I Am Thinking About Freezing My Eggs. How Does It Work?

Apr 9, 2024 | Featured, Women's Health, Your Health

 

Egg freezing is popular among women looking for options and balancing family planning with other important responsibilities. Thanks to significant scientific advancements in the laboratory, success rates are higher than ever.

In this Q&A, Alan Copperman, MD, Director of the Division of Reproductive Endocrinology and Infertility and Vice Chair of the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Mount Sinai Health System, explains the process of egg freezing and its benefits. Dr. Copperman is also Managing Director and Chief Executive Officer of RMA of New York.

“Fertility preservation has the potential not only to safeguard fertility, but also to empower women to choose parenthood on their terms, at their own pace, aligning with personal and professional aspirations,” says Dr. Copperman. “It enables informed decisions about future family planning.”

Why should I freeze my eggs?

Egg freezing halts the biological clock, which is crucial for women whose age may mean they are facing possible declines in egg quality and quantity. Preserving eggs at a younger age enhances the chances of future conception and reduces risks of chromosomal abnormalities in offspring. It safeguards a woman’s fertility timeline while optimizing her prospects of having biological children later in life.

When should I freeze eggs?

Freezing eggs at a younger age is advisable, ensuring eggs are preserved at their peak quality and minimizing age-related reproductive challenges.

How does the process work?

Over a two-week period, the ovaries are stimulated to release multiple mature eggs for retrieval. Patients self-administer fertility medications, attend monitoring appointments, and then undergo a brief egg retrieval procedure under light sedation. Eggs are frozen and securely stored for future use.

How many eggs are frozen?

The number of eggs to freeze varies based on a woman’s age and family-building goals. Some may require multiple rounds of egg freezing to collect an adequate number of eggs.

What happens next?

When you are ready to conceive, your frozen eggs are thawed and fertilized with sperm, leading to embryo transfer into the uterus to achieve pregnancy.

Contact RMA of New York at 212-756-5777 or email info@rmany.com to schedule a consultation.
Learn more about Reproductive Endocrinology and Infertility Services at Mount Sinai

Student Sooyun Caroline Tavolacci, MD, MSCR, Shares How Mount Sinai Inspired Her to Study Thoracic Oncology and Enhanced Her Career in Medicine

Apr 9, 2024 | Featured, School

Sooyun Caroline Tavolacci, MD, MSCR

Sooyun Caroline Tavolacci, MD, MSCR, is a first-year student in the PhD in Clinical Research Program at the Icahn School of Medicine at Mount Sinai. As a graduate of the Master of Science in Clinical Research program, she reflects on her experiences and achievements, and discusses why she chose Mount Sinai for her PhD education.

What brought you to Icahn Mount Sinai as a master’s student?

Five months after arriving in the U.S. following my graduation from medical school in South Korea, I began searching for a master’s program. While I had gained experience in basic science research throughout my medical education, I lacked exposure to translational and clinical research. I sought a program that would bridge the gap between scientific research and clinical practice. Mount Sinai’s Graduate School seemed ideal for gaining insight into both realms and stood out for its distinguished physicians and scientists.

What were some of your achievements as a master’s student?

Nearly every course I undertook was an eye-opening experience. I was able to directly apply the research methodology and statistics I learned in class to real-world projects. Engaging in discussions with colleagues from diverse backgrounds provided invaluable insights into different aspects of the U.S. health system.

I joined the lab of Fred Hirsh, MD, PhD, at the Center for Thoracic Oncology at the Mount Sinai Tisch Cancer Institute and gained translational science experience while working on a National Institutes of Health-funded COVID-19 study in patients with lung cancer. I interacted with patients daily, observed clinic encounters, and gained more than just research experience under the guidance of Jorge Gomez, MD, and Nicholas Rohs, MD. In the lab, while working alongside two postdoctoral fellows, translational scientist Philip Mack, PhD, virologists, immunologists, pathologists, and statisticians, and simultaneously utilizing cutting-edge techniques to analyze serological responses, I gained invaluable experience in basic science research and statistical analysis. In my second year, I also explored the efficacy of treatment in lung cancer patients with Dr. Hirsch and Rajwanth Veluswamy, MD, MSCR, who is also a graduate of my master’s program. I participated in two studies: one evaluating the difference in the efficacy of immune treatment between sexes in lung cancer patients, and another investigating radiation pneumonitis among locally advanced lung cancer patients who received chemoradiation. I presented three abstracts as a first author at national and local conferences and published two articles under my mentors’ guidance.

