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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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During the course of her treatment, which consisted of a mastectomy, reconstruction surgery and hormone therapy, Thomas received several pieces of good news about her prognosis. The first came on the same day as her surgery in November of 2016: Her cancer had not spread to her lymph nodes. Genetic testing also showed that she does not have the BRCA genes, which raise the risk of developing breast and several other types of cancer. A genomic test showed that she would not need chemotherapy and determined that she has a relatively low chance of recurrence. In spite of the good news, and her relatively straightforward treatment, Thomas says getting through it all has been challenging both emotionally and physically. Her close-knit family helped her stay strong and positive throughout treatment and recovery, both in-person and by video. She had to make some difficult choices along the way, including deciding to freeze her eggs. She has ongoing struggles with pain in her chest and has had to learn how to manage it with physical therapy. She has made serious lifestyle changes, including changing her diet and getting more serious about working out, to improve her chances of remaining healthy. And she continues to see Nelson for follow-up appointments to make sure there are no subtle signs of a recurrence.
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Her doctor referred her to the USC Norris Comprehensive Cancer Center, where she saw Maria Nelson, MD, a surgical breast oncologist at Keck Medicine of USC, to operate on her and guide her through treatment. Nelson, who also is assistant professor of clinical surgery at the Keck School of Medicine of USC, explained to Thomas that she had early stage breast cancer — ductal carcinoma in situ (DCIS) in her left breast and DCIS and invasive ductal carcinoma in her right. Surgery is the mainstay for early stage breast cancer, but most patients also typically need some combination of radiation, chemotherapy and hormone therapy, depending on factors such as whether the cancer has spread and what type of surgery is performed. As is the case with most patients, the first big decision Thomas had to make was whether to have a lumpectomy or mastectomy. Nelson notes that research has demonstrated that treating early stage breast cancer with mastectomies versus lumpectomies plus radiation results in equivalent survival.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
The breast cancer specialists of USC Norris Comprehensive Cancer Center know that after receiving a breast cancer diagnosis, patients have a lot of questions in the initial stages of treatment about the disease and their recovery. One way to help? The multidisciplinary USC Breast Center. New patients have the opportunity to meet with all of their doctors in a single day, which provides the opportunity for patients to ask questions of and share their concerns with the surgeons, oncologists and radiologists — all of whom specialize in treating breast cancer — overseeing their care. Before meeting the patient, the breast surgeons, medical oncologists, plastic surgeons, radiologists and psycho-oncologists create a care plan that meets the specific needs of each patient. Depending on the type of breast cancer and its severity, the team consists of three to five doctors. This approach offers many benefits, explains Maria Nelson, MD, assistant professor of clinical surgery at the Keck School of Medicine of USC. Traditionally, patients see each doctor separately, but this multidisciplinary clinic eliminates the need for scheduling multiple appointments. Patients also get the big picture of their personalized plan and why the team believes this plan addresses their specific cancer in the most effective way. Perhaps most importantly, Nelson says, it also helps deal with the anxiety that comes with a cancer diagnosis. “When the patient understands how the disease works and what the treatments are and how it all works together, they feel more comfortable and, hopefully, a little less anxious,” Nelson says. “They can see for themselves that all the doctors are on the same page and communicating and working together.” Ancillary service providers, including genetics counselors, dietitians, physical therapists, occupational therapists and social workers also meet with patients at the multidisciplinary breast clinic, rounding out the treatment team. Each patient receives a book that contains invaluable information including imaging studies and pathology reports, a glossary of breast cancer terms, and pages of notes from each of their visits explaining each treatment stage and the next steps in their care. “It can be overwhelming and this gives them a guide that they can refer to throughout their treatment,” Nelson says.
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
Though nearly 270,000 women will be diagnosed with breast cancer this year*, most are older women, with the median age of diagnosis being 62. And while it is rare in younger women, with fewer than 5% of new cases occurring in women under 40, breast cancer can strike at any age. In the days before she got her results, Thomas says she prayed more often than normal and, through prayer, she came to believe two things. “I knew it was going to be cancer and I knew I was going to fight it,” she says.
