First Epilepsy Surgery Performed at VA Medical Center

Affected by a seizure disorder since the age of 30, Steven Schaffner wasn’t able to play basketball, drive a car, hold a job, or go anywhere by himself.

Medication wasn’t working – each new drug would work for awhile and then quit. With three young children and a supportive wife by his side, Schaffner wanted to do all the things normal fathers and husbands do.

A Navy veteran, Schaffner moved from California to Houston last year and entered the Seizure Disorder Clinic at the Houston VA Medical Center, where he came under the care of Dr. Perry Foreman, a staff epileptologist (a physician specializing in epilepsy). After a year of treatment, Dr. Foreman was able to limit Schaffner’s seizures to two a week. By then, Schaffner was also being considered as a candidate for seizure surgery.

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

Scaffner’s case went before the hospital’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 is the director of the Epilepsy and Movement Disorder Surgery Center and director of the hospital’s Clinical Neurophysiology Laboratory. Dr. Foreman and Dr. Hrachovy evaluated and treated Schaffner, and performed diagnostic neurophysiology studies such as electroencephalograms, video EEGs, and intracranial monitoring.

Dr. George Ringholz, a neurologist and neuropsychologist, evaluated Schaffner’s speech, behavior, and memory functions which could be affected by the surgery. Dr. Ronald Rauch, a neuroradiologist, evaluated Schaffner’s imaging studies. Dr. Richard Simpson, chief of the hospital’s neurosurgery section, and Dr. Daniel Yoshor, a hospital staff neurosurgeon with specialty training in epilepsy surgery, evaluated Schaffner’s surgical risk and performed the surgery and intracranial electrode placements. The team also included Dr. Kathryn Kotrla from the hospital’s psychiatry department and Dr. Emilie Roauh from the pathology department.

Using a multidisciplinary approach, the team assessed the severity of Schaffner’s disease, the impact on his life, and the risks and benefits of surgical intervention. The team determined that Schaffner’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.

Schaffner made the final decision to proceed with the surgery, and today he remains seizure free.

"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 think the surgery was well worth it," Schaffner said.

Schaffner’s surgery was the first for the hospital’s Epilepsy and Movement Disorder Surgery Center. The Center was established in August 1999 by Dr. Yadollah Harati in close collaboration with Dr. Hrachovy and Dr. Simpson, with the purpose of providing state-of-the-art diagnosis and treatment for epilepsy. 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 1 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," Dr. Foreman said.

"It is our hope that with specialty centers such as this one, we will be able to offer 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.

E-Mail: tmcinfo@texmedctr.tmc.edu
URL: http://www.tmc.edu/tmcnews/05_01_02/page_25.html