Epilepsy - Sleep - Clinical Neurophysiology

Duke University Medical Center has been at the forefront in the development and application of both medical and surgical treatments for epilepsy in the past 30 years. Duke was the first medical center in the Southeast to utilize intracerebral electrode implantation to determine the location of seizure onset. Surgical treatment for uncontrolled epilepsy has been available at Duke since 1961. There has been a similar period of basic science effort funded by the National Institutes of Health (NIH) to investigate the pathophysiologic mechanisms and genetics of epilepsy. The expertise at Duke in the evaluation and treatment of epilepsy has evolved with advances in technology, such that epilepsy surgery is now available for many patients. There is a long history of high level of seizure relief and low level of complications of the surgical approach at Duke which has been documented in the scientific literature (Neurology (1990) 40:413-419, Neurology (1993) 43:1088-1092, Radiology (1993) 189:835-842, and Annals of Neurology (1994), In Press).

The staff at DUMC includes adult and pediatric Neurologists and Neurosurgeons, Neuroradiologists, nurses, and technologists. Duke is privileged to have on its staff physicians who are leaders in national and international epilepsy groups, including the past president of the American Epilepsy Society. The inpatient Epilepsy service is available for the presurgical evaluation of medically intractable epilepsy, as well as the characterization of spells or seizure type using long-term video-EEG monitoring. Residents and Fellows participate in the management and care of these patients. In addition to the video-EEG monitoring, presurgical (Phase I) work-ups typically include prolonged sleep-deprived EEG recording for epileptiform activity localization and quantification, high resolution MRI of the brain using Fast-Spin Echo techniques for evaluation of mesial temporal sclerosis, PET of the brain for interictal temporal lobe hypometabolism, SPECT for comparison of interictal and ictal cerebral blood flow, neuropsychological testing, and intracarotid amobarbital (Wada) for lateralization of language and memory function. Should invasive (Phase II) monitoring be necessary, depth electrodes, subdural strip or grid array electrodes, or peg electrodes are utilized as needed. Surgical treatment includes lobectomy, lesionectomy, corticectomy, hemi-spherectomy, or corpus callosotomy. An Epilepsy conference is held twice a week for data presentation and to recommend site and type of surgery, or additional invasive monitoring using intracranial electrodes, if indicated.

For more information on Epilepsy, call the Epilepsy Foundation of North Carolina at (800) 451-0694.

Comprehensive Epilepsy Clinic
There is a separate Comprehensive Epilepsy Clinic at Duke that meets weekly and includes staff Epileptologist, Clinical Neurophysiology Fellows, and the resident on the EEG rotation. Senior residents may also request an elective rotation by arrangement. There is also an Epilepsy Clinic at the Durham VA Hospital that meets twice a month, alternating weeks with Duke Epilepsy Clinic. This clinic is staffed by Epileptologists, Clinical Neurophysiology Fellows, and the Duke residents on rotation at the VA Hospital. New patients at both clinics are evaluated for medical and surgical therapy for intractable seizures, as well as characterization of spells which may be epileptic or nonepileptic in origin.

Sleep Disorders Center
The Sleep Disorders Center at Duke is comprised of staff Neurologists, Psychiatrists, Clinical Psychologists, and Clinical Neurophysiology Fellows. Outpatient clinics are held twice a week, and evaluate patients with all forms of sleep disorders, including dyssomnias (e.g. obstructive sleep apnea, narcolepsy, etc.), para-somnias (e.g. sleep terrors, REM sleep behavior disorder, etc.) and sleep disorders associated with medical or psychological disorders (e.g. neurodegenerative diseases, substance abuse, depression, etc.). Senior residents may request an elective rotation by arrangement.

Sleep laboratory evaluations are carried out via traditional in-lab overnight polysomnography or out-patient ambulatory cassette recording. In-lab recordings focus primarily on evaluation of nocturnal respiratory dysrhythmias and measure EEG, axial and limb EMG, electro-oculogram (EOG), ECG, oxygen saturation, airflow and respiratory effort, and video monitoring. Ambulatory studies focus primarily on sleep stage (EEG, EMG, EOG), as well as leg movements and single measure of airflow, and predominately evaluate patients with insomnia. Multiple sleep latency testing and vigilance testing are also performed at the Duke Sleep Disorders Center.

Electroencephalography is performed at Duke North Hospital and is available on an emergency basis. EEG's are also done at the Durham VA on weekdays. Evoked potentials are performed at Duke North Hospital and also used for operative monitoring (BAER, SSEP). Residents, fellows, and attendings participate in the performance and interpretation of all studies. There were 1881 EEG's, 616 evoked potentials, and 712 overnight sleep studies done in 1999 at Duke. There were 631 EEG lab studies at the Durham VA Hospital. Central Neurophysiology/Epilepsy Fellowships are available for one and two year slots. Research opportunities are also available.

Adult:

Aatif Husain, M.D.
James O. McNamara, M.D.
Rodney A. Radtke, M.D.
Kevan Vanlandingham, M.D., Ph.D.

Pediatric: Darrell V. Lewis, M.D.