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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“There was really nothing to think about,” says Thomas, who chose to have a double mastectomy. “I have never been so sure about a decision as I was with that and it took me no time to make it.” Thomas felt her choice would reduce her anxiety about the possibility of recurrence, which Nelson says is a fear that tends to be heightened among younger patients. While recurrence is a concern most patients have, younger people have more years ahead of them — which also means more time for the cancer to stage a return, Nelson says. Though fear of recurrence is a genuine concern for all patients, Nelson also points out that advances in breast cancer research have had a positive effect on survival rates. Genetic tests and genomic assessment have shed light on some patients’ ongoing risk profile and negates the need for chemotherapy in others. New drugs are targeting certain cancers and preventing the recurrence of others. "Things have changed because we know more about how tumors work," Nelson says. "To me, that is hopeful because the more we learn about how cancers work, the more precise we can be with our therapies, the better outcomes we can have."
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In spite of the good news, and her relatively straightforward treatment, Thomas says getting through it all has been challenging both emotionally and physically. Her close-knit family helped her stay strong and positive throughout treatment and recovery, both in-person and by video. She had to make some difficult choices along the way, including deciding to freeze her eggs. She has ongoing struggles with pain in her chest and has had to learn how to manage it with physical therapy. She has made serious lifestyle changes, including changing her diet and getting more serious about working out, to improve her chances of remaining healthy. And she continues to see Nelson for follow-up appointments to make sure there are no subtle signs of a recurrence. In spite of the challenges, she says that she has a lot to be grateful for. “I am aware that everyone’s story doesn’t end as well as mine,” she says. “I am so grateful Dr. Nelson entered my life. I am grateful that I have this story and I thank God I was able to survive it.”
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While climbing into bed one night in 2016, Angela K. Thomas felt something unexpected. Though she knew that fibrocystic breasts — a benign condition she had — feel lumpy to the touch, this time was different. Her right breast had a lump. Only 32 at the time, Thomas had no reason to think anything would be wrong. She was an otherwise healthy young woman enjoying a busy life in her adopted home of Los Angeles. The aspiring actor was racking up credits on TV shows and in theater, worked in hospitality and was very involved in her church. And she had no changes in her skin on her breasts, pain or discharges from her nipples, which can be early warning signs of breast cancer. Yet, Thomas called her doctor the morning after she felt the lump and her doctor ordered an ultrasound. In the days that followed, she also had a mammogram and biopsies on both breasts. Within a week, she received the news that she had cancer in both of her breasts.
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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According to the Centers for Disease Control and Prevention, someone in the United States has a stroke every 40 seconds and someone dies from one every four minutes. It is the nation’s fifth leading cause of death and a leading cause of serious, long-term disability. Speed and efficiency, while maintaining the highest standards of care, are the guiding principles of the protocols developed by the stroke specialists at Keck Medicine. USC-VHH performs rapid, thorough lab tests and imaging studies to determine the type of stroke a patient is having, where the blockage is located and whether they can stay at USC-VHH or need to be transferred to Keck Hospital of USC for more serious intervention.
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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McClure’s CAT scan showed that he had an ischemic stroke, the most common type, from a blockage in his carotid artery, which caused a blockage in an artery in the brain. He received a clot-busting medication at USC-VHH called tissue plasminogen activator, or tPA, but because the blockage was in a large artery, the team concluded he was going to need surgery at Keck Hospital. Matthew Tenser, MD, assistant professor of clinical neurological surgery at the Keck School, notes that the tPA breaks up clots in about 45% of cases. “Studies show that the larger the vessel, the less likely it will work,” he says. Keck Medicine has advanced imaging capability, a dedicated neurointensive care unit for stroke patients and can treat complex cases, including those that require open surgery. Most of the physicians on the team are board certified in stroke and neurocritical care.
