Doctors 'cautiously optimistic' following
rare epilepsy surgery

The patient, 18-year-old Michele (pronounced mik-hale-ee) Angeloni from the island of Sardinia in the Mediterranean Sea, averaged about one seizure an hour for the last 11 years. He has had no seizures since neurosurgeon Dr. G. Alexander West, assistant professor of surgery, removed a congenital tumor at the base of his brain. The boy suffered from a variety of seizure disorders, including extremely rare gelastic seizures, which are characterized by laughter. Approximately 100 cases of gelastic seizures have been reported worldwide.

A surgical team removed a tumor known as a hamartoma at the base of the brain. The tumor was the focus for epileptic seizures that occurred on a daily basis for 11 years.

"Some of the seizure types were very quiet, so the symptoms were not recognizable to his family, but others were more severe," Dr. West said. "In fact, he suffered a grand mal seizure in the car the day before he was admitted to the hospital.

"Since the operation, the patient has had no seizures, going without one for the first time in more than 11 years."

Surgery was performed after all anti-epilepsy medicines failed to control the seizures and after the Angelonis sought other opinions throughout Europe. Dr. West met the family while in Italy to give invited lectures, and family members invited him to stay in their home on Sardinia. "During my visit I witnessed many seizures throughout the day," he said. "Michele had exhausted all medical opportunities. The lesion he had, in my view, left no alternative but surgery."

Dr. West consulted with neurosurgical colleagues in Dallas and Seattle before consenting to do the surgery. Several physicians in Europe had advised the family that it was too risky to perform. The boy had a tumor, known as a hamartoma, at the base of the brain and adjacent to the hypothalamus and optic nerve. The hypothalamus controls eating, sleeping and other functions and is connected to other key control centers in the brain. Michele's tumor caused seizures that started at age 6 1/2 and intensified with hormonal changes at puberty. His cognitive development was frozen at the first-grade level after his seizures began, said his mother, Silvana Angeloni.

Michele's father, Giampaolo, a commander in the Italian Navy; his mother; and his godfather, Alfredo Lupi, paid $14,000 toward the $100,000 surgery and accompanied the boy on the trip. Dr. West and other faculty physicians waived their fees, and two companies, Radionics Inc. and The Armamentarium Inc., donated electrodes and titanium plates used in the surgery.

After arriving in Texas, the family visited with Jack Farmer, Michele's uncle in Corpus Christi. "These are unbelievable people and the devotion they have and how they deal with this boy is incredible," Dr. West said. "They are important for him and they are always there for him."

"We are very happy now. I see him well; I see him without seizures," said his mother, Silvana Angeloni, as Dr. West met with the family in the hospital room. She told a story of love and persistence in acquiring the best care for her son and eventually securing a trip to San Antonio. The family first had to receive permission from the Italian government to seek surgery in the United States.

"I was the one who would not accept that this was epilepsy," she said at a briefing for San Antonio media. "I said, 'no, no, no.' My husband said to me, 'Sometimes life goes this way, but science can move fast to find a remedy.'"

They consulted physicians who said surgery could result in death, paralysis or loss of one of the senses. Others suggested resection of a lobe of the brain, likely to have a severe impact on Michele's ability to function. "We said no, we have no right to do that to Michele," his mother said.

After meeting Dr. West, who described surgery that could help Michele while not damaging his abilities, the family agreed to bring Michele to America. "Dr. West is a friend who said differently. We said, 'Do the miracle,'" Mrs. Angeloni recalled.

In an initial operation Aug. 9 at University Hospital, Dr. West and his team placed strips of electrodes directly on the brain to pinpoint the boy's epileptic activity. The major surgery took place Aug. 12, when the team removed a bone above the right eye to gain a clear view of Michele's hypothalamus, then resected the hamartoma. "No one has ever done this approach--removing bone to allow minimal retraction around the brain," Dr. West said. Retraction refers to holding open a wound for the purpose of surgical resection.

"I am cautiously optimistic that we will see an improvement not only in control of seizures but in Michele's cognitive and behavioral development."

Michele left his hospital room Aug. 16 for the first time. "When he walked down the hall, all the nurses were clapping for him," Dr. West said. "He's a very special kid who has been through a lot. We hope this will free him to live an entirely new life of learning and remembering."

His mother voiced the same hope. "Now that the seizures have disappeared he will make friends, because when he wants to he says funny and intelligent things. I just want to say thank you to everyone."

Dr. West's team members included Dr. C. Akos Szabo from the Department of Medicine; Dr. Dennis Vollmer, chief of the Surgery Department's Division of Neurosurgery; Drs. Tod Sloan and Kathryn Hamilton from the Department of Anesthesiology; faculty from the departments of Radiology and Pathology; Dr. Glenn Harper, seventh-year neurosurgical resident; and Cindy Rogers, Division of Neurosurgery, registered nurse and clinical coordinator. Beverly Combs, administrative secretary in neurosurgery, communicated with the Angelonis in Italy and obtained housing for the family in San Antonio with the Defense Language Institute at Lackland Air Force Base.

Michele will be on three anti-epileptic medications for the foreseeable future, down from a previous maximum of 14.

Dr. G. Alexander West, surgery/neurosurgery, is interviewed by KSAT-TV medical reporter Angela Vierville for a segment on a rare epilepsy surgery he performed.

