Eli Goldensohn: A Tribute

Eli S. Goldensohn, MD, professor emeritus of neurology at P&S, died March 22, 2013. Timothy A. Pedley, MD, the Henry and Lucy Moses Professor of Neurology and former chair of neurology at P&S, spoke about his friend and mentor at Dr. Goldensohn’s service

Timothy A. Pedley, MD

Eli Goldensohn was an academic physician to his core. He was a towering figure in epilepsy and EEG, and I want to explain just one aspect that I think is fundamental to understanding the significance of his contributions.

First some background: The EEG is a record of the brain’s electrical activity over time, quite analogous to the EKG being a record of the heart’s electrical activity. However, as the brain is much more complicated than the heart, the EEG record derives from simultaneous recordings of brain electrical activity from multiple areas on the scalp—at least 22 in routine EEGs, many more in certain conditions like epilepsy. For many years, interpretations of EEG activity were based on “pattern recognition.” One pattern of electrical activity was associated with epilepsy, another one with coma, another one with brain tumor, and so on. Eli, however, was one of a handful of people who played a major role in changing the focus of EEG interpretation from one of pure pattern recognition to one that emphasized the link between the underlying physiology of neurons in the brain and how their normal function, or disturbances in their function, leads to the patterns we see in the EEG. Eli argued that we would be able to use the EEG more effectively, and make it a better diagnostic tool, if we had a more thorough understanding of the ways in which the brain’s physiology is altered by different diseases and conditions.

This brings me to a second point that I think made Eli one of a small elite group of neurologists at the time: He was a physician-scientist. In addition to working with patients, he had a research laboratory in which he studied the physiology of the cerebral cortex in the actual brains of experimental animals, particularly with regard to the development of epilepsy, and how epileptic activity in the brain’s neurons resulted in the particular abnormalities we see on the EEG. Just as one example, working with Dr. Dominick Purpura, Eli was one of the first to record electrical activity from individual nerve cells within both the normal and the epileptic cortex of anesthetized animals.

As a clinician, Eli saw mostly patients with epilepsy. He established the seizure clinic at what was then Columbia-Presbyterian Medical Center and, in addition to providing care to patients with epilepsy, the clinic became a center for testing new antiepileptic drugs and studying patients with particular subtypes of epilepsy. Eli was one of the pioneers in developing an essential tool of modern epilepsy care, video-EEG monitoring, the simultaneous recording of a patient’s actions and behavior on video camera along with EEG. This made it possible to analyze second by second and minute by minute the changes in a patient’s awareness and behavior in relation to epileptic discharges occurring in that patient’s EEG. Video-EEG monitoring has transformed the way we classify subtypes of epilepsy and, as a result, the way we treat patients with different types of epilepsy. Today, surgery provides great benefits to patients with the type of epilepsy that is unresponsive to antiepileptic drugs, and that advance would not be as widely used without video-EEG.

Among the many things Eli taught me were an increasingly sophisticated and critical approach to EEG, the subtleties of managing patients with complicated forms of epilepsy, and a great deal of practical know-how about selecting patients for surgery. He constantly emphasized that everyone—especially academic neurologists—should set the bar for achievement high, saying that if accomplishing something was too easy, it probably was not worth pursuing.