Doctors 'cautiously optimistic' following
Health Science Center faculty performed successful surgery this month on a teenage boy with an extremely rare form of
epilepsy. The operation, the first of its kind in San Antonio, took place Aug. 12
at University Hospital.
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.
Michele Angeloni of Cagliari, Sardinia, visits in
his hospital room with clinical coordinator Cindy
Rogers, surgery/neurosurgery, and Dr. West.
Silly hats and Hawaiian shirts
Those oddball hats or loud
shirts that seem destined for the mothballs can have a second life during
the upcoming State Employee Charitable Campaign (SECC).
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
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.
Calendar for August 23 - 29
Monday, August 23, 1999
Orthopaedic Teaching Conf. "Bunions" (MED: 309L)
Medical Housestaff Specialty Conf. Resident & Intern M&M (MED: 409L)
Rehab Medicine Lecture "Prosthetic Biomechanics, Alignment & Gait:
Sagittal Plane Alignment & Ankle Joint," Dr. Andrew Gitter (UH: Reeves Rehab Center 3rd-floor classroom)
Tuesday, August 24, 1999
Podiatry Case Conf. (LEC: 2.010)
Medical Housestaff Specialty Conf. (MED: 409L)
Rehab Medicine Journal "Sports & the Amputee," Drs.
Charles Dempsey & Norman Gall (UH: Reeves Rehab Center 3rd-floor classroom)
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
Vascular Surgery Grand Rounds, Dr. Mellick Sykes (MED: 209L)
Medical Grand Rounds "Geriatric Neurology for Internists," Dr.
April McVey, Wilford Hall Medical Center (MED: 409L)
Surgery Trauma M&M Conf., Dr. Ronald Stewart (MED: 309L)
Thursday, August 26, 1999
Thoracic Surgery Resident Teaching Conf. (VA: 4th-floor CT Library A404 )
Pain Management Grand Rounds, Dr. James Rogers (UH: Reeves Rehab Center 3rd-floor classroom)
Pulmonary, Thoracic & Oncology Conf. (MED: 209L)
Surgery Tumor Conference, Dr. Anatolio Cruz (MED: 209L)
Friday, August 27, 1999
Pediatric Grand Rounds "Acute Management of Pediatric
Poisonings," Dr. Brian Bates, Methodist Children's Hospital (MED: 409L)
General Surgery Grand Rounds, Dr. Wayne Schwesinger (MED: 409L)
Saturday, August 28, 1999
Surgical Physiology Conf., Dr. Kenneth Sirinek (MED: 209L)
General Surgery Grand Rounds, Dr. Wayne Schwesinger (MED: 209L)