Seizure-prevention surgery
is now available in Wayne

As reported by Phyllis Moore
News-Argus Staff Writer

A procedure to prevent seizures was performed for the first time in Wayne County last month.

Neurosurgeon Robert Lacin of Goldsboro Neurological Surgery said the vagus nerve stimulation therapy has been around for several years but this was the first time the surgery had been done at Wayne Memorial Hospital.

It is designed to help epilepsy sufferers who continue to have siezures despite being on medications.

Success rate for the procedure is very high, Dr. Lacin said. The complications are minimal and the cost savings to the patients are great because the need to take pills for the rest of their lives is eliminated.

"That's really the main reason the FDA approved this," he said. "It's a good alternative to taking pills forever."

Couple that with the side effects from continued use of medications, concern over blood levels, liver function, and interactions between medicines, and the surgery is the wise option to consider, he said.

Experiments over the years found that the vagus nerve is most directly connected to triggering seizures. One of 12 cranial nerves, it moves the diaphraghm and vocal cords and has sensory functions.

"For some reason we really don't know, if you stimulate the vagus nerve, you can decrease the intensity and-or frequency of seizures," he said. "So if you have a patient who has an aura, a feeling or sensation they're going to have a seizure, for these people if you put stimulators under the skin, you can touch it with a magnet and abort the seizure."

There are two parts to the unit --- electrodes that resemble very tiny plastic thread, and a lightweight device about the size of a pocket watch. One of the electrodes is wrapped around the vagus nerve and the other connects to the battery.

Called a pacemaker for the brain, the battery portion last up to 10 years. Similar to a computer, the doctor programs it to give an electrical charge. The unit can either be left on all the time or activated when the patient feels the seizure coming on, by placing a magnet over the device and swiping it back and forth.

He said close to 50 percent of people who have the surgery have fewer seizures during the three years afterwards. Patients typically continue taking their medicine for a short time following the surgery, and are tapered off of it.

Dr. Lacin said the surgery is not difficult if a physician knows how to expose and handle a nerve. Two incisions are made on the patient, one in the neck area and another near the armpit to access the chest wall and implant the device under the skin. Scarring in these areas is minimal, he said.

The surgery is done under general anesthesia and takes about an hour. The patient generally goes home the same day.

"As soon as it's done, they will feel a difference right away," he said. "It really doesn't matter what kind of seizure you have. It works on all types."

The main after effects are voice-related. Coughing, hoarsness and a change in the voice can occur because the vagus nerve is connected to the vocal cords.

Two surgeries were done Aug, 29, both on women in their 30s. One of the women, Karen Peele, has worked at Wayne Memorial Hospital for 12 years and is a nurse technician.

Mrs. Peele began having seizures at 3 years old but over time they improved and stopped when she reached 18. They mysteriously returned again when she turned 30 and she said she averages between six and 12 a month.

Hers are unique in that they most often occur at night. Until 10 a.m., she does not know when they will strike so is unable to drive before that and relies on someone to bring her to work. Even on weekends, she says, she might have them up to two hours after she wakes up.

She said she found out about about the new procedure from a magazine article and ordered a video about it. When she saw her doctor in April, it was suggested she go to Duke for the surgery since Wayne Memorial did not offer it. In July, though, when she learned Dr. Lacin would be doing the surgery at Wayne Memorial, she made the choice to wait.

"I felt more at home here," she said. "I trusted the people around me, and my family would not have to travel as far. The Lord worked it out for me to find out about the procedure and have it done here."

She said she spoke with a representative from the company that manufactured the device and viewed a video of a surgery, so she felt very comfortable with the procedure.

"I was excited and everyone at work knew it," she said. "I told them, if you lived with something this long, you'd be excited, too. It's the first breakthrough in 100 years."

She and her husband do not have any children yet because she has been on medication, but now there is the hope that she might be able to do that.