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Tenser first performed angioplasty and stenting on McClure — using a tiny balloon to widen the area in his carotid artery and a stent to prop it open. He then performed a thrombectomy, which involves threading a catheter through an artery in the groin to access the blockage in the brain. A small device on the catheter pulled the clot out of the brain. According to McClure, he was able to move his left side again even before Tenser had completed the procedure. McClure spent only 24 hours in the neuro-ICU and was released from the hospital two days after his stroke. He is one of the fortunate ones because he did not need any rehabilitation and has no deficits from his stroke. Only a few weeks later, McClure was on a fishing trip, reeling in 100-pound halibut off the coast of Alaska. He also is back on his motorcycle and living life to its fullest. McClure realizes that a number of things worked in his favor that day, starting with the fact that his buddy answered the phone when he called. Mostly, though, he gives credit to the team of doctors and nurses who treated him. “I had fantastic medical attention starting at USC-VHH,” he says, crediting their quick work to get him to Keck Hospital. “Dr. Bulic and Dr. Tenser and all the nurses were absolutely phenomenal. I enjoy life and they gave it back to me.”
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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David McClure didn’t know what was wrong the morning that his left arm and leg suddenly wouldn’t move while parking his car. Unable to get out of his car, he reached for his phone and called a friend. “I said to him, ‘I need you, buddy.’”
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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I said, ‘Let’s go.’ This was my chance to get better.
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
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Though McClure didn’t know what was happening, his friend recognized the one-sided paralysis for what it was — a telltale sign of stroke — and immediately dialed 911. Proximity was on McClure’s side that morning. His friend lives nearby and was at his side in minutes. He was yards from a fire station, so paramedics were tending to him quickly. Also working in his favor that day was the fact that he was taken to USC Verdugo Hills Hospital, a primary stroke center that is part of Keck Medicine of USC, which boasts a specialized stroke team that provides the most advanced and comprehensive care possible. The instant that stroke hits, blocking the flow of blood to the brain, the clock starts ticking. The longer the brain is deprived of blood, which carries oxygen to the brain, the more brain cells die, increasing the likelihood the person will suffer a lifelong disability.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
A Stroke
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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As Bill Walston tended the oranges and grapes growing on his Visalia ranch or hiked across the Central Valley countryside, he often felt a worrying shortness of breath and fatigue. The retired school superintendent thought it was simply a sign of aging. He kept his symptoms to himself, not even telling his wife, Judy. But in 2014, Walston, then 76, had a mild heart attack, and doctors opened a blocked artery with a stent. Two years later, another attack required a second stent. The interventions helped, but not enough. The problem: aortic stenosis, a narrowing of the aortic valve opening. When the valve’s flaps or leaflets become stiff and thick from calcium deposits, they have difficulty opening and closing. That forces the heart to work harder to pump blood to the rest of the body. Left untreated, aortic stenosis can lead to fatal heart failure. By April 2019, Walston needed a new valve. His cardiologist sent him to a place where a team of interventional cardiologists and cardiac surgeons are pushing the boundaries of heart valve repair and replacement — the CardioVascular Thoracic Institute (CVTI) at Keck Medicine of USC. The Walstons arrived at Keck Medicine at a fortuitous moment.
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What helped make it even easier for Walston was the model of care at Keck Medicine. The Centers for Medicare & Medicaid Services require that centers performing the TAVR studies have both an interventional cardiologist and cardiac surgeon involved. That spirit of interdisciplinary collaboration was already in place at Keck Medicine. Within the CVTI, cardiologists no longer hand off cases to cardiac surgeons. “We review the data together and discuss the treatment options, then we meet with the patient together in our valve clinic,” says cardiac surgeon Mark J. Cunningham, MD, director of structural heart surgery and surgical director of the heart transplant program. The entire cardiac team was “amazingly warm, so friendly,” Judy Walston remembers. Equally important, “you’re not a number,” she adds. The attention is individual, as are the solutions. On Walston’s procedure day, Matthews and Cunningham entered a hybrid operating room, designed by Cunningham as a combination surgical suite and catheterization lab. Supporting them was both a surgical team and a catherization team to ensure backup was in place if Walston required surgery. “We take that extra step as part of Keck Medicine’s commitment to safety for the patient,” says Cunningham, associate professor of clinical surgery at the Keck School. Bill’s procedure, in which the team guided a specialized valve into place, went without complications. Most TAVR procedures take about an hour and a half, compared with four hours for surgical valve replacement. Findings from the low-risk TAVR trial, in which Walston participated, echoed those of earlier studies, which showed that TAVR has an excellent safety profile and performed as well, or better, than surgical replacement. Results included shorter hospital stays, quicker recovery times and improved quality-of-life scores.
