The Epilepsy and Brain Mapping Program operates a large research laboratory designed to enhance patient care by developing new non-invasive diagnostic technologies for identifying more accurately where seizures originate in the brain by creating a virtual 3D map of the brain's activity. With a detailed description of the seizure, a history highlighting etiological factors, a neurological exam and diagnostic imaging recordings, our physicians are better able to determine the best therapy and/or treatment option.
Through our collaborative efforts with Huntington Medical Research Institutes, California Institute of Technology and NASA JPL, scientists, physicians and technologists coregister all functional and anatomical information with our Stereotactic Laboratory. The Lab uses a Leksell Frame coordinates for precise 3D imaging of the entire brain. Volumetric MRI, PET, SPECT, and Digital Subtraction Angiography (DSA) anatomical data are combined on a Silicon Graphics Imaging (SGI) computer for rapid, comprehensive correlation. The Lab also uses EEG with 100 channel Brain Mapping to localize eloquent brain regions and areas of damaged and epileptic tissue for correlation with anatomical information in the SGI.
In addition, the Magnetoencephalography (MEG) Unit provides passive recordings measuring the magnetic energy which emanates from the brain. MEG and EEG recording measure neural activity more precisely. The EEG recording is usually taken by electrodes pasted by an electrical conducting gel to the surface of the scalp. The EEG can also record electrical currents in the brain trhough implanted depth electrodes. In comparison, MRI provides very high resolution images of soft tissue structures within the brain.
Ongoing research with MEG in a large magnetically shielded room is developing new, more accurate non-invasive methods to image dynamic brain function for faster outpatient diagnosis using electromagnetic multiple dipole source imaging. For over 20 years, Dr. William Sutherling and the research team have been at the forefront of research in neurological disorders. With support from the National Institutes of Health, they developed these approaches to help localize the origin of epileptic seizures and safely remove these areas. Because of these advances many patients with epilepsy are now enjoying a new life without seizures.
Through its affiliation with Huntington Medical Research Institutes (HMRI), the Epilepsy and Brain Mapping Program offers the latest and most advanced technologies available for the treatment of complex seizure disorders.
HMRI has pioneered many medical devices include the hydrocephalus shunt to relieve "water on the brain;" the vagus nerve stimulator for neural rehabilitation for the control of epilepsy; and the first clinical magnetic resonance imaging (MRI) and spectroscopy (MRS) units in the western United States. For more information on HMRI, please visit www.hmri.org.

New Scientific Advances In Epilepsy

The Epilepsy and Brain Mapping Program (EBMP) has been involved in many new dynamic scientific advances for epilepsy.
Currently, EBMP can now record the MEG at the same time with intracranial electrodes during seizures of a patient with temporal epilepsy. When our physicians record the MEG and intracranial electrodes simultaneously, they can see how much of the brain's electrical activity the MEG sees with our present analysis techniques.
The advantage of this simultaneous recording allows our physicians to improve analysis of MEG to make the MEG identical to intracranial electrodes to improve localization non-invasively.
The MEG can now identify electrical activity in the brain non-invasively precisely to within 1.4 millimeters, that is, one and one-half millimeters. This accuracy is superior to any other technique available and the best we are aware of in the U.S.
During December of 2000, EBMP made six presentations at the internationally attended American Epilepsy Society Meeting in Los Angeles which have been subsequently published in the December Epilepsia magazine.
Three presentations were demonstrating the advances in using the whole cortex MEG:

1. "Whole Cortex MEG With MRI (MSI) In Intractable Extratemporal Neocortical Partial Epilepsy."
2. "Non-Invasive Microscopic Spatio-Temporal Imaging of Multiple Sources In Human Sensorimotor Cortex."
3. "Whole Cortex MEG and MRI (MSI) Localizes Sensorimotor Cortex Adjacent To Epilepsy and Tumors."

In addition, Dr. Tatiana Maleeva made a presentation on:
"Neurocardiogenic Sycope On Video-EEG And EKG: Two Cases Mimicking Seizures."
The Ketogenic Diet team also presented two scientific abstracts on the effectiveness of the Diet for pediatric and adult patients. The Diet is still more effective in treating pediatric patients. Long term studies indicate that compliance is a major factor in the adult patient's success with the diet.
Several scientists have been visiting the MEG Lab and will be collaborating with our group to further advance epilepsy research.
Currently, Drs. John Mosher and Richard Leahy, pioneers in the technique of Multiple Signal Classification (MUSIC), have created “BrainStorm” software to be shared on the internet for other scientists.
The Fall 2000 issue Vol. 13, No. 1 of Brain Topography featured a scientific paper on “Conductivities of the Three-Layer Human Skull” which sheds new light on electric properties of the human skull.
Although, non-invasive techniques using MRI and CT may be developed to determine the conductivity of the skull, values of conductivity obtained through direct measurements as in this study will be helpful for comparison.

Curry® And BrainStorm Offer
Visual Perspective Of The Brain's Surface

Curry® Software developed by Neuroscan Labs and BrainStorm Software developed by Dr. Richard Leahy is a multi-modal neuroimaging tool which is advancing brain mapping and localization for the treatment of epilepsy.
Using MEG, MRI, and EEG image recordings, neurosurgeons can now fuse the data sets into a single image.
As a result, Curry® allows clear visualization of the brain's surface and reconstruction algorithms in a comprehensive 3D image.
This information helps to precisely locate a tumor or epileptic foci within a millimeter.

VNS Stimulator

A team of research scientists under the direction Dr. William Agnew at Huntington Medical Institutes developed vagus nerve stimulator to help reduce medically intractable bilateral temporal partial seizures.
This is the only antiepileptic therapy which uses an implantable medical device similar to a pacemaker.
Vagus nerve stimulation consists of electrical signals that are applied to the vagus nerve located in the neck for transmission to the brain.
The vagus nerve is one of the primary communications lines from the major organs of the body to the brain.
The device and lead are implanted in the chest and neck in a procedure lasting from 45 minutes to two hours.

Neuropsychometric Evaluation

What Is A Neuropsychological Evaluation?

A Neuropsychological Evaluation is a com-prehensive one-on-one evaluation with the neuropsychologist.
This evaluation is conducted to assess concentration, memory, language skills, perception concepts, problem-solving skills and other cognitive abilities:

The Evaluation Will Help:

• Identify and determine neurological disorders/or conditions.
• Determine cognitive strengths and weak-nesses.
• Discriminate between psychiatric (e.g., depression) and neurological symptoms.
• Diagnose and treat learning disorders, attentional disorders, etc.
• Provide evidence of functional disability for Social Security services, Worker's Compensation and disabled student services.

Preoperative & Postoperative Evaluation Will Help

• Localize and laterlize the seizure focus to help identify potential risks associated with surgery.
• Document improvement or problems post-operatively.
• Identify specific deficits which can be addressed by cognitive rehabilitation or other services.

Purpose Of The WADA Test:

• The WADA Test is conducted to determine whether a patient is a candidate for surgery.
• Determine memory function in each hemisphere.
• Identify the location of essential language functions.
• Provide additional localization information in identifying a seizure focus.

Why The Need For Speech Mapping?

• Identify critical language centers in the bran prior to surgery.
• Reduce the risk of language problems which may occur post-operatively.