LBC 0308004 Brainwave - Methodist Le Bonheur Healthcare

Spring 2008
Referrals: 888-890-0818
Neuroscience Institute
Brain Tumor Program
Makes Strides for
Young Patients
Le Bonheur First to Use New VNS
Therapy on Epileptic Patients
As home to one of the nation’s busiest
pediatric surgical brain tumor programs,
parents often find that Le Bonheur is the
last chance for saving their child’s life.
In fact, about half of the kids Le Bonheur
neurosurgeons operate on have been told
at another children’s hospital that their
situation is inoperable, says
Dr. Frederick Boop, medical director of
pediatric neurosurgery.
Le Bonheur’s brain tumor program is a
joint effort with St. Jude Children’s Research
Hospital. In 2007, the Neuroscience Institute
saw 175 brain tumor cases.
“When I started training, the chances of
a child living five to 10 years with our most
common brain tumors was about 25 percent,”
Dr. Boop says. “Now, 15 years later, 70
percent have long-term success.”
Dr. Robert Sanford, who helped start the
brain tumor program in 1985, says that
advancing the science is just as important
as providing great care. Part of the goal is
to create better techniques and scientific
advances. Sanford recently completed a
15-year study demonstrating that surgical
resection is curative for low-grade gliomas.
In the most common type of pediatric
brain tumor, medulloblastoma, a cure rate of
80 percent has been maintained with reduced
morbidity by complete surgical resection,
reducing the dose of radiation and improved
chemotherapy. In 2007, Le Bonheur saw
44 children with that specific type of tumor.
“We take care of brain tumors in a way
so that when we’re finished, we’ve made
advancements in the science as well,”
Sanford says.
The latest implant features advanced internal
Neuroscientists at Le Bonheur Children’s
monitoring of its electronic system and has
Medical Center are the first to use the latest
the future capability of seizure detection,
advancement in Vagus Nerve Stimulation (VNS)
once software is developed and approved.
Therapy for epileptic patients.
Neurologists also have more capabilities to
The new VNS Demipulse 103 is an updated
program this device specifically for the patient
model on therapy that has been used since
who wears it.
1997 to treat uncontrollable seizures. VNS
The device is about half the size of previous
Therapy is the only device approved for
models, making it less noticeable under the
epilepsy and is often used when medicines
skin. It also alerts the physician when the
aren’t effective in controlling seizures.
VNS Therapy delivers stimulation via a device battery is about to expire.
implanted just under
the skin in the left
chest area. The
small pacemakerlike device sends
precisely timed
and measured mild
electrical impulses
to the left vagus
nerve, which then
activates various
areas of the brain.
The patient or
caregiver also
has the ability to
initiate or abort
stimulation with a
hand-held magnet.
Dr. James
Wheless, director
of the Le Bonheur
Neurosurgeon Stephanie Einhaus, M.D., (left) inserts the newest VNS model in a
Neuroscience Center Le Bonheur patient with the help of UTHSC neurosurgical resident Jody Helms, M.D.
and Comprehensive
“This new device represents a significant
Epilepsy Program, was involved in the
advance
over the prior models in the treatment
development of VNS Therapy. VNS Therapy
of epilepsy. We are happy to continue being
manufacturer Cyberonics approached Wheless
on the forefront of new treatments for children
and his team to implant the newest model.
with epilepsy at Le Bonheur Children’s Medical
“We selected Le Bonheur as one of the
Center,” Wheless says.
first facilities in the country to implant the
An ideal candidate for the procedure has
new Demipulse 103 because of the center’s
been on two or three medicines, but still
reputation as one of the South’s leading
has seizures. Once evaluated in Le Bonheur’s
neurological institutes,” said Dan Moore,
Comprehensive Epilepsy Center, neurologists
Cyberonics’ president and chief executive
can decide whether VNS Therapy would be
officer. “Since VNS Therapy was FDA-approved
appropriate.
in 1997, Dr. James Wheless has been a believer
“VNS Therapy is the only approved device for
in finding the right treatment to reduce
epilepsy, and after medicine, it is the second
seizures and offer a better quality of life for
most commonly used treatment,” Wheless says.
the countless patients he’s treated, as well as
their families.”
Neurosurgeon Alex Sanford, M.D., evaluates brain scans.
lebonheur.org/neuroscience
NIH Study Tests Seizure Drugs
for Children with Epilepsy
Researchers at Le Bonheur Children’s
Medical Center are helping lead a
National Institutes of Health (NIH) study
to test new seizure drugs in children with
absence epilepsy.
The study, which is the largest pediatric
epilepsy study funded by the NIH, includes
36 study centers across the country.
Dr. James Wheless, director of Le Bonheur’s
Neuroscience Institute, is the Mid-South’s
primary investigator for the program.
Absence epilepsy, also known as staring
spells, is a subtle version of the disease in
which children “zone out” for a period
of time.
The NIH study is studying three drugs
that are used to treat the disease –
Depakote (valproate), Lamotrigine and
Zarotin – to see which works best for the
population, says Michelle Ellis, research
coordinator for the Neuroscience Institute.