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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Specialists at Keck Medicine’s USC CardioVascular Thoracic Institute help revolutionize treatment for aortic valve disease in a series of life-changing clinical trials.
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On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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Starting in 2011, TAVR has been tested in a series of multi-institutional trials for a full range of patients with aortic disease — initially high-risk patients not recommended for surgery, then patients at intermediate surgical risk and, finally, patients for whom surgery is considered low risk. In the TAVR procedure, doctors don’t need to open the chest. Instead, they make an extremely small incision in the groin. Once at its destination, the catheter is positioned to push the new valve (made from bovine or porcine pericardial tissue) into place over the damaged old one, resulting in a kind of valve-within-a-valve. “We are changing what surgery looks like for these patients,” Matthews says. Although 81, an age when surgery can be chancy for many patients, Walston, a former soccer coach and Boy Scout leader, fell into the low-risk group because of his active lifestyle. He was happy to join the clinical trial. “I was very lucky there was a procedure that could be done so easily,” he says.
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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In August 2019, the U.S. Food and Drug Administration approved the use of TAVR in low-risk patients, extending it to all levels of patients. TAVR essentially has become the “gold-standard” treatment, taking the place once occupied by surgery. However, there still will be patients for whom TAVR is not the first-line choice, including those with bicuspid valves (two leaflets instead of the normal three), as well as those who can’t tolerate blood thinners or have active heart infections. What’s needed next is data on TAVR’s long-term durability and treatment outcomes. Patients like Walston are enrolled in registries that will follow them over the next decade. “We must be cautious,” Matthews says, “at the same time we want to move this paradigm forward. That’s what progress is.” Building on its experience, USC CVTI is currently enrolling patients in two clinical trials studying transcatheter mitral valve replacement. For Bill and Judy Walston, progress has opened up new adventures. Home after two days in Keck Hospital of USC, he noticed how effortless it was to get a full breath and walk farther. “Hiking a trail has become a lot easier,” he says. “It’s so nice not to get tired.” Both avid travelers, they had written off a planned trip to Machu Picchu, the Incan citadel in Peru, because it seemed too rigorous. Now that trip is back on, Walston adds, “one more thing to check off our bucket list.”
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USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
Traditionally, treatment for aortic stenosis has been open heart surgery, with cardiac surgeons having to cut the chest bone and open the rib cage to replace the affected valve. Over the past decade, Keck Medicine cardiovascular specialists have helped to perfect a game-changing minimally invasive procedure called Transcatheter Aortic Valve Replacement (TAVR). “We’ve been on the cutting edge of developing this therapy,” says Ray Matthews, MD, professor of clinical medicine at the Keck School of Medicine of USC, and director of the catheterization lab at Keck Medicine.
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
Freedom from Worry
“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
I can run a mile almost as fast as I used to...I am me again.
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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According to Raymond Hah, MD, assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC and a spine surgeon at Keck Medicine of USC, these fractures typically heal and never lead to any further problems. In some people, however, the injured vertebra later slips on the vertebra below it, resulting in spondylolisthesis. Depending on the severity of the slip, it can cause significant pain, stiffness and difficulty walking or standing. In practical terms, Hill describes the pain emanating from his lower back as a complete quality-of-life killer. At 36, with two young daughters and a full-time job, he already devoted less time to bone-crushing sports, but he and his family liked to spend as much time as possible outdoors. By the time Hill was referred to Hah, kicking soccer balls in the park and short hikes were out of the question. Even picking up his children, the youngest of whom was just a few months old, had become a struggle. “By the time he came to me, Chris had gone through a pretty rapid decline in his function,” Hah says. Patients with spondylolisthesis may improve with more conservative measures, such as physical therapy or injections, but those treatments did not provide any sustained relief for Hill. Hah ultimately recommended surgery because of the amount of pain Hill was experiencing, combined with his loss of function. Hah added that patients with severe spondylolisthesis tend to have excellent outcomes with surgery. Hill had what is called an anterior and posterior lumbar fusion in September of 2018. This operation is performed by making incisions on both the front and back of the patient in order to fuse the spine on both sides.
