Obituary: Paul H. Crandall, 89, UCLA professor pioneered surgical approach to treat epilepsy
Dr. Paul H. Crandall, who co-founded the UCLA Department of Neurosurgery and pioneered surgical approaches still used today to treat stubborn epileptic seizures, died March 15 from complications related to pneumonia at UCLA Medical Center–Santa Monica. He was 89.
"Paul was the father of UCLA's epilepsy program," said Dr. Neil Martin, chair of neurosurgery at the David Geffen School of Medicine at UCLA. "His clinical work laid the foundation for our current strategies to treat epileptic seizures, and his scientific research informs neurosurgeons' treatment of epilepsy today."
The youngest of seven children, Crandall was born to Arthur and Ellen Crandall on Feb. 15, 1923, in Essex Junction, Vt. He looked up to his siblings: One was a physician, two were attorneys, two owned businesses and one became food editor for the Boston Globe. According to Crandall's wife, Barbara, his older brother who was a surgeon encouraged him to pursue a career in neurosurgery.
Crandall graduated cum laude and earned his medical degree from the University of Vermont in 1946, then completed his residency training in neurosurgery at the University of Illinois in Chicago in 1952. There, he met his wife, now a professor emeritus of pediatrics and genetics at UCLA, who was in residency training at the same time.
In 1944, Crandall enlisted in the U.S. Army and served for two years. After the service paid for his medical education, he enlisted again in the Army Medical Corps in 1952 and was stationed for two years in Frankfurt, Germany, where he served as chief of neurosurgery at the military hospital.
In 1954, Crandall joined the UCLA School of Medicine as one of three founding members of the neurosurgery division, which was upgraded to a department in 2008. He taught and conducted clinical research for 32 years, retiring in 1988 as a professor emeritus.
Moved by his epileptic patients' suffering, Crandall launched in 1960 UCLA's first research program in the surgical treatment of the brain disorder, which provokes sudden and repeated seizures that can damage the brain, causing cognitive impairment and memory loss. While anti-convulsant drugs controlled epileptic seizures in most people, the medications didn't work in up to 40 percent of patients.
Funded by one of the longest running UCLA grants from the National Institutes of Health, Crandall performed or supervised surgeries on more than 300 epileptic patients, not including those he treated in the clinic. He developed experimental techniques for identifying the brain region causing epileptic seizures that didn't respond to drugs — an approach now standard at all major medical centers.
He achieved this by using electroencephalography (EEG), a test that tracks brain waves to uncover abnormal electrical patterns. Crandall was the first to pinpoint the origins of epileptic seizures by implanting EEG wires directly into the brain over several days to record electrical activity during spontaneous seizures.
Crandall next worked with UCLA neurologist Dr. Richard Walter to develop the first EEG telemetry unit, which allowed prolonged recording of brain activity to capture spontaneous seizures in patients with epilepsy. Later coupled with continuous video recording, the technique enables physicians to correlate how a patient behaves during seizures with simultaneous brain activity. Hospitals worldwide now use EEG telemetry to test patients whose epileptic seizures don't respond to drugs.
Crandall was the first to use ultra-fine wire electrodes to record activity from single brain cells during a patient's evaluation before surgery and to combine this approach with a surgical technique that removed the epileptic tissue in one piece. Previously, the tissue was suctioned from the brain, making it impossible for researchers to study the causes of epilepsy at the cellular level. His efforts enabled scientists to correlate the function of single cells with the cellular abnormalities revealed by examinations of the excised brain tissue.
Crandall's findings set the stage for human research on the fundamental physiological mechanisms that cause epilepsy. He also participated with the UCLA team that was the first to use positron emission tomography (PET) to scan epileptic patients and image their brains' abnormal metabolic activity.
"Paul was the first to insert EEG electrodes in the brain over long periods of time to record irregular brain waves during spontaneous seizures, the first to perform EEG telemetry on patients with epilepsy, and the first to perform prolonged recordings of single human brain cells," said Dr. Jerome Engel Jr., UCLA's Jonathan Sinay Professor of Neurology, Neurobiology and Psychiatry and director of the UCLA Seizure Disorder Center. "Those of us who followed in his footsteps owe him a huge debt for his contributions."
Crandall served on the U.S. Department of Health's national commission for epilepsy from 1976–77. After his work demonstrated the value of longtime monitoring of seizures and procedures for managing difficult cases, the commission recommended the establishment of specialized centers for epilepsy in all major urban centers. His efforts also resulted in the field extending the benefits of surgery to children with epilepsy.
Last year, Thomas and Nadia Davies committed $2 million to the UCLA Department of Neurosurgery in memory of their daughter, Alfonsina (Nina), and in honor of Crandall, who ended her epileptic seizures in the late 1970s.
The Davies family had invested more than a decade in seeking ways to stop the uncontrollable seizures that had assailed their daughter since birth. When they arrived at UCLA in 1977, Crandall suggested an experimental surgery to control Nina's intractable epilepsy. At the time, few surgical programs for epilepsy existed in the United States, and doctors were often reluctant to consider a surgical approach to treating the disease.
"Dr. Crandall's scientific knowledge and surgical skills saved our daughter's life," said Nadia Davies. "We are eternally grateful for his lifelong study of surgical interventions to prevent epileptic seizures."
Active in many organizations devoted to improving the lives of people with epilepsy, Crandall served as president of the American Epilepsy Society in 1979, which presented him with the William G. Lennox Award in 1991 for his groundbreaking body of work. He was elected a fellow of the Royal Society of Medicine in 1991 and later received the University of Vermont's distinguished alumnus award.
In addition to his wife, Crandall is survived by his four children and three grandchildren. In lieu of flowers, the family requests donations to the Dr. Alfonsina Q. Davies Endowed Chair in Honor of Paul Crandall, M.D. for Epilepsy Research. Please make checks payable to the UCLA Foundation Fund #818830, c/o UCLA Department of Neurosurgery, 757 Westwood Plaza, Suite 6236, Los Angeles, CA 90095.