Beyond my education and thesis project, I had the privilege of meeting several cardiothoracic surgeons and collaborating on research with them. I engaged in student activities and worked together with graduate and medical students on various projects. The Mount Sinai community is diverse and extensive, and I am grateful to have met such outstanding mentors and colleagues who will undoubtedly remain assets even after I graduate from the program.

What attracted you to this area of study?

Throughout my pre-medicine education, I had an exceptional professor, Ho-Yeon Song, MD, PhD, at the Department of Microbiology and Immunology, College of Medicine, Soon Chun Hyang University, who sparked my interest in immunology. During my medical education, this interest further developed, particularly in transplantation medicine. At the time of my graduation from medical school, I was considering general surgery or cardiothoracic surgery for my specialty. I was drawn to thoracic oncology due to my longstanding interest in immunology and cardiothoracic surgery.

Why continue your education with a PhD in Clinical Research?

The two years of training in the master’s program were intense and filled with invaluable experiences. While I felt close to achieving my goal of becoming an independent physician-scientist, I recognized the need for more practice and experience. By the end of my master’s program, my mentors provided me with opportunities to continuously work on their projects. I also refined my interest in health outcomes research and wanted to pursue advanced statistical courses that would be highly beneficial for analyzing large health care data in comparative effectiveness studies. I felt like once I started my graduate medical training, I might not have dedicated time for research unless I had continuous mentorship and my own projects.

I appreciated the flexibility of my master’s program, which allowed students to gain real-world experience and tailor their education. Therefore, I was determined to continue my education in the same program, even if it meant self-funding. With the experience I gained at the Mount Sinai Tisch Cancer Institute, I was offered a promising position. However, just over six months into my new role, I faced the decision of whether to continue both work and pursue a second doctoral education.

Thanks to Mark Hurwitz, MD, Department Chair/Director of Radiation Medicine at New York Medical College and Westchester Medical Center, who supported my decision to pursue a PhD while maintaining my work duties and readily agreed to be my mentor, I am balancing both work and education. Recently, I applied for a grant to initiate my outcome research project under his guidance before entering the dissertation phase. Having mentors at Mount Sinai and in the field of medicine through the PhD program has been a great source of support as I navigate my career.

What are your plans after you complete your PhD?

After completing my second year in the PhD program and transitioning into the dissertation phase, I intend to apply for graduate medical education in surgery or cardiothoracic surgery. While pursuing training in my desired field, I aim to concurrently work on my dissertation project. My ultimate goal is to become a surgeon-scientist.

Learn more about the PhD in Clinical Research Program

Advancing Heath Equity With Data: Collaborating With Stakeholders at Mount Sinai Queens

Apr 5, 2024 | Diversity and Inclusion, Featured, Research

Jill Goldstein, MA, MS, RN

At Mount Sinai, a key pillar in advancing health equity focuses on the collection and use of self-reported patient demographic data to identify gaps in care. The Health Equity Data Assessment (HEDA) team is engaging key stakeholders across the Health System and collaborating to address variances.

A highlight of these efforts is the Mount Sinai Queens Nurses Against Racism (NAR) system council, which endeavored to evaluate incidences of hospital-acquired pressure injuries (HAPI) using an equity lens.

A pressure injury is a localized injury to the skin and/or underlying tissue, resulting from compression between a bony prominence and an external surface for a prolonged time. Monitoring HAPI specifically focuses on the occurrence of these injuries during an inpatient hospital stay.

According to Jill Goldstein, MA, MS, RN, Deputy Chief Nursing Officer, Vice President of Nursing at Mount Sinai Queens, and NAR sponsor, their collaboration with HEDA began in January 2023, combining subject matter expertise and data modeling to evaluate differences in HAPI rates across patient populations. She  noted that the interdisciplinary team explored the impact of race, gender, age, language, payor, length of stay, clinical service, and other factors on the incidences of hospital-acquired pressure injuries.

Further, the data showed that in terms of race, there were no meaningful differences observed between white, Black, or Hispanic patients in any model.

