Research. Critical review of the responsive neurostimulator system for epilepsy.  2015; 8: 405–411.

RNS stimulator with depth and surface electrodes.

Notes: Example of a patient with both neocortical surface electrodes and hippocampal depth electrodes.

Abbreviation: RNS, responsive neurostimulator.

$1 Million Gift Will Establish the James H. Cummings Foundation Epilepsy Monitoring Center

A $1 million gift to establish a 12-bed state-of-the-art Epilepsy Monitoring Unit at the James H. Cummings Foundation Epilepsy Monitoring Center at Oishei Children’s Hospital was presented at Women & Children’s Hospital of Buffalo.

"The James H. Cummings Foundation believes that ‘having a state-of-the-art hospital focused on children's and adult's needs is critical to our community”. The new hospital being located on the medical campus will bring a tremendous opportunity for the medical community and higher education to collaborate in ways we can't even imagine today,” stated Charles F. Kreiner, Jr., president of the James H. Cummings Foundation.

Read more

Medical Marijuana

Cannabidiol (CBD) is the most abundant non-psychoactive cannabinoid in cannabis.  The Investigational Medicinal Product (IMP) is formulated from extracts from the Cannabis sativa L. plants that have a defined chemical profile and contain consistent levels of CBD as the main phytocannabinoid. Animal studies have demonstrated anticonvulsant efficacy in multiple species and models.  Anecdotal reports and recent open label reports have suggested  CBD to be effective in children with treatment-resistant epilepsies, especially Dravet syndrome. An open label study found  CBD to have a promising efficacy and safety profile in children with a variety of epilepsy syndromes.  Children and young adults with Dravet syndrome appeared to have the greatest reduction in seizures, but atonic seizures also respond well. 

We have started participation in  multi-center double blind placebo controlled adjunctive therapy studies with CBD for patients with Lennox Gastaut and Dravet Syndrome.

We look forward to continue our research utilizing CBD in our efforts to help patients with refractory seizures.

For more information on cannabidiol use for treatment in patients with Dravet Syndrome and Lennox-Gastaut Syndrome, please read the following two articles from the New England Journal of Medicine:

Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome

Effect of Cannabidiol on Drop Seizures in the Lennox–Gastaut Syndrome

Service Parent