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The procedure begins on the front, removing the disc and inserting a cage filled with bone graft that realigns the spine, provides support and promotes the spine fusion. Once complete, Hah performed a decompression of the nerves and inserted screws and rods into the vertebrae, along with more bone graft, to further stabilize the spine and promote more bone growth. Though not all surgeons are trained to do so, Hah uses minimally invasive techniques to access the spine from the back. Employing minimally invasive techniques, Hah notes, has improved the experience for patients in part because it causes less damage to the back muscles. “Patients used to be laid up a long time after a fusion,” he says. This technique allows them to spend less time in the hospital, experience less postoperative pain and reduces infection rates. Hill was on his feet a few hours after surgery, and a day later he went home to the San Fernando Valley with orders to walk every day, but to avoid bending, twisting or lifting. Within a week, Hill was walking a mile or two every day without pain. Six weeks later, when Hah lifted the ban on bending and lifting things, he raced home to pick up his youngest daughter for the first time in months. “That was a waterworks moment,” he recalls. At that moment, he says, he knew he was on the path to returning to what he had been — an active dad who hikes and skis and spends quality outdoor time with his family. A year after his surgery, he is just that. “I can run a mile almost as fast as I used to. I can go to one of these crazy workout classes for an hour and keep up. I am me again.”
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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— Chris Hill
Years of charging basketball hoops, bombing down ski slopes and playing many other sports left Chris Hill with more than his share of wounds. He has broken each of his limbs, had one of his shoulders repaired and has had countless scrapes, sore muscles and minor injuries.
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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I was never very easy on my body,” he says, noting that he has endured a lot of pain in his lifetime, but nothing as debilitating as the pain he experienced in the spring of 2018. At its worst, the nerve pain in Hill’s back and legs became so intense that he could barely walk from his car to his office, a distance he estimates at a couple hundred feet. Before he could start working, he was often forced to lie on the floor in the fetal position, which, he discovered through trial and error, helped his pain subside. An X-ray at the USC Spine Center revealed the source of his problem: Hill suffered from a condition called spondylolisthesis, which results from a stress fracture in the lumbar region of the spine. This type of fracture, called spondylolysis, is common among young athletes, especially those whose chosen sport involves frequent bending of the lower back.
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If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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When contemplating a night out with friends, most people would hope to avoid going to a hospital. But for people over 65 in the Glendale, La Cañada Flintridge and Foothills communities, Hillside Café at USC Verdugo Hills Hospital (USC-VHH) has become the new hot dinner spot.
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On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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Improving Access to Advanced Care
Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
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The trend started when the hospital began offering a “senior dinner” discount in July, which provided anyone over the age of 65 with 30% off all prepared meals at the café between 5-8 p.m. This provides older adults with an ideal option for anyone who may not have the time or ability to make dinner each night. Hillside Café also offers multiple mindful eating options, specifically designed by a registered dietitian to have lower sodium, fewer calories, less fat, or more fiber, for example. “The mindful eating options make it easy for our customers to make healthy choices without sacrificing satisfaction or settling for just the salad bar,” says Stephanie Wood, RD, clinical nutrition manager at USC-VHH. “Furthermore, people’s appetites become naturally reduced with age, so the mindful options help ensure that our older customers get their necessary daily nutrition even though they are eating less.” The discounted dinners initially attracted older adults who were patients, former patients or volunteers at the hospital. As these customers started coming more frequently and inviting family and friends, Hillside Café became a comfortable place where seniors from the community could socialize with others their age.