Notably, the most actionable finding was the elevated risk for patients who prefer to speak a language other than English or Spanish. In these patients, 40 percent were more likely to have documented HAPI when compared to English-speaking patients.

With the data the HEDA team helped to collect and interpret, the system-wide nursing team will seek interventions to eliminate this disparity. This interdisciplinary approach serves as a model to incorporate an equity lens into other quality work, according to Ms. Goldstein.

Access the Health Equity Data Assessment (HEDA) Portal

Mount Sinai Queens-Crescent Street Officially Opens, Signifying a New Era of Care in Queens

Updated on Apr 5, 2024 | Community, Featured

From left: Anna Kril,Eartha Washington, Rabbi Jonathan Pearl, Tiffany Echevarria, Jill Goldstein, Ken Long (behind), Donovan Richards, Cameron R. Hernandez, MD, Michael Gianaris, Lynn Schulman, Florence Koulouris, Amrita Gupte, David L. Reich, MD, Ricardo Bonitto, and Nancy Papaioannou

The opening of Mount Sinai Queens-Crescent Street, a new multispecialty care outpatient practice in Queens, underscores Mount Sinai’s commitment to improving health and its commitment to the community.

“Mount Sinai Queens-Crescent Street marks a transformative milestone in the delivery of care in Astoria and beyond,” says David Reich, MD, President of The Mount Sinai Hospital and Mount Sinai Queens. “We are focused on enhancing the patient experience at Mount Sinai, and are committed to opening new facilities and increasing the range of advanced health care services we provide; and that is what we have done in our neighborhood.”

On Thursday, March 7, Mount Sinai Queens hosted a ribbon-cutting ceremony to celebrate the opening of the new outpatient practice.

Designed to enhance multispecialty care in a convenient state-of-the-art facility, Mount Sinai Queens-Crescent Street offers the latest diagnostic and treatment options and specialized care.

Services include heart care from the world-renowned Mount Sinai Fuster Heart Hospital on the Second Floor and centers for hematology/oncology, gastroenterology, endocrinology/diabetes care, rheumatology, and physical medicine and rehabilitation (physical therapy, occupational therapy, and speech-language pathology) on the Third Floor.

The new practice features new accommodations, including spacious exam rooms, comfortable waiting areas, bathrooms, and beautiful modern fixtures in an accessible, easy-to-navigate building. In addition, the Physical Medicine and Rehabilitation Department has a large gym that features new equipment, more privacy, and a bigger area, making it more accessible to patients.

“Our goal is to make this facility the destination for care in Queens,” says Cameron R. Hernandez, MD, Executive Director and Chief Operating Officer, Mount Sinai Queens. “Mount Sinai Queens-Crescent Street will play a pivotal role not only in ensuring that community members—our neighbors—receive the care they deserve but also in creating an immersive and comprehensive health care experience for patients and clinical experts.”

Within the next year, a Mount Sinai retail pharmacy and Mount Sinai Express Care—an urgent care clinic associated with the hospital’s emergency room—will also open on the First Floor of the building.

Mount Sinai Queens is committed to providing the community of western Queens and beyond with the best outpatient, emergency, and inpatient medical care. Patients have access to a highly trained team of nearly 500 physicians representing almost 40 medical and surgical specialties and subspecialties. The team of physicians, nurses, and support staff uphold the Mount Sinai tradition of excellence by providing high-quality, patient-centered care, delivered with compassion.

Attending the groundbreaking were the Mount Sinai Queens leadership team that includes Amrita Gupte, MD, MPH, MBA, Jill Goldstein, MA, MS, RN, Ellina Babar, Ricardo Bonitto, MBA, and Zachary Kee. They were joined by Dr. Reich; Donovan Richards Jr, Queens Borough President; Michael Gianaris, State Senator; Lynn Schulman, Council Member; and Tiffany Echevarria, Community Liaison for Congresswoman Nydia Velasquez.

