MDNews - San Antonio

Pamela Kittrell, MSN, RN, Clinical Research Nurse–Senior, reviews notes with Carlayne Jackson, MD, FAAN, neurologist and Director of the ALS Clinic. THE UNPAR ALLELED WORK OF THE SOUTH TEX AS COMPREHENSIVE EPILEPSY CENTER THE ONLY SPECIALIZED center in the region, and the only one recognized with a Level 4 designation by the National Association of Epilepsy Centers, the South Texas Comprehensive Epilepsy Center treats more than 5,000 patients annually. The center — a partnership of the University Hospital System and UT Medicine — utilizes a multidisciplinary approach, combin- ing neurology and neurosurgical expertise under the leadership of Charles Szabo, MD, Director of Clinical Services at the center, Chief of Epilepsy, Professor and Co-director of Epilepsy Surgery at the UT Health Science Center at San Antonio. Extending its reach to an underserved patient population in the Lower Rio Grande, the center offers outreach epilepsy clinics in Eagle Pass, Laredo and Del Rio. The center's most exclusive feature is a 14-bed — 10 adult and four pediatric — video-EEG neuro-monitoring unit at University Hospital, equipped with state-of-the-art technology and man- aged by a highly trained staff available 24 hours a day to follow patients experiencing seizures in order to evaluate them and design a plan of care. Wada tests in the angiography suite help physicians establish which side of the brain controls memory and language, while other imaging techniques, including SPECT, MRI, PET and functional brain MRI, can identify the area of the brain causing the seizures. Innovative neurosurgical approaches may then be employed. "Our goal is always to make a patient seizure-free, and we work toward that with medication combinations and, if necessary, surgical intervention to provide patients with the best quality of life and the ability to live productively," Dr. Szabo says. Less Invasive Craniosynostosis During their tenure and leadership of UT Medicine's Neurosurgery Department, Constance Barone, MD, FACS, Clinical Professor in UT Medicine's Department of Neurosurgery and Dr. Jimenez accomplished another innovative neurosurgical advancement by developing less invasive surgical techniques to repair craniosynostosis, a birth defect that causes misshapen heads in infants. This neurological abnormality occurs in four out of 10,000 live births, according to the CDC. "Craniosynostosis affects children born with a seam in the skull that closes prematurely," Dr. Jimenez explains. "Traditionally, operations to correct it took nine to 10 hours and required massive blood transfusions and a weeklong hospital recovery. Dr. Barone and I created a procedure that is much less invasive and takes approximately 45 minutes." The physicians' research and innovation led to the develop- ment of the Center for Endoscopic Craniosynostosis Surgery. Pediatric patients receiving this less invasive procedure have minimal blood loss during surgery and only stay overnight in the hospital. Drs. Jimenez and Barone perform these neurosurgical procedures to treat coronal, lambdoidal, metopic and sagittal suture synostosis. Epilepsy Center of Excellence Another UT Medicine neuroscience initiative formed the South Texas Comprehensive Epilepsy Center. A dedicated team of five highly skilled epileptologists and one of the largest video-EEG neuromonitoring units in Texas serve patients coping with debilitating epilepsy, which affects one in 26 people and is the fourth most common neurological disorder. "There are multiple levels of treatments available at the center," says Linda Leary, MD, Associate Clinical Professor of Neurology and Pediatrics at UT Health Science Center at San Antonio. "We can provide video-EEG monitoring with 24/7 trained technician coverage to better characterize seizure types and determine the brain regions where the seizure begins, including advanced imaging technologies to localize the seizure onset zone and important brain functions. We perform vagus stimulation in hospitalized patients and offer an array of epilepsy surgery procedures when needed." "Seventy to 80 percent of patients have seizure-free outcomes with temporal lobectomy," says Charles Szabo, MD, Chief of Epilepsy and Co-director of Epilepsy Surgery and of the South Texas Comprehensive Epilepsy Center. "If patients do qualify for surgery, we have highly skilled neurosurgeons who are trained and experienced in intracranial electrode placement, surgical resections and implantation of neurostimulators, as well as neuropsychologists to evaluate the impact surgery may have on cognition and behavior. All of these factors are vital to the success of our program." U T Medicine neurosurgeons at the center perform 20–25 epilepsy surgeries each year, including temporal lobectomy, the most common epilepsy procedure, which removes a portion of the temporal lobe identified as the cause of the seizures. M D N E W S . CO M ■ MD NEWS San Antonio | 7

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