Candace Pearson
“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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“It is so important for all people to find ways to reach out and be part of the community and socialize with others,” says Philip Downs, an active participant in the USC-VHH Cardiac Rehab Center and a frequent patron of the café. “While we are all unique, we are much more alike than we are different.” Downs first came to the café with his wife and fellow participants from the Cardiac Rehab Center. When his dinner companions expressed how much it meant to them to spend time with friends and just get out of the house for awhile, he realized the value of these group interactions. Soon, Downs and his friends invited spouses and other friends. Other older adults in the community who caught wind of the discounted dinners started frequenting the Hillside Café as well. The crowds during the senior dinner hours continue to grow, as does Phil’s supper club. The group meets informally on Thursday evenings to enjoy not only a mindfully planned dinner, but more importantly, the company of friends. “These dinners are enhancing the quality of life by giving us a means to socialize,” says Downs. “And it’s a good meal, to boot.”
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
I said, ‘Let’s go.’ This was my chance to get better.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
These dinners are enhancing the quality of life by giving us a means to socialize. And it's a good meal, to boot.
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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
Read article
Improving Access to Advanced Care
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
Looking for another option?
KeckMedicine.org/epilepsy (800) USC-CARE
Subscribe
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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— Khashayar Pirouzmand
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Samplaski and her team explored the active ingredients and advertised claims of 50 T boosting supplements. Their findings were published in The World Journal of Men’s Health. Researchers performed a Google search with the search term “testosterone booster,” mimicking a typical internet research for someone looking to increase testosterone levels, They then selected the first 50 products that came up in their search. The team reviewed published scientific literature on testosterone and components found in the supplements such as zinc, fenugreek extract and vitamin B6. While 90% of the T booster supplements claimed to boost testosterone, researchers found that less than 25% of the supplements had data to support their claims. Many also contained high doses of vitamins and minerals, occasionally more than the tolerable limit. Unlike drugs, supplements are not intended to treat, diagnose, prevent or cure diseases, according to the FDA. Samplaski would like to see more regulation around T boosting supplements to protect consumers. She also would like to encourage the dissemination of more accurate information in the hopes that it encourages patients to see a medical professional for low testosterone issues. Samplaski says there is something men can do to address their concerns. “The safest and most effective way for men to boost low testosterone levels is to talk with a medical professional or a nutritionist.”
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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Jonathan Russin, MD
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Many supplements on the market merely contain vitamins and minerals, and don’t do anything to improve testosterone.
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the storm
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
Don Millici
Listening to the Brain
Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
— Khashayar Pirouzmand
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Improving Access to Advanced Care
examinations
The Calm
Candace Pearson
“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
Looking for another option?
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
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If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
Men who want to improve their libido or build muscles often turn to testosterone supplements, also known as T boosters. Keck Medicine of USC’s Mary Samplaski, MD, says supplements aren’t really the answer.
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I said, ‘Let’s go.’ This was my chance to get better.
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In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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T boosters are frequently used as an alternative to traditional testosterone replacement therapy. But these supplements may not have ingredients to support their claims, according to Samplaski, who is a male infertility specialist and assistant professor of clinical urology at the Keck School of Medicine of USC. “Many supplements on the market merely contain vitamins and minerals, and don’t do anything to improve testosterone,” Samplaski says. “Often, people can be vulnerable to the marketing component of these products, making it difficult to tease out what is myth and what is reality.” Testosterone is the primary male sex hormone and the reason why men produce sperm and have Adam’s apples, why men develop more “masculine” features like bulging muscles and a deeper voice. After age 30, most men experience a gradual decline in testosterone, sometimes causing these features to diminish or new symptoms to occur, like erectile dysfunction. In an attempt to fight this, some men will turn to T boosters.
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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Which foods are the healthiest, and which cause us harm? It’s been debated for decades, but even the widely acknowledged healthy diets like fish and fruit may be harmful in higher doses for certain vulnerable groups. That’s because of exposure to pesticides and other contaminants in these foods, according to a new study from the Keck School of Medicine of USC.