Learn more about Mount Sinai Queens-Crescent Street or make an appointment

Alumni Kiran Nagdeo, BDS, MPH, Shares How Mount Sinai Enabled Her to Integrate Her Oral Health Experience Into a Public Health Career

Mar 29, 2024 | Community, Featured, School

Kiran Nagdeo, BDS, MPH

Kiran Nagdeo earned her BDS degree at D.Y. Patil University School of Dentistry in India and has eight years of clinical experience. She recently graduated from the Master of Public Health program, specializing in Global Health (Epidemiology and Biostatistics) from the Icahn School of Medicine at Mount Sinai.

Why did you decide to study at Icahn Mount Sinai?

The main reason I chose Mount Sinai is because it’s one of largest academic medical systems in the New York metro area. That gives you hope that it will open multiple opportunities, which it did. Another big reason was that the location really mattered to me. Mount Sinai is located very close to Central Park, and close to the subway, which made commuting easier.

What attracted you to study Public Health? What about it inspires you?

I was a completely clinically oriented dentist, practicing in India, and I was happy—until COVID-19 hit. It was during the pandemic that I realized the importance of broader level or upscale interventions. I had been working on an individual level—patient-doctor one to one relationship—but if I was equipped back then, I could have helped and contributed on a bigger scale to support many more people. Around this time, I decided to pursue public health.

My love and passion for dentistry and oral health is strong, and I have embraced avenues for my continued interest in this area. I have learned that there isn’t a heavy focus on oral health in the public health sector. There are very few select professionals, who usually tend to have a dental background, who have contributed to dental public health.

My goal going forward is the integration of oral health in public health and to advance maternal and child health. Women are key change agents, and children are the future we are bringing this change about for.

What were some of your achievements as a master’s student?

During my time in the Graduate Program in Public Health, I am proud to have accomplished so much. This includes: Two full text publications with multiple under review and work in progress publications; attending four conferences with about ten presentations; participating in the global health summer research program, which included visiting Rikers Island for shadowing the dental team and the medical complex care services team; participating in a Community-based Participatory Research Program in Queens; honored with winning four awards; and being inducted into the Delta Omega honorary society.

What activities outside the classroom have contributed to your success?

I’ve been the most active with the World Federation of Public Health Associations (WFPHA), and I owe all my success to Hyewon Lee, DMD, MPH, DrPH, the Chair of the Oral Health Workgroup (OHWG). She has elevated me and invested in my growth on a professional as well a personal level. I would not have been as successful or learned as much without her mentorship. I am currently the Vice Chair of the workgroup, directly under Dr. Lee’s leadership. I had my first ever publication with her, and first ever presentation at the largest public health conference, the American Public Health Association.

I’ve also participated in many research activities. I worked as a research assistant in Mount Sinai’s Department of Environmental Medicine and Public Health, which helped in my professional growth and development. I learned the basics of research thanks to my professor Maayan Yitshak-Sade, PhD, and Vishal Midya, PhD. They laid the foundation for my understanding in research.

I’ve been involved in several student organizations within Icahn Mount Sinai. This kind of exposure led me to gain more perspective as a graduate student in a medical school. I’ve held two positions in the student council in my time at Icahn Mount Sinai, most recently being the second year class representative for MPH. Along with that I’ve led five other organizations, while participating in many more. Even as a student, my strongest skill has been collaborations; I’ve collaborated with postdocs, medical students, MD/PhD students, different groups that I’m leading, and other student body structures, while leading the planning of multiple events. I’ve noticed how collaborations help us all bring our resources and friends together to have a much bigger event that is mutually beneficial.

I’ve also written for The Scoop, which is the MPH newsletter, on racism in public health. And written in the Helen journal about my unforgettable experience at the AADMD One Voice conference.I completed a student leadership in global oral health course with the Alliance for Oral Health Across Borders (AOHAB). That led to working closely with the president of AOHAB, Deborah Weisfuse, DMD, MSc, and I now hold a leadership position of Program Director in the organization.

I’m currently a part of the American Institute of Dental Public Health (AIDPH) Dental Public Health Leadership Academy (DHPLA) as a student leader. I also hold leadership positions at APHA, as External Relations Co-Chair in the APHA Student Assembly, Student Fellow in the Maternal and Child Health Sections, and a member of the Scientific Planning Committee in the Oral Health Section. I’ve also had the opportunity to be a teaching assistant for Maya Korin, PhD, MS, and Laura MacIsaac, MD, MPH, for MPH students, and for Georgina Osorio, MD, MPH, and Gallane Abraham, MD, for Clinical Research Students.

