Adult Epilepsy Service

Overview

The Adult Epilepsy Service offers evaluation and management using the most advanced techniques available to people with epilepsy and related disorders in a setting focused on the advancement of knowledge about epilepsy and related disorders. The Epilepsy Service is an academic teaching service that is committed to clinical and basic research, medical education, and clinical service. Patients seen in this environment benefit from the input of multiple physicians and investigators that results directly from our academic medical approach to evaluation and management.

Our comprehensive range of clinical services includes:

• Consultation services at the request of primary care physicians, neurologists, neurosurgeons and other specialists
• Epilepsy surgery for patients with epilepsy that is poorly controlled by medication
• First Seizure Clinic for rapid evaluation of patients with newly recognized episodes thought to represent seizures
• Epilepsy Monitoring Unit for sophisticated evaluation of potential surgical candidates and for diagnostic evaluation of patients with episodes that may represent seizures
• Online second opinions and record-review services in which we offer consultation and record review using electronic data transfer, without the need to travel to Boston
• Pediatric Epilepsy Services at Mass General for Children in which specialists diagnose and treat seizures and related conditions in infants, children and adolescents

Filling an Important Need

Andrew J. Cole, MD, founded the Epilepsy Service in 1992 and continues to serve as our director. He has helped assemble a world-class team of subspecialists, including dedicated neuroradiologists and neurosurgeons who specialize in epilepsy surgery. Together, we have earned a reputation for communicating and collaborating closely with neurologists in Greater Boston, around the country and around the world.

Among our key milestones:

• In 1999 we launched the First Seizure Clinic, which was one of the nation's first clinics to focus exclusively on patients suffering seizures for the first time.
• In 2002 we launched the Mass General Pediatric Epilepsy Program.

As a National Association of Epilepsy Centers-certified Level 4 Epilepsy Center, we provide the more complex forms of intensive neurodiagnostics monitoring, as well as more extensive medical, neuropsychological and psychosocial treatment. We also offer a complete evaluation for epilepsy surgery, including intracranial monitoring and complex surgical procedures that many other institutions do not perform.

Research & Clinical Trials

The Epilepsy Service maintains an active research program, and some patients will have the opportunity to enroll in research or clinical trials. For information about ongoing studies and the ability to participate, please call 617-726-5904.

The Epilepsy Service at Massachusetts General Hospital is committed to improving the lives of people with epilepsy and related disorders through clinical services, clinical and basic research, and medical education and training.

We offer comprehensive diagnostic and treatment services for patients, from first seizure events to surgical evaluation of seizure disorders. In addition, we use detailed neurophysiological, neuroradiological and neuropsychological testing as required to ensure accurate diagnosis and treatment.

The Epilepsy Service maintains an active research program involving projects ranging from healthcare outcomes research to advanced neuroimaging techniques to basic molecular studies of mechanisms of disease. Current projects are focused on understanding neuronal injury following seizures and developing strategies for neuroprotection that may eventually have clinical utility. The laboratory is particularly interested in understanding the biochemical pathways that mediate injury. Another current focus is on characterizing and modulating the activity of intracellular signaling kinases and their targets. These studies, initiated in cell culture, are now being extended to whole animal models. Ultimately, all of these projects aim toward the creation of both invasive and non-invasive mechanisms for restoring damaged neuronal function

For more information please refer to the research webpages on our seizure website.

What to Expect

If you are interested in a clinical consultation with us, we strongly recommend that you first receive a referral from your primary care physician or neurologist. A referral letter outlining your issues allows us to make your first visit as productive as possible. A referral to our center would be appropriate if your seizures have not been brought under control after three months of care by a primary care provider or after 12 months of care by a general neurologist.

Because epilepsy is a chronic condition, the most significant benefit we offer patients comes from evaluating your symptoms and proposing changes to your treatment program. Once we have taken these steps, we typically partner with your primary care physician or neurologist to manage your continuing care. If you should encounter any setbacks, we work with the referring physician to make necessary adjustments in your treatment.

Please note: We accept both physician referrals and self-referrals for an appointment at the First Seizure Clinic or for a second opinion or record review. In the case of second opinions, our preference is to comanage your ongoing care with your treating physician.

