The mission of Cleveland Clinic Epilepsy Center is to support epilepsy patient care with extensive clinical and laboratory research.
In the Epilepsy Center, research is fundamental and supported with technology and experience necessary to map the brain’s electrical activity, localize the seizure source and, if appropriate, remove the source for patients with adult epilepsy.
The Epilepsy Center’s staff is involved in research programs investigating the causes of epilepsy including:
- Molecular, genetic and cellular mechanisms of epilepsy
- Novel imaging techniques for the identification and localization of various types of epilepsies
- Development of new treatment techniques for adult epilepsy
Dedicated research efforts target specific areas such as women’s health and specific issues directly related to adult epilepsy in women.
The epilepsy research program has been continuously funded from national public and private institutions, including the National Institutes of Health and the Epilepsy Foundation of America, American Academy of Neurology, and the American Epilepsy Society since 1995.
Innovations That Have Made a Difference for Epilepsy Patients
Innovations pioneered by Cleveland Clinic physicians include:
- Instrumental epilepsy research that has helped neurosurgeons distinguish normal brain tissue from tissue that causes seizures. Because the difference is not apparent to the eye, they developed a brain mapping technique that allows them to identify and remove the desired tissue, thereby increasing the likelihood of eliminating seizures for adult epilepsy patients without damaging vital functions.
- Pioneering of a microsurgical technique used in anterior temporal lobe surgery that protects the lobe and adjacent tissue.
- Development method of sorting and analyzing electroencephalogram (EEG) imaging data on a computer to make pertinent information more readily accessible.
Current Epilepsy Research
Today, the Epilepsy Center continues to be involved in basic and clinical research designed to better understand the cause of adult epilepsy and find more effective ways of treating it. These involve methods of:
- Improving presurgical monitoring
- Modifying surgical techniques
- Ensuring the protection of vital brain functions
- Testing the effectiveness of new medication combinations
In addition, we are working with advanced techniques used at Cleveland Clinic for other brain disorders, including Gamma Knife surgery and deep brain stimulation, to see how they may be applied to adult epilepsy patients with equal success.
Current Research Projects
Mechanisms of Epilepsy
Through active funding from the National Institutes of Health and the National Institutes of Neurological Disorders and Stroke, the research team at the Section of Adult Epilepsy was able to identify specific proteins that may constitute the molecular basis for the generation of seizures in patients with brain malformations and epilepsy. These findings are of paramount importance, as they may constitute the basis for the design of specific medications that are effective in seizure control but are devoid of the side effects that are most commonly seen after the administration of most standard antiepileptic medications. These results have been presented in National and International meetings and published in peer-reviewed National and International Journals.
Recent work at the Adult Epilepsy research program has led to the discovery of a novel gene that may be implicated in a type of generalized epilepsy associated with a common movement disorder.
Neuronal cells in epileptic tissue (arrows in C and D) harbor specific proteins (in red, C) that enhance the activity of one of the main excitatory glutamate receptors (NMDA) and therefore, contribute to the expression of seizures in patients with cortical dysplasias. These proteins are absent from nonepileptic tissue (A). The identification of this differentially expressed protein may lead to the development of specific therapeutic options and enhance our ability for imaging areas that are able to generate seizures. These pictures were taken using a confocal special microscope that is available at the Cleveland Clinic Lerner Research Institute Core facility.
Imaging Techniques for the Investigation of Patients with Epilepsy
The Cleveland Clinic Epilepsy Research group has been actively involved in the testing of novel imaging modalities such as Magnetic Resonance Spectroscopy (MRS) for the diagnosis and localization of various types of epilepsies. The testing of this technique was performed in animals and later applied to patients with epilepsy. This technique is now commonly used in the presurgical evaluation of some patients with epilepsy.
A team from the Epilepsy Center and the Department of Neurosurgery recently developed a computer program that is designed to three-dimensionally visualize the brain and to detect epileptic lesions and to localize the areas of potential epileptic activities.
Research on the Development and Introduction of Novel Treatment Techniques
Our physicians and researchers have been actively involved in the development of novel techniques for the treatment of epilepsy.
This figure shows a “map” of the MRS metabolic changes (increase in lactate that typically reflects a significant focal increase in the activity of the brain) seen in the brain of a patient with right temporal lobe epilepsy after one of his seizures. This technique allows the localization of the seizure in a non-invasive way.
Electrical stimulation of the brain as a treatment modality in epilepsy (“Brain pacemakers”)
Over the last 5 years, the research team at the Epilepsy Center has been testing various means that use electrical stimulation of various brain targets for the treatment of epilepsy in animal models of seizures using our state of the art neurophysiology facility. We are currently testing novel brain targets and methodologies that benefit from computer technologies that enable us to detect seizure activity and to automatically stimulate and control the area of seizure onset.
This cartoon shows the principals behind the various modes of electrical stimulation of the epileptic areas in the brain. The “overdrive method” (illustrated in the purple fibers) is the one that was introduced at the Cleveland Clinic Epilepsy Center and is currently being tested.
This image shows the three dimensional reconstruction of the brain from MRI images. Computer enabled co registration (in blue color) of the area of the lesion that caused the patient’s seizures is seen together with the location of the electrodes (green circles) that were surgically placed on the brain to map the motor and speech regions.
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