What are your plans now that you have completed your degree?

I will be continuing my work as a research assistant in the Microbial Exposomics lab under the leadership of Dr. Midya and Shoshannah Eggers, PhD, in the Department of Environmental Medicine and Climate Science at Icahn Mount Sinai, in collaboration with the Department of Epidemiology at the University of Iowa. I will be continuing my commitments at WFPHA, APHA, and AOHAB. I have been accepted and will be pursuing my PhD of Public Health in Epidemiology at New York University School of Global Public Health.

Learn more about the Master of Public Health Program at the Icahn School of Medicine at Mount Sinai

Purple Day: Raising Awareness, Ending Stigma of Epilepsy

Mar 28, 2024 | Featured, Research, Your Health

Every year on March 26, people and organizations around the world band together in solidarity for Purple Day. They wear purple and host events to raise awareness about epilepsy, with the goal of ending its stigma. For Purple Day this year, we got together experts from the Mount Sinai Health System to explain what epilepsy is and answer other top questions people might have.

Is epilepsy contagious?
“You cannot spread epilepsy from one person to the other,” says pediatric neurologist Natasha Acosta Diaz, MD, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai.

Epilepsy is not an infection. It is a neurological condition characterized by seizures caused by abnormal brain electrical activity, says Dr. Acosta Diaz.

Is epilepsy electroencephalogram (EEG) testing painful?
In a standard EEG test, electrodes—small metal discs—are attached to the scalp with the help of a glue. The EEG test is not painful, says Anuradha Singh, MD, Director of the Epilepsy Monitoring Unit, and Professor of Neurology at Icahn Mount Sinai.

EEG tests study brain rhythms to look for any sign of irritability.  A standard EEG test records these brain rhythms for 20 minutes to an hour, says Dr. Singh. “Sometimes you get a little glue left on your scalp but it’s not painful at all,” she adds.

Is epilepsy surgery dangerous?
“The myths about the danger of epilepsy surgery come from the past, from about the last 100 years or so,” says neurosurgeon Fedor Panov, MD, Director of the Adult Epilepsy Surgery Program and Associate Professor of Neurosurgery at Icahn Mount Sinai. “What you currently find on the internet (about the dangers) unfortunately is not appropriate and it just perpetuates this myth that epilepsy surgery is dangerous,” he notes.

Epilepsy surgery has its risks and benefits. “Most certainly, the benefits outweigh the risks,” says Dr. Panov. As the epilepsy care team might phrase it to patients, the risk of going through a year with epileptic seizures far outweighs the risk of a surgical intervention to cure the epilepsy, he says.

Can epilepsy seizures be triggered by flashing lights?
There is a type of epilepsy that can be triggered by flashing lights, called photosensitive epilepsy. “However, this is very rare,” says Dr. Acosta Diaz.

When testing a patient for epilepsy, flashing lights are used to see if they provoke a seizure, and if so, appropriate recommendations for care can be given, she adds.

Can people with epilepsy drive a car?
“You can drive a car if you’re seizure-free,” says Dr. Singh. However, different states can have different rules and regulations. People with epilepsy will have to check with their state’s Department of Motor Vehicles, she notes.

What are some epilepsy surgical options?

Vagal nerve stimulator
Involves placing a small wire around a nerve in the neck to decrease seizure activity. The wire is attached to a small battery inserted under the skin of the chest.

Stereotactic laser ablation
Uses lasers to remove a part of the temporal lobe of the brain to help control seizures. The procedure is guided by magnetic resonance imaging (MRI), allowing for very precise cuts and removal.

Staged craniotomy
A two-stage surgery that involves removal of part of the skull to expose the brain, followed by removal of the brain tissue that is causing the seizures. Removing the damaged part of the brain does not cause deficits, as other parts of the brain adapt and pick up function. The procedure improves the overall brain network because it allows the healthy areas to work without constant electrical interference from the seizure “hot spot.”

Responsive neurostimulation
A device is implanted that automatically records and detects electrographic seizures, then rapidly delivers electrical stimulation to suppress seizure activity. It is the first device that the U.S. Food and Drug Administration has approved for use in the brain to listen, learn, and respond to seizures.

