North Shore-LIJ’s Cynthia L. Harden, MD and Gregory Kapinos, MD, MS Publish Work in Prestigious Neurology Journal



Cynthia L. Harden, MD, North Shore-LIJ’s chief, division of epilepsy and electroencephalography and director of the Comprehensive Epilepsy Care Center, and Gregory Kapinos, MD, MS, brain injury specialist and neurointensivist at North Shore-LIJ’s Cushing Neuroscience Institute, have been featured in one of the most widely read and highly cited peer-reviewed journals, Neurology (Oct. 15, 2013).

 Dr. Harden served as senior author of “Evidence-based Guideline Update: Vagus Nerve Stimulation for the Treatment of Epilepsy,” which updates a 1999 AAN guideline on this topic. Vagus nerve stimulation (VNS) is a therapy that sends electrical signals to the brain.  A small device called a vagus nerve stimulator is implanted into the body through the left side of the chest.  The device produces repeating, low-level pulses of electrical current.  It is connected to a wire attached to the vagus nerve.  Nerves carry messages to and from the brain and other parts of the body and one path goes from the neck up to the brain.  VNS therapy uses this path to send electric signals to the brain which may help to reduce the number of seizures.

“According to the newly updated guidelines, VNS may help as adjunctive therapy in children and adults (12 years and older) with partial or generalized epilepsy or with patients who have a rare and serious form of epilepsy called Lennox-Gastaut syndrome,” said Dr. Harden. “Based on the data from 14 Class III studies, we found that VNS was effective in achieving more than a 50 percent seizure rate reduction.  We also found that VNS may be considered progressively effective in patients over multiple years of exposure.”

Also published in the October 15 issue of Neurology, Dr. Kapinos authored a book review of “The Evidence for Neurosurgery,” edited by Zoher Ghogawala, MD, et al, in which the authors looked at an extensive review of clinical studies up to 2010 to support decision-making for common neurosurgical procedures. 

Dr. Kapinos highly recommends the book to all neurosurgery residents, neurologists and practitioners with patients facing the decision to undergo some type of neurosurgical operation.  Dr. Kapinos says that the book will prove invaluable to practitioners as they decide what to offer their patients who are candidates for spine surgery for radiculopathy or myelopathy; functional neurosurgery for pain, psychiatric or movement disorders; lesionectomy for epilepsy or neoplasm; cerebrovascular surgery to avoid intracranial hemorrhage; and, decompression surgery for victims of brain or spine trauma.

 “The strength of ‘The Evidence for Neurosurgery’ is that the authors not only compare surgical techniques to each other but also cover nonsurgical alternative treatment options, like cognitive and physical therapy for back pain, radiation therapy for bone metastases, or pharmacologic and critical care therapeutic modalities to address delayed cerebral ischemia after subarachnoid hemorrhage,” says Dr. Kapinos.  “In this book, readers learn from authoritative experts about imperfections of prior reviews or studies and build their own unbiased conclusions on what the most rigorous data really tells us. The authors provide their own set or recommendations at the end of each chapter, with level of evidence and grade of recommendation.  This book represents a valuable contribution to the neurosciences.”

One of the suggestions Dr. Kapinos recommended is that the authors transform “The Evidence for Neurosurgery” book into a web site that would include constant updates as soon as new studies are published, serving as a pertinent tool for many neurologists, neurosurgeons, intensivists, urgentists and internists so that they have access to the latest evidence.

For the complete updated VNS guidelines, click here and for Dr. Kapinos’ book review of “The Evidence for Neurosurgery,” click here

For more information about North Shore-LIJ’s Cushing Neuroscience Institute and Comprehensive Epilepsy Care Center go to