About 20 percent of epilepsy patients have seizures that can’t be controlled by medication. These seizures affect quality of life, and impair the ability to learn, drive, work, and socialize. For some of these patients, Kenneth Vives, MD, and his colleagues at the Yale Epilepsy Center—the only such program in Connecticut—can provide a life-altering surgical alternative.
Vives works closely with an interdisciplinary team to evaluate epilepsy patients, using EEG, MRI, PET, and SPECT to locate the source of the seizures. Then the team determines, with the help of a neuropsychologic exam, which areas of the brain aren’t working. In most cases, Vives also does an intracranial electrode study, placing up to 200 electrodes on the surface of and inside the brain. When the seizures occur, the electrodes tell him where. Then, he determines whether removing the affected part of the brain will impinge on movement, language, sensation, or other functions. If it’s safe to operate, he removes it. “Patients can tolerate it because that area of the brain is not working correctly to start with,” he said.
Vives performs stereotactic surgery, a computer-based technique involving a threedimensional coordinate system that guides him to the problem area. Mapping data, measurement of neurochemicals, and imaging data are merged into one imaging workspace. “It allows me to see all of these things at the same time in the OR so I can remove or treat the area where epilepsy is coming from but avoid areas where there are critical functions,” he said.
His patients vary widely in age, from 3 years to 60-plus, but treating children gives him the most satisfaction. “If you can stop their seizing and allow them to get the proper schooling, it makes such a huge difference in their lives,” he said, citing the recent case of an 11-year-old girl who was able to catch up to her grade level after years of being left behind.
Vives is also an expert at treating Parkinson disease using deep brain stimulation—he places electrodes in the basal ganglia, the area of the brain afflicted by the disease. He expects that this technology will be used increasingly in the coming years to treat a variety of disorders, including OCD, depression and schizophrenia, for which there are currently clinical trials under way. In the meantime, he is studying the use of viruses to deliver genes to enhance the survival and function of the dopamine-secreting cells in the brain that are affected by Parkinson disease, a technique that has already shown promising results in monkeys.
More about Dr. Vives
Name: Kenneth Vives, MD
Title: Associate Professor, Director of Stereotactic and Functional Neurosurgery
Area of expertise: Surgical treatment of epilepsy and Parkinson disease
Place of birth: Jersey City, N.J.
College: Rutgers College of Engineering
Med School: Yale School of Medicine
Training: Yale Neurosurgery Residency
Family: Married to Carrie Ferrigno, nurse practitioner in women’s health
What is most challenging to you in academic medicine? Balancing my focus between patient care, training of residents and research. Each item cries out for and deserves my full attention, but my participation in each area benefits the others.
What is most rewarding? Changing a patient’s life by curing a chronic affliction.
What do you like most about your practice? The interactions with other faculty and residents—they constantly challenge my current thinking and help me continue to grow.
Personal interests or pastimes: Cooking (I am smoking a lamb shoulder with pomegranate-spiced glaze and serving it with a fresh fennel, urfa pepper and caper pickle to celebrate our graduating chief resident’s Turkish heritage). Gardening (I have 85 tomato plants that I started from seed on my deck).
Last book read: Descartes Bones by Russell Shorto. I am trying to get through Barcelona and Modernity: Picasso, Gaudi, Miro, Dali, but I’m stalling.
What would you do to improve our clinical environment if you had a magic wand? Increase the research funding level at the NIH so that more investigators are able to receive funding. I truly believe that innovation in translational research is where we can invest in the future of medicine.
This Article was submitted by Mark Santore, on Tuesday, January 21, 2014.
Source: Yale Medical Group