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Michael E. DeBakey VA Medical Center - Houston, Texas

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Houston VA Performs Complex Surgery for Intractable Epilepsy

January 16, 2008

HOUSTON – An estimated two million Americans of all ages have epilepsy. Most are successfully treated with medications, but more than 30 percent of epileptic patients are termed drug-resistant, experiencing frequent, sometimes disabling seizures. Surgical procedures being offered at the Michael E. DeBakey VA Medical Center (MEDVAMC) offer veterans suffering from this lifelong problem the hope of freedom from seizures.

One of those leading the effort at the MEDVAMC's Comprehensive Epilepsy Program is Bruce Ehni, M.D., Neurosurgery Section chief. "For some patients, surgery to remove the part of the brain where seizures originate may be the best treatment option and offers a potential cure. The success of epilepsy surgery depends on the accuracy with which we can locate the seizure-generating areas and careful testing to ensure that surgical removal of this area does not affect critical brain functions such as language, memory, or motor abilities," said Ehni.

In the past, patients usually tried several medications with poor results for many years, even decades, before being considered for surgery. But more recently, surgery is considered sooner because studies have shown the earlier surgery is performed, the better the psychosocial and functional outcome.

“Epilepsy treatment has evolved to include consideration of the patient's quality of life, not just the number of seizures. Both continued seizures and high doses of medication impose costs on all areas of a person's life — intellectual, psychological, social, educational, and employment,” said David Chen, M.D., Neurophysiology Laboratory director.

At the MEDVAMC, state-of-the-art technology is applied to perform the safest and least-invasive procedure to help the patient achieve the highest possible quality of life. Epilepsy surgery candidates undergo extensive evaluations including advanced imaging techniques, neuropsychologic evaluations, extracranial video-EEG monitoring, and if necessary, intracranial grid electrode by MEDVAMC’s team of neurologists and neurosurgeons working with neurophysiology technicians, neuroradiologists, neuropsychologists, and neurology nurses.

“The primary aim is to pinpoint the location of the seizure-generating brain areas and identify what functions that region of the brain might be involved,” said Richard Hrachovy, M.D., a MEDVAMC neurophysiologist with more than 25 years experience in epilepsy evaluation and management.

“When the area causing seizures is far removed from areas having important brain functions, the surgical procedure is not unlike other kinds of brain surgery. However, if language, motor, or visual areas are located close to the surgical target, we may choose to wake up the patient during surgery and electrically map out the region to avoid damaging critical functions,” said neurosurgeon Daniel Yoshor, M.D. “This kind of ‘awake surgery’ lessens the risk of neurological deficits from the surgery.”

Surgery has the potential to relieve seizure activity in more than 70 percent of appropriately selected patients with temporal lobe epilepsy. But, Ehni notes, after five to 10 years, "a significant number of patients relapse. This failure of surgery is the subject of intense research. Recent data suggests the biggest predictor of relapse is the number of years for which a patient experienced uncontrolled seizures before undergoing surgery. I think we are learning that surgery should not be put off as a last resort. For some patients, it may be best to pursue this option as soon as it is evident that medications are not likely to control seizures."

Epilepsy is the second most common serious neurological condition in the United States after stroke. According to the National Institute of Neurological Disorders and Stroke, which is a division of the National Institutes of Health, about 125,000 new patients develop epilepsy each year.

"The Michael E. DeBakey VA Medical Center is proud to be known for providing our veterans with the most advanced technology available in the health care industry today," said Thomas A. Kent, M.D., Neurology Care Line executive. "We are working to expand our Comprehensive Epilepsy Program to serve as a regional referral site for veterans with complex epilepsy from the entire Gulf Coast region.”

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