Can people with epilepsy have a job?
“Absolutely,” says Dr. Panov. “It’s a myth to say you cannot work if you have seizures.” Epilepsy care teams are available to help patients be a part of their community, including having and holding jobs. The Americans with Disabilities Act prohibits discrimination against people with disabilities in several areas, including employment.

While it is not mandatory that people with epilepsy disclose their condition to employers or coworkers, it is recommended that someone at the workplace is aware, says Dr. Acosta Diaz. “Just in case you have a seizure, somebody can be with you or help you,” she says.

Can people with epilepsy have children?
People with epilepsy can have happy, healthy children, says Dr. Singh. Women with epilepsy should work with their OB/GYN and epileptologist to ensure they’re on the safest drugs for the pregnancy, says Dr. Singh.

Can people with epilepsy stop taking medications when seizures stop?
The goal of any Comprehensive Epilepsy Center is to get patients seizure-free, and ultimately off the medications, says Dr. Panov: “The idea is that you will come off your meds once the seizures stop.”

It is important, however, that patients do not stop taking medications without discussing with their specialists, says Dr. Singh. A lot of factors go into the consideration of stopping medications, including EEG results and MRI scans, so that process should be done in consultation with an epileptologist.

Can people with epilepsy swallow their tongue?
“No way, there’s no way that you’re going to swallow your tongue,” says Dr. Acosta Diaz. During a seizure, the tongue can go to the side of the mouth and people can accidentally bite their tongue. To assist someone with a seizure, be calm and lay the person on the side, and definitely do not put anything in the mouth, such as a spoon, she says.

Does a ketogenic diet help people with epilepsy?
It does, in certain cases, says Dr. Singh. A ketogenic diet is a high-fat, adequate-protein, and low-carbohydrate diet. It is more often used in pediatric epilepsy, especially for children in whom medications do not work well, says Dr. Acosta Diaz.

Ketosis, a state where the body derives its sources of energy from fat rather than glucose, is known to have anticonvulsant properties. However, it’s not easy for a person to enter into ketosis. That is why an epilepsy care team involves overseeing a patient’s metabolism and nutrition as well, notes Dr. Acosta Diaz. “It’s not something you can try by yourself at home. It’s not just doing a keto diet to lose weight,” she says.

Caring for people with epilepsy is a team effort. At the Mount Sinai Epilepsy Center, staff members across all levels of care work together to provide exceptional care. Here’s the Center at a glance:

100+ team members

• Adult epileptologists  • Pediatric epileptologists  • Neurosurgeons  • Neuropsychiatrists  • Neuroradiologists  • Nurse practitioners  • Neurosurgery  • NPs and PAs  • Researchers  • Registered nurses  • Social workers  • Dietitians  • Recreational therapists  • EEG technicians  • Administrative staff

 

 

Designated as a Level 4 medical facility by the National Association of Epilepsy Centers (NAEC), which is the highest recognition of care and expertise for people with epilepsy

Three inpatient Level 4 epilepsy centers at The Mount Sinai Hospital, Mount Sinai Kravis Children’s Hospital, and Mount Sinai West, and six outpatient locations in New York City and Long Island.

ABRET-certified labs

Five Mount Sinai sites have received American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET) Lab accreditation for achieving highest levels of quality and competence performing neurodiagnostic tests.

In 2023

The Mount Sinai Health System performed more than 13,000 electroencephalograms and completed 100 surgeries to reduce or eliminate seizures for adult and pediatric patients.

To call the Mount Sinai Epilepsy Center

212-241-2627

In addition to treating patients with epilepsy, the Mount Sinai Health System and Icahn Mount Sinai conduct research to push the frontiers of understanding the neurological conditions and what is possible with treatment. Here are some examples of what Mount Sinai is doing to further science in epilepsy.

Clinical trial: Epilepsy associated with Lennox-Gastaut syndrome

Lennox-Gastaut syndrome (LGS) is a severe form of epilepsy, with seizures beginning in early childhood. To treat seizures that have not been well controlled through conventional medication, researchers are using novel responsive neurostimulation (RNS) strategies. This is the first clinical trial using RNS for LGS.

The trial is supported by a five-year grant from the National Institutes of Health, and conducted in collaboration with five other centers in the United States.

Click here for more info.