Silly hats and Hawaiian shirts
mark SECC campaign fund raisers

As an added wrinkle to this year's SECC, volunteers are sought to model their cheerful attire and raise funds for the campaign. Contest participants who raise the most money will receive prizes for having the Silliest Hat and the Silliest Hawaiian Shirt. The contests start Wednesday, Sept. 1, the same day the annual SECC begins.

Each hat or shirt contestant who signs up to raise funds will receive a free 11-by-17-inch promotional flier (with photo of said hat or shirt) to assist the fund-raising effort. To enter and receive a flier, call Al Julian, director of photographic services and member of the SECC Advisory Committee, as soon as possible at ext. 2269.

Contestants will wear their highfalutin headgear at the Silly Hat Day festivities on Friday, Sept. 10, with judging at 12:30 p.m. in the surface parking area by the new parking garage next to the auditorium. Judging will be in the vicinity of a basketball competition being held on the lot at that time. That competition is a challenge match between several departments.

A new twist this year is a visit by the Spurs Coyote and the NBA Championship Trophy on Thursday, Sept. 16. The basketball-uniformed, ear-flapping, tail-wagging mascot will appear at an SECC food fest set for 11 a.m. to 1:30 p.m. in the auditorium foyer. The Coyote is scheduled to arrive at about 11:30 a.m.

For $5, SECC donors may be photographed with the Coyote and the trophy. Donors will be allowed to keep the negatives from the photos. Proceeds will go to the United Way of San Antonio and Bexar County.

Hawaiian Shirt Day will be held Friday, Sept. 17, with judging at 12:30 p.m. in the third-floor Medical School snack bar area. Fund raising is encouraged, but not required, for contest entry; employees may opt to join the fun by paying $1 to participate before judging begins. Employees may enter one or both contests.

The SECC ends Sept. 17. A top institutional fund-raiser the last two years, the Health Science Center this year is a Pacesetter Institution and the campaign is earlier than usual. The campus campaign raised $193,000 two years ago and $207,000 last year.

The SECC will continue to feature personal choices by employees about what they wish to donate. Payroll deduction, check payment and cash payment of charitable donations is available. Contribution materials soon will be available in departments, divisions and offices; employees with questions may check with their departmental SECC representatives.

Departments will again raise funds for SECC through taco sales, bake sales and other events.

Dr. Brackley honored as a quality educator

IMS vendors to visit campus

SCT will present its Banner system throughout the day Sept. 22 in the auditorium foyer. PeopleSoft will be on campus Sept. 28 at a location to be determined.

Mentoring program celebrates 10 years

It has been a decade since the first Health Science Center volunteers walked the halls of John Glenn Elementary School in the Northside Independent School District, seeking to improve reading skills and foster friendships. During the past years, volunteers also began working with students at John Holmgreen Junior and Senior High School.

Today the mentoring program, which pairs Health Science Center staff and faculty volunteers with at-risk students, is still going strong, but new mentors are needed for this year. Both schools are looking for more volunteers to begin the program during late September or early October. During the first week of September, tables will be located around campus to provide information and applications for mentoring at both schools.

Volunteers work with students one hour a week during the 8 a.m. to 3 p.m. school day on reading ability, problem solving, setting goals and improving academic skills. The sessions are designed to prevent dropouts, increase self-esteem and improve academic performance.

In Memoriam

Dr. Yeung was a competitive long-distance runner and participated in events around the country, including the Boston Marathon. Most recently, Dr. Yeung was conducting research at the Health Science Center on the development of a genetic system for Actinomyces.

Calendar for August 23 - 29

Tuesday, August 24, 1999
6:30 a.m.
Podiatry Case Conf. (LEC: 2.010)
8:00 a.m.
Medical Housestaff Specialty Conf. (MED: 409L)
8:00 a.m.
Rehab Medicine Journal "Sports & the Amputee," Drs. Charles Dempsey & Norman Gall (UH: Reeves Rehab Center 3rd-floor classroom)
4:00 p.m.
Molecular Medicine Seminar Series "The Rb Family & Cdks in the Cell Cycle & Cancer," Dr. Antonio Giordano, Jefferson Medical College (LEC: 3.002)

Wednesday, August 25, 1999
7:00 a.m.
Vascular Surgery Grand Rounds, Dr. Mellick Sykes (MED: 209L)
8:00 a.m.
Medical Grand Rounds "Geriatric Neurology for Internists," Dr. April McVey, Wilford Hall Medical Center (MED: 409L)
9:00 a.m.
Surgery Trauma M&M Conf., Dr. Ronald Stewart (MED: 309L)

Thursday, August 26, 1999
7:30 a.m.
Thoracic Surgery Resident Teaching Conf. (VA: 4th-floor CT Library A404 )
8:00 a.m.
Pain Management Grand Rounds, Dr. James Rogers (UH: Reeves Rehab Center 3rd-floor classroom)
Noon
Pulmonary, Thoracic & Oncology Conf. (MED: 209L)
4:00 p.m.
Surgery Tumor Conference, Dr. Anatolio Cruz (MED: 209L)

Friday, August 27, 1999
7:30 a.m.
Pediatric Grand Rounds "Acute Management of Pediatric Poisonings," Dr. Brian Bates, Methodist Children's Hospital (MED: 409L)
9:00 a.m.
General Surgery Grand Rounds, Dr. Wayne Schwesinger (MED: 409L)

Saturday, August 28, 1999
7:15 a.m.
Surgical Physiology Conf., Dr. Kenneth Sirinek (MED: 209L)
9:00 a.m.
General Surgery Grand Rounds, Dr. Wayne Schwesinger (MED: 209L)