An Exciting Time for Neurology

The joy of laughter: Texas Children's Hospital laser breakthrough cures epilepsy

Keagan Dysart with his father, Khris
MRI-guided laser surgery showing Keagan Dysart's brain in November 2010
Texas Children's Hospital
Dr. Daniel Curry, Texas Children’s director of pediatric surgical epilepsy andfunctional neurosurgery and assistant professor of neurological surgery atBaylor College of Medicine
Photo by Sylvester Garza
Dr. Angus Wilfong, director of Texas Children’s comprehensive epilepsy programand associate professor of pediatrics and neurology at Baylor College ofMedicine
Keagan Dysart hosts a lemonade stand

For the first eight years of his life, Keagan Dysart suffered from a crippling form of epilepsy that included gelastic seizures — mirthless giggling two or three times per hour — and occasional tonic seizures that involved a stiffening of the body followed by an extended sleeping period. The condition was the result of a lesion near the hypothalmus, a particularly sensitive region of the brain.

Keagan was among the 40-percent of epilepsy patients who don't respond to drug therapies. Traditional craniotomy surgery would have in turn put him at risk for loss of sight, stroke from artery damage or the development of diabetes insipidus, a potentially fatal condition in which the kidneys are unable to conserve water because of disruption to the area of the brain that releases the body's anti-diuretic hormone.

With prospects grim, Keagan traveled from San Antonio with his parents to Texas Children's Hospital in search of help.

After recovery, Keagan's parents heard him laugh for the first time, not as a symptom of gelastic seizures, but from sheer joy.

"We were always waiting for the next shoe to drop," says father Khris Dysart. "We knew we needed something to be done quickly."

At the Houston hospital, Keagan became one of the first children to undergo a pioneering MRI-guided laser surgery developed at Texas Children's. Dr. Angus Wilfong and Dr. Daniel Curry are the first doctors to perform the innovative surgery that they believe will forever change the way epilepsy is treated.

During the surgery in March, magnetic resonance imaging was used to map the area of Keagan's brain where the lesion was located. During the procedure, performed by Curry, who serves as director of pediatric surgical epilepsy and functional neurosurgery, a 3.22 mm hole — the size of the tip of a pen — was made in the child's head, through which a catheter and laser light were directed at the lesion. An automatic feedback system shut off the laser when its heat approached nearby critical brain structure.

In a matter of 51 seconds, the lesion was ablated and Keagan's epilepsy had been cured. After recovery, his parents heard him laugh for the first time, not as a symptom of gelastic seizures, but from sheer joy.

"This is one of the most exciting times in neuroscience that has ever existed," says Wilfong, medical director of Texas Children's Comprehensive Epilepsy Program. "There are a lot of huge advances being made, such as ways to stop seizures and help the brain heal itself from diseases like epilepsy."

The new technique reduces the risk of infection and reduces recovery time. Six such surgeries have been performed at Texas Children's in patients ranging from 5 to 15 years old. The patients were released from the hospital between one and five days later and in each case they have remained seizure-free.

Being the largest medical center in the world and headquarters of a litany of medical technology companies, Houston is ground zero for children's epilepsy research.

"Children come from all over the world to our center because of the specialized care that we provide," says Wilfong. "And more people are going to come for this epilepsy treatment."

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A crucial big 4-0

Your heart in pictures: Methodist images provide a stark reminder of how quicklyheart disease strikes

Doctors use an imager to see where blood flow is weak. This image of an abnormalheart shows weakness in blue or black.
This is what a normal, healthy heart looks like.
The heart is enlarged in this image, showing a bypass graft, indicated by thesquiggly line.
This is what a heart with normal blood flow looks like.
This aorta shows evidence of a an aneurysm, a widening of the blood vessel. Thewhite line points to the aneurysm.
These images compare a normal abdominal aorta to an abdominal aortic aneurysm.

It's easy to dismiss heart disease as a health problem only affecting older people, or those with a family history of the deadly disease. The reality is, coronary heart disease is the number one cause of death in America for men and women of any ethnic background.

As the average age of people diagnosed with heart disease creeps lower, lifestyle changes are crucial to hitting the big 4-0 without having a cardiologist’s number saved in your iPhone.

The Methodist DeBakey Heart & Vascular Center shared images with CultureMap, giving us an up close and personal look at how that cheeseburger, lack of sleep and stressed-to-the-max life can increase your risk of heart disease. The American Heart Association (AHA) encourages people to quit smoking, lose excess weight, eat a healthful diet, control blood pressure and keep cholesterol levels in check to maintain a healthy heart.

Pictures of an abnormal heart show blood flow is weak across certain areas of the heart (blue or black). Information about blood flow helps doctors diagnose what ails a heart, and also help them decide how to approach surgery.

Two in three men and one in every two women are at risk for cardiovascular heart disease at the age of 40. If it’s hard to imagine what that looks like, consider a series of images of the same heart, as the imager moves in three dimensions. Each pair of rows is a different dimension. Red shows where blood is flowing the most.

The aorta is the largest and most important artery in the body taking blood from the heart, extending down to the bottom of the abdomen. The appearance of an aneurysm, a widening of the blood vessel, is usually the result of a weakening in the blood vessel wall. If left untreated, aneurysms can rupture, leading to internal bleeding and possibly death.

Cardiologists treat coronary artery disease with a bypass graft. The grafted blood vessel is taken out of a patient's leg, then surgically attaching it to the heart and the aorta. A bypass gives blood a clearer path, allowing it to flow more easily from the heart.

Other courses of treatment include mechanical heart valves commonly used by surgeons at the Methodist DeBakey Heart & Vascular Center. Surgeons insert a replacement heart valve by moving the device up the aorta, from the leg to the heart, avoiding open-heart surgery.

The same everyday choices that endanger the heart can also help it. The AHA suggests positive self-talk, deep breathing, counting to 10, smiling, doing things you enjoy and relaxation exercises as ways to tame the stress in life.

Even if you only smoke in social situations, cut it out. That is especially poignant for people between 25 and 44 — the age range with the highest percentage of people who smoke. Cigarette smokers generally have higher blood pressure which stretches arteries, causing scarring. Bad cholesterol, called LDL, often gets lodged in the scar tissue and combines with white blood cells to form clots. Good cholesterol, called HDL, helps keep the LDL from sticking and building up.

Consistent exercise is another heart-healthy choice and a mere 30 minutes a day can do wonders for the heart. Eating at least four and a half cups of fruits and vegetables plus a minimum of two three and a half ounce servings of oily fish, like salmon, tuna, mackerel, herring and trout, weekly are also encouraged by the AHA.

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