The study, which is in its second year,
was originally scheduled to last five years
but has been extended because of its
success and the NIH’s desire to gather
more data.
Of the 436 children in the study, ages
2 to 13, Le Bonheur has enrolled eight,
Ellis says.
Ellis adds that investigators are also
conducting a genetic component as part
of the study in hopes of pinpointing a
specific protein that is found in children
with epilepsy.
“It’s such an honor to be a part of this
study,” Ellis says. “You have to have a
good research reputation to be selected.”
For more information, contact Ellis
at 901-287-5330.
EMU Coordinator Works with Families,
Physicians to Facilitate Care
When parents feel lost and unsure of
what the future holds for their children,
Karen Butler brings comfort.
Whether she’s explaining the intricacies
of epilepsy or helping them find a hotel
room, Butler is a resource to families
in Le Bonheur’s Epilepsy Monitoring
Unit, or EMU.
A self-proclaimed jack of all trades,
Butler is the EMU’s point person
for referring physicians, families
and neuroscientists in Le Bonheur’s
Neuroscience Institute.
“I’m fortunate that this sort of fell in
my lap,” Butler says. “It’s a wonderful
opportunity to learn and to grow and to be
part of this team.”
Le Bonheur’s EMU has seven specially
equipped rooms with 24-hour video/EEG
monitoring.
Butler has held a handful of roles at
Le Bonheur in her more than 20 years at
the hospital – from staff nurse to PediFlite
flight nurse to Pediatric Intensive Care
clinical director. She landed her
relatively new role as EMU coordinator with
some coaxing and just three days
of training.
“From the first day I met
Karen, I knew she had the right
combination of professional and
people skills to excel in this
position. This position requires
a person who can explain
to families the complicated
diagnostic testing their child
will receive, and to be able to
adapt this to that family’s level of
medical sophistication,” said
Dr. James Wheless, director of
Le Bonheur’s Comprehensive Epilepsy
Program. “She must also be responsive
to the referring physician’s office, and
work well with their office staff. She is
always looking for ways to improve our
communication with the families and
physicians we serve.”
Butler has also proven to be an
invaluable resource to referring physicians
by sending them any discharge information
and other important information about
the patient.
“Referring physcians are a key piece to a
patient’s consistent care,” she says.
For her, though, Butler is most impressed
with watching physicians change the course
of their patients’ lives.
“It is a very impressive physician group,”
says Butler. “They work together well, are
very interested in research and are wellrespected. What their expertise is doing for
these kids is life-changing.”
Butler can be reached by phone at
888-890-0818 or 901-287-5916. Her fax
number is 901-287-5304.
Epileptologist to
Share Expertise
with Caribbean
Dr. Dave Clarke,
an epileptologist
and sleep
neurophysiologist
at Le Bonheur
Children’s
Neuroscience
Institute, was
recently selected by
the International
League Against
Epilepsy, or ILAE, to
share his expertise
with epilepsy centers
in the Caribbean.
Dave Clarke, M.D.
Clarke will serve as
a visiting professor at the University of the
West Indies and will also work to establish a
telemedicine program between Le Bonheur’s
Neuroscience Institute and the university.
Clarke is one of four visiting professors
selected by ILAE from North American
Epilepsy Centers to travel to Latin America or
the Caribbean to assist in teaching medical
professionals, students and residents about
developments in epilepsy research and
treatment. Clarke will focus his work with
the Jamaican Chapter of ILAE. He will travel
to the Caribbean at least four times the first
year to teach. He hopes to include physicians
from neurosurgery, psychiatry and the entire
epilepsy team.
“Part of Le Bonheur’s mission to provide
exceptional health care to children is to reach
beyond our walls and help share our knowledge
with other health care professionals. Dr. Clarke
and the Neuroscience Institute are leaders in
treating epilepsy and are the ideal ambassadors
for sharing their expertise,” said Meri Armour,
president of Le Bonheur Children’s.
Clarke says his goal is to foster joint research
projects and help epileptologists in Jamaica
and the Caribbean set up a pediatric surgical
epilepsy component to their program.
“This should not be perceived as a one-way
mentorship program. The idea is to foster a
both clinical and academic interrelationship in
which both centers may learn and benefit from
each other’s different cultural environments
and patient populations and possibly
foster new research opportunities for both
institutions,” Clarke says.
Clarke was also selected to establish a
telemedicine program between Le Bonheur
Children’s and physicians in Jamaica. This
program will provide pediatric neurologists in
Jamaica with the knowledge and resources of
Le Bonheur’s team in dealing with difficult-totreat epilepsy cases.
Clarke is co-director of neurophysiology
at Le Bonheur. He has a special interest in
pediatric epilepsy, sleep-related disorders in
patients with epilepsy and the neurological
complications of sickle-cell disease.
Epilepsy Monitoring Unit Coordinator Karen Butler (right)
with Le Bonheur patient Olivia Jones
lebonheur.org/neuroscience