Clinical trial: Efficacy of subanesthetic doses of IV ketamine for treatment-resistant epilepsy

Ketamine is an anesthetic that provides pain relief, and came into clinical use in the 1960s. In a hospital setting, ketamine is used intravenously at anesthetic doses to treat unrelenting seizures known as status epilepticus in comatose patients. Mount Sinai researchers are exploring using ketamine at subanesthetic doses in an outpatient setting for patients who have treatment-resistant epilepsy. With subanesthestic dose-ketamine recently approved by the FDA for treatment-resistant depression, researchers are optimistic about its safety, and are hopeful that this will provide relief for patients with hard-to-treat epilepsy as well.

Click here for more info.

Clinical trial: Phase 3 trial for a once-daily, oral treatment for those living with focal seizures (XTOLE2)

Focal seizures are when brain cells on one side of the brain malfunction, causing symptoms, and are considered the most common type—making up more than half of all seizures. Symptoms could include one or more of the following: motor, sensory, autonomic, or cognitive. While treatment can stop or reduce the frequency of the seizures, for some patients, current treatment options may be insufficient. Mount Sinai is participating in a Phase 3 study with Xenon Pharmaceuticals to explore the use of XEN1101, a potassium channel opener, along with the patient’s existing medication, for focal seizures. Clinical data from previous trials have shown up to around 50 percent reduction in focal seizures among participants who have received the drug.

Click here for more info.

Clinical trial: Phase 3 trial for Staccato® Alprazolam in participants 12 years and older with stereotypical prolonged seizures

Benzodiazepines are more commonly known for treating anxiety or panic disorders, but they can also be used to terminate most seizures in an inpatient setting. Approved therapies include a rectally-administered gel and intranasal formulations. However, there are no approved treatments for rapidly terminating an ongoing seizure in an outpatient setting. Mount Sinai is participating in a Phase 3 trial with pharmaceutical company UCB to study the effectiveness and safety of Staccato® Alprazolam, a breath-triggered device that delivers the benzodiazepine deep into the lung for rapid absorption and systemic exposure, with the goal of achieving rapid epileptic seizure termination (REST). In a previous clinical trial, in an inpatient setting, nearly 66 percent of participants who received the drug responded to the treatment, compared to 43 percent of participants who received a placebo. For participants who responded to the intervention, the Staccato® Alprazolam group saw seizure cessation in a median time of 30 seconds, compared to 60 seconds for those who had received a placebo. The Phase 3 trial tests the treatment in an outpatient setting.

Click here for more info.

Clinical trial: Electrographic seizure pattern modulation biomarkers in responsive neurostimulation for epilepsy

Although the therapeutic benefit of RNS is well established, predicting how well and when a patient might respond to the device is difficult. It may take several months for a patient to report a reliable change in seizure status, during which time the programming clinician has no objective guidance regarding whether or not to adjust settings. RNS devices can provide EEG recordings, offering an insight to seizure patterns, but there is little knowledge about how to use these recordings in individual patients. Thus, a critical need exists to develop methods for using a patient’s own data to predict when seizure reduction should be expected or to confirm objectively the presence and maintenance of a clinical response.

Icahn Mount Sinai researchers are working with Massachusetts General Hospital to apply machine learning, neurostatistics, and data science to improve the effectiveness of RNS, especially for children and adults who are not considered suitable surgical candidates.

Click here for more info.

Laboratory for Human Neurophysiology

The Laboratory for Human Neurophysiology seeks to understand how human cognition arises from the interaction of multiple brain areas and neurotransmitter systems, particularly in decision-making behavior. These research efforts involve studying prefrontal cortical and subcortical areas directly in the human brain by conducting intracranial electrophysiology recordings in patients undergoing neurosurgical treatment.

Ongoing research projects in the laboratory include investigating the neural basis of human decision-making under uncertainty using distributed intracranial EEG recordings in epilepsy patients, decoding overt subject behavior from preceding, distributed brain activity in reward-related brain regions, and studying reward and mood processing across multiple brain areas in epilepsy patients with and without comorbid depression. The lab is led by Ignacio Saez, PhD, Associate Professor of Neuroscience, Neurosurgery, and Neurology at Icahn Mount Sinai.

Click here to read more about the lab.

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