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Michael E. DeBakey VA Medical Center - Houston, Texas

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Houston VA Medical Center Performs its First Epilepsy Surgery

April 15, 2002

Houston VA Medical Center Performs its First Epilepsy Surgery

HOUSTON, TX - Steven Schaffner wasn't able to play basketball or go running, enjoy his hobby of photography, drive a car, hold a job, or go anywhere by himself. He has had a seizure disorder since he was 30 years old. Medication wasn't working. Each new drug would work for a while and then quit. With three young children and a supportive wife by his side, Steven wanted a better life. He wanted to do all the things normal fathers and husbands do.

Steven, a Navy veteran, moved from California to Houston and entered the Seizure Disorder Clinic at the Houston VA Medical Center (HVAMC) where he came under the care of Dr. Perry Foreman, a staff epileptologist. After a year of treatment, Dr. Foreman was able to limit Steven's seizures to two a week. By then, the Neurology Care Line had also begun the evaluation process for Steven to undergo seizure surgery.

"Steven was a good candidate for surgery. He had well-defined lesion, an old hemorrhaged cavernous hemangioma, that was in a location that was amenable to surgical resection," said Dr. Foreman.

Steven's case went before the HVAMC's Epilepsy and Movement Disorder Surgery Center Committee for testing and monitoring. Each member of this team plays a different, but vital, role in a patient's care.

Dr. Richard Hrachovy, a member of the HVAMC Neurology Care Line since 1982, is the director of the Epilepsy and Movement Disorder Surgery Center and director of the HVAMC Clinical Neurophysiology Laboratory. Dr. Foreman and Dr. Hrachovy evaluated and treated Steven, and performed diagnostic neurophysiology studies such as EEG, Video-EEG, and intracranial monitoring. Dr. George Ringholz, a neurologist and neuro-psychologist, evaluated Steven's speech, behavior, and memory functions which could be affected by the surgery. Dr. Ronald Rauch, a HVAMC neuroradiologist, evaluated Steven's imaging studies such as the MRI and CT scans. Dr. Richard Simpson, Chief, HVAMC Neurosurgery Section, and Dr. Daniel Yoshor, a HVAMC staff neurosurgeon with specialty training in epilepsy surgery, evaluated Steven's surgical risk and performed the surgery and intracranial electrode placements. The team also included representatives from HVAMC's psychiatry department, Dr. Kathryn Kotrla, and pathology department, Dr. Emilie Roauh.

Using a multidisciplinary approach, the team assessed the severity of Steven's disease, the impact on his life, and the risks and benefits of surgical intervention. The team determined that Steven's brain lesion was anatomically well defined, in a location that was consistent with behavioral and electrographic characteristics of his seizures, and that the potential benefit of becoming seizure-free outweighed the risks of the surgery.

Once a consensus was made, the team discussed the assessment with Steven. At that point, it was up to Steven to make the final decision to proceed with surgery or not.

Steven underwent surgery on April 26, 2002 at the HVAMC, and as of today, he is seizure-free. "Steven has had no seizures since surgery and, although it is still very early in the recovery phase, we are optimistic about his prognosis," said Dr. Foreman.

Steven's surgery was the first for the HVAMC's Epilepsy and Movement Disorder Surgery Center. The Center was established by Dr. Yadollah Harati, Executive, HVAMC's Neurology Care Line in close collaboration with Dr. Hrachovy and Dr. Simpson in August 1999 with the purpose of providing state of the art diagnosis and treatment for epilepsy to veterans. There is also a section devoted to the evaluation and surgical treatment of Parkinson's Disease and other movement disorders.

"Epilepsy is a potentially devastating condition affecting up to one percent of the population. While many people respond to medical therapy, a significant number of patients with epilepsy continue to have seizures that prevent them from being able to work, enjoy recreational activities, or even interact in a normal fashion with their families and friends," said Dr. Foreman.

It is our hope that with specialty centers such as this one, we will be able to offer such veterans the opportunity to be free of seizures. At the present time, Houston is one of only a few such centers in the VA system," said Dr. Harati.

"I found the Houston VA Medical Center to be one of the best medical facilities I've ever been to. The doctors were very thorough - they did their homework. I was especially impressed with the neuro team here at the VA. They were very conscientious. They cared about me and my family. I think the surgery was well worth it," said Steven.

Patient Steven Schaffner with Dr. Perry Foreman about a week after surgery.
Patient Steven Schaffner with Dr. Perry Foreman about a week after surgery.
Patient Steven Schaffner with Dr. Richard Hrachovy about a week after surgery.
Patient Steven Schaffner with Dr. Richard Hrachovy about a week after surgery.

Point of Contact: VHAHOU Public Affairs

04/21/04 08:25