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In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
KeckMedicine.org/epilepsy (800) USC-CARE
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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“The choice of organic over conventionally grown fruits contributed to lower exposures of pesticides and phthalates, while retaining the health benefits of fruit and vegetable consumption,” Chatzi says. “We believe the results carry important public health messages related to the avoidance of excess exposure to environmental contaminants with toxic effects on humans.”
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
by jenesse miller
You are what you eat
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
by
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
“Pregnant women and children are particularly vulnerable to exposures to food contaminants,” says study co-author Lida Chatzi, MD, PhD, associate professor of preventive medicine at the Keck School. “During gestation and early development, the fetus and the child, respectively, are vulnerable to the effects of environmental chemicals. A balanced diet during these periods is also critical for optimal nutritional status, but what to eat, and how much, are critical questions.” A large team of investigators from USC and institutions throughout Europe looked at the association between diet and levels of 33 environmental contaminants in mothers and their children from six European countries. They found that the higher the fish consumption, the higher the levels of toxic persistent chemicals in the blood for both pregnant women and their children. The chemicals included polychlorinated biphenyls (PCBs), perfluoroalkyl substances (PFAS) and the toxic metals arsenic and mercury. The study authors assessed the effect of dietary recommendations for fish on maternal and child levels of environmental chemicals: specifically, up to three servings of fish per week for pregnant women and up to two servings per week for children. They found that, if the recommendation was followed, it resulted in lower levels of PFAS, arsenic and mercury. They also found that fruit consumption of more than two servings each day was positively associated with the levels of four organophosphate pesticides (OP) metabolites measured in urine samples for both pregnant women and children. Finally, the researchers found that children who ate organic food more than once per week had lower levels of OP and phthalate metabolites in their urine, compared to children who reported not eating organic food.
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
Pregnant women and children are particularly vulnerable to exposures to food contaminants.
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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The study was conducted within the Human Early Life Exposome (HELIX) project, a multidisciplinary study including 1,000 pregnant women and their children who were followed up to the age of 6-to-10 years old across six European countries: France, Greece, Lithuania, Norway, Spain and the United Kingdom. Researchers assessed how the consumption of several food groups — meat, fish, dairy, fruits, vegetables, bread and cereals, and pulses and legumes — was related to the levels of 33 environmental contaminants measured in blood and urine samples from pregnant women and their children. The authors say it’s the most comprehensive assessment of the association between food consumption and biomarker-measured exposures to environmental contaminants in mother-child cohorts. The innovative approach estimated the effects of clinical-based dietary advice on the blood and urinary levels of contaminants that are abundant in human biological samples worldwide.
— Lida Chatzi, MD, PhD
For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
Freedom from Worry
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
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Candace Pearson
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Jonathan Russin, MD
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Don Millici
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The authors found that consumption of non-organic fruits and vegetables has been a major source of exposure to OP pesticides. The use of these synthetic pesticides is prohibited in the production of food certified as organic. Organically grown food typically contains lower pesticide residues than food that is conventionally grown. The U.S. Department of Agriculture reports that consumer demand for organically produced goods has shown double-digit growth during most years since the 1990s. Fresh fruits and vegetables have been the top selling category of organically grown food.
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— Khashayar Pirouzmand
Additional authors include Line Småstuen Haug, Amrit Kaur Sakhi, Anne Lise Brantsaeter, Helle Katrine Knutsen, Helle Margrete Meltzer and Cathrine Thomsen of the Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health; Xavier Basagana, Maribel Casas, Sílvia Fernández-Barrés, Lea Maitre, Martine Vrijheid of Barcelona Institute for Global Health (ISGlobal), Universitat Pompeu Fabra (UPF) and CIBER Epidemiología y Salud Pública (CIBERESP); Regina Grazuleviciene and Sandra Andrusaityte of the Department of Environmental Sciences, Vytautas Magnus University; Rosemary R. C. McEachan and John Wright of Bradford Institute for Health Research, Bradford Teaching Hospitals National Health Service (NHS) Foundation Trust; Theano Roumeliotaki and Marina Vafeiadi of Department of Social Medicine, Faculty of Medicine, University of Crete; and Remy Slama of University Grenoble Alpes, Institute for Advanced Biosciences, Joint Research Center. The research was funded by the European Community’s Seventh Framework Programme (FP7/790 2007–2013) and the National Institute of Environmental Health Sciences.