A Collaborative, Multidisciplinary Environment

When assessing a patient, our first priority is to understand the underlying cause of his or her disease. We meet weekly to review all active cases, so patients benefit from the input of multiple physicians and research investigators across a wide range of subspecialties.

The Epilepsy Service conducts pioneering research efforts via clinical trials, imaging research and laboratory research. In the latter category, for example, we aim to better understand brain activity by using innovative neurophysiological recording techniques with the long-term goal of improving therapies for patients with epilepsy.

Advanced technologies available at Mass General help us continually set new standards in the field. For example, as a result of our sophisticated imaging capabilities, we can maintain dedicated scanning protocols optimized for the pathologies that cause epilepsy. In fact, many regional and even national centers refer patients for specific imaging studies or contact us for guidance on imaging and scanning.

Finally, the Epilepsy Service is well known as a leader in epilepsy surgery. Evaluation is directed by one of our seasoned epileptologists, who works with a multidisciplinary team including neurosurgeons, a neuroradiologist, neuropsychologists, nurse practitioners and other health professionals. To date, we have performed over 500 surgeries, giving us experience that few epilepsy centers can match.

Epilepsy Consultations

The Epilepsy Service offers comprehensive clinical consultation for patients with seizures and related disorders. A referring physician usually initiates consultations by submitting our outpatient referral form (PDF).

A referral letter outlining the issues allows us to optimize your visit. When you come for a consult, please bring all relevant medical records, films and EEGs (original data, not just reports), and a witness who can describe your events. If it is not possible for a witness to accompany you, please arrange for an individual who has seen your events to be available by telephone.

Second Opinion and Record Review

The Epilepsy Service offers second opinion services to patients and physicians with complex neurological problems. Our goal is to work with patients and their local physicians to optimize diagnosis and care. We can provide opinions based on review of medical records, images and test data, or based on a comprehensive consultation including examination and discussion with the patient and family members.

Training & Facilities

Led by Andrew J. Cole, MD, the Epilepsy Service is home to a world-class team of subspecialists including dedicated neuroradiologists and neurosurgeons who specialize in epilepsy surgery. We have earned a reputation for communicating and collaborating closely with neurologists in Greater Boston, around the country, and around the world.

As a National Association of Epilepsy Centers-certified Level 4 Epilepsy Center, we "provide the more complex forms of intensive neurodiagnostics monitoring, as well as more extensive medical, neuropsychological and psychosocial treatment." We also offer a complete evaluation for epilepsy surgery, including intracranial monitoring and complex surgical procedures that many other institutions do not perform.

Facilities

Training in clinical neurophysiology is supported by a busy EEG and Evoked Potentials Laboratory, a five-bed Epilepsy Monitoring Unit, a busy Long-Term Bedside and ICU Monitoring Program, an eight-bed Sleep Laboratory, an Intraoperative Monitoring Program, and an Electromyography Laboratory housed in the Neuromuscular Center.

The Epilepsy Monitoring Unit is equipped with a state-of-the-art fully networked Xltek digital video-EEG system. Three adult beds, one pediatric bed, and one portable unit are used for data acquisition. Studies are reviewed on-line on dedicated review stations located throughout the clinical neurophysiology laboratory, the neurology clinic, and the Epilepsy Service office suite. Monitoring studies include pre-surgical localization studies using extracranial electrodes, intracranial electrodes, and diagnostic studies in both adults and children.

Clinical Fellowships

Clinical Neurophysiology Fellowship
This two-year fellowship provides a strong foundation in clinical epileptology and the technical, interpretive and clinical aspects of electroencephalography and evoked potentials.

Epilepsy and Neurobiology Fellowship
The Fellowship offers advanced training in clinical epileptology and neurobiology, with emphasis on research in epilepsy and disorders of neuronal excitability.

Pediatric Epilepsy and Clinical Neurophysiology Fellowship
The Pediatric Epilepsy and Clinical Neurophysiology Fellowship program occurs in conjunction with our Mass General Epilepsy and Clinical Neurophysiology Fellowship program. Clinical Neurophysiology encompasses the clinical areas of Electroencephalography (EEG), Intraoperative monitoring (IOM), Epilepsy, and Electromyography (EMG).

Epilepsy Research Fellowships

Epilepsy Postdoctoral Fellow Research Associate

This fellow or research associate will study neuronal injury and neuroprotection in epilepsy using anatomic, biochemical and molecular techniques.