Mrs. Peele returned to work five days after her surgery and said she felt fine. She said she knows the device is there but it's not prominent. It will be activated Sept. 19 and at that point, she expects to be tapered off her medication.

"They'll set it and every five minutes, there'll be a jolt from the unit," she said. "When you feel one coming on, you take the magnet that can be worn as a wristwatch or a pager, and swipe across it."

She plans to attend the health fair sponsored by the hospital Sept. 21 at Berkeley Mall, representing the hospital and giving a testimonial about her experience. She said she would like to think her story might give others hope.

Dr. Lacin said the only candidate who might who might be discouraged from having the procedure would be one who's doing well on medication.

He does about 80 operations a year and anticipates he will average 12 operations for the vagus nerve stimulation. There are 2.5 million people in the United States who are affected by epilepsy or one percent of the population.

Reporter stays vertical during surgery

By Phyllis Moore
News-Argus Staff Writer

The perks of being a reporter can be mighty heady: free food now and then, maybe a coffee mug or a magnet, sometimes more information than you want or need to know.

You may even get to experience things and go places that would otherwise be closed off to you, such as sitting in on a surgery.

I had interviwed Dr. Robert Lacin about a procedure that would be done for the first time at Wayne Memorial Hospital. The "pacemaker for the brain" could stop a seizure before it started.

My daughter had a seizure disorder when she was very young, so I understood the frustration of finding the right dosage and combination of medicines to control them and then regular bloodwork to make sure the levels never went too high. The idea of wrapping an electrode around a nerve that could prevent the seizures and keep them under control seemed intriguing.

I never imagined I would find myself within a foot of the patient, leaning over an operating room table and taking a picture.

I wasn't prepared for the invitation to join them in the operating room. My birth certificate assures my admission to the adult world, but it's not really a place I choose to nest. Surely today would not be the day I'd feel faint.

They dressed me out in pants, jacket and overshoes as well as cap and face mask. I actually looked like an operating room nurse except the fear in my eyes likely betrayed my naivete.

The first order of the day was the music selection.

"Do you like the Drifters?" Dr. Lacin asked me.

When I gave it a thumbs up, he said I had passed the basic test for being there.

The room was filled with nurses and an anesthesiologist. Because they are professional and know their roles by heart, there can be a more relaxed atmosphere as they go about their jobs.

It was like any medical show you see on television where the banter is easy and free-flowing as long as there is no emergency.

I glanced over now and then, kind of like when you were forced to watch a driver's ed film but you really didn't need to have that much information in your face.

When they prepare the patient, a transparent sheet is spread over the area where surgery will be done and a reddish solution is swabbed over it. Amazingly, when the incisions are made, there is very little blood and a suction hose takes care of any there might be.

Still, try as I might, the mind over matter thing didn't work for me as the room grew warmer and warmer and I tried to convince myself it was because of all the medical garb I was wearing from head to toe.

I weighed carefully being a wimp and sitting down or taking the chance that when I fainted, it would be even more noticeable if I ripped out several cords and plugs from the machines as I went down.

I feel I was very considerate not to interrupt the surgery in that way.

Dr. Lacin, however, must have thought I was not being a good team player.

"Phyllis," he said. "Do you want to look at what I'm doing and take a picture now or would you prefer to be pale and sit there , feeling faint?"

Hmmmmmm. I told him I'd prefer the latter but stood up anyway and did my job.

As they closed up the incision areas, the stitches were done from beneath the skin so that none would have to be removed later and there would be even less scarring.

It was fascinating to see the intricacy of the human body and be reminded of how doctors and medical professionals really do hold life in their hands at times.

At that point, I was free to return to my real job. They were still putting the finishing touches on the surgery as I departed like a commuter who was trying to get out and beat the traffic.

I felt rather badly bidding my goodbyes while they were all still completing the operation, especially when some of them stopped what they were doing to answer me and trade pleasantries. But at least I got out of there without fainting.

I really prefer for people to know me a while before the get to witness that.

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