The 1970s

In 1972 the Veterans Administration formally designated West Haven as an Epilepsy Center along with the Durham VA associated with Duke University under the leadership of Dr. Antonio Delguado-Escueta. Other centers were later initiated throughout the country at Dallas, UCLA, Madison (Wisconsin), Minneapolis and Seattle. With this official recognition came funding for more extensive video and polygraphic monitoring equipment as well as wiring and camera placement in four private rooms. In addition to the monitoring equipment, the funding provided for a dedicated nursing staff with no other responsibilities and a clinical nurse specialist, Jean Shope, R.N. A neuropsychologist, Dr. David Glass, was also recruited reflecting the common cognitive, affective and behavioral problems encountered by our patient population having resistant complex partial epilepsy as well as frequent non-epileptic problems.

In 1974 the Yale/VA Epilepsy Center hosted the first of a number of epilepsy workshops and representatives from worldwide attended. Many issues were presented including early review of videotaped seizures from several centers. These examples were later part of the data used by the ILAE to establish a classification of seizures. At this meeting it was also agreed the VA Epilepsy Centers should collaborate in clinical research to address unanswered questions. Dr. Mattson agreed to lead a study on comparison of antiepileptic drugs and Dr. Antonio Delgado-Escueta proposed a study of treatment of status epilepticus (later led by Dr. David Treiman, an Associate of Dr. Escueta).

Dr. Mattson collaborating with colleagues from VA Medical Centers throughout the U.S. began comparative studies with the executive direction of Joyce Cramer that evaluated all the standard antiepileptic drugs over a period of 15 years. These were the largest controlled trials ever conducted in the field of epilepsy.

About the same time a small research pharmacology lab was also set up in a nearby room to conduct levels of alcohol and folate being studied in clinical trials. Antiepileptic drug level determination initiated by Dr. Brian Gallagher on the Yale campus in the late 1960's were also conducted in this lab with the arrival of Joyce Cramer in the mid 70's. She conducted some of the original studies of protein binding and interactions of valproate with phenytoin and developed a quick simple method of ultrafiltration later utilized in commercial preparations.

Soon it became clear that the epilepsy unit capabilities far exceeded the local VA need and other VA hospitals did not send sufficient referrals to fully utilize the capacity of the center. At the same time the Yale Epilepsy Clinic staffed by Drs. Richard Mattson, Brian Gallagher and Dennis Smith had large numbers of patients who were appropriate candidates for admission to such a facility but were not veterans. A unique "sharing agreement" was set up with Yale-New Haven Hospital allowing Yale patients to be admitted to the unit. YNHH billed the patient and paid the largest portion to the VA to underwrite the costs of operation. Very soon the epilepsy unit was admitting a majority of the patients under this agreement including women and children. Because no other large facility existed south of Montreal or north of Duke (Durham, NC), many admissions were from the eastern U.S. via Yale.

The initial focus in the Yale/VA Center in the late 1960's and early 1970's was monitoring of events to establish the diagnosis of epilepsy and specific seizure type or non-epileptic events. Polysomnograms were also conducted for suspected sleep disorders. The unit was also used for clinical research studies of the effect alcohol, sleep deprivation and hormones on seizures. The facility and staff also provided the site for clinical pharmacokinetic studies of antiepileptic drugs. In collaboration with Dr. Brian Gallagher, many early studies of antiepileptic drug level testing and correlation with clinical effects were carried out.

In the early 1970's Dr. Peter Williamson returned to the Yale neurology department after military service, joined the epilepsy team and focused on evaluation of intractable epilepsy for epilepsy surgery. Working with the Yale Electronics Engineering Lab, he developed intracranial depth electrodes using a modification of the "Ray" probe initially developed at the Mayo Clinic. Working with Dr. John Van Gilder, a neurosurgeon, the surgery program was born.

In the mid 1970's Dr. Van Gilder's student Dr. Dennis Spencer completed neurosurgery residency at Yale and continued on the faculty with special interest in epilepsy surgery, replacing Dr. Van Gilder who had taken another position. Soon thereafter Dr. Susan Soloway (later Spencer) after completing neurology residency at Yale joined the team with a special interest in epilepsy surgery. She assembled the cases that had been studied and treated by Drs. Peter Williamson, Dennis Spencer and Richard Mattson, and reported one of the earliest outcomes of this diagnostic and therapeutic approach using intracranial recording. The Yale Epilepsy Center quickly became one of the largest and most important epilepsy surgery centers worldwide.