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For the vast majority of people who are not exposed to chemicals through their jobs, consumption of contaminated food is the main source of exposure to a wide range of toxic environmental contaminants. These chemicals have been linked to a wide range of health defects that can affect children’s cognitive, motor and behavioral development and result in higher risk for preterm delivery, childhood obesity, type 2 diabetes and asthma. Mounting research on the risks associated with these toxins has resulted in calls to reduce exposure in vulnerable populations. “Changes in our diet and food choices can be an effective route to avoid excess exposure to environmental chemicals,” said study co-author Eleni Papadopoulou, a researcher from the Norwegian Institute of Public Health. “Understanding sources of dietary exposures to environmental chemicals can inform exposure assessment and identify intervention strategies to reduce exposure.” The authors found that moderate fish and seafood consumption within health-based dietary recommendations may prevent excess exposure to persistent PCBs and PFAS, as well as mercury and arsenic. In addition, high fruit consumption was related to increased exposure to pesticides, while the choice of organic fruits contributed to lower exposures of pesticide residues. Human exposure to PFAS has been a major concern for Americans since reports were released on widespread exposure to PFAS-contaminated drinking water. The U.S. National Health and Nutrition Examination Survey (NHANES) has detected these PFAS in the blood of all children ages 3–11 tested from 2013 to 2014. In line with the study findings, fish and seafood has been identified as a major source of exposure to PFAS. “Our study found that exposure to PFAS, arsenic and mercury could be reduced if pregnant women and children did not exceed the current dietary recommendation for fish,” Chatzi said.
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
by
50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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Using a different approach — employing assistive technology to enhance, not replace, natural senses — our team adapted AR glasses that project bright colors onto patients’ retinas, corresponding to nearby obstacles.
KeckMedicine.org/epilepsy (800) USC-CARE
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
Kremer Johnson Photography
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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the storm
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
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Augmented Reality Glasses: A New Way to See the World
Nearly one in 30 Americans over the age of 40 experience low vision — significant visual impairment that can’t be corrected with glasses, contact lenses, medication or surgery.
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— Khashayar Pirouzmand
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
Freedom from Worry
Listening to the Brain
Return Home
For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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— Khashayar Pirouzmand
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In a new study of patients with retinitis pigmentosa, an inherited degenerative eye disease that results in poor vision, Keck School of Medicine of USC researchers found that adapted augmented reality (AR) glasses can improve patients’ mobility by 50% and grasp performance by 70%. “Current wearable low vision technologies using virtual reality are limited and can be difficult to use or require patients to undergo extensive training,” says Mark Humayun, MD, PhD, director of the USC Dr. Allen and Charlotte Ginsburg Institute for Biomedical Therapeutics, co-director of the USC Roski Eye Institute and University Professor of Ophthalmology. “Using a different approach — employing assistive technology to enhance, not replace, natural senses — our team adapted AR glasses that project bright colors onto patients’ retinas, corresponding to nearby obstacles,” Humayun says. Patients with retinitis pigmentosa wore adapted AR glasses as they navigated through an obstacle course based on a U.S. Food and Drug Administration– validated functional test. Using video of each test, researchers recorded the number of times patients collided with obstacles, as well as the time taken to complete the course. Patients averaged 50% fewer collisions with the adapted AR glasses.
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
Candace Pearson
Improving Access to Advanced Care
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
Patients also were asked to grasp a wooden peg against a black background — located behind four other wooden pegs — without touching the front items. Patients demonstrated a 70% increase in grasp performance with the AR glasses. “Patients with retinitis pigmentosa have decreased peripheral vision and trouble seeing in low light, which makes it difficult to identify obstacles and grasp objects. They often require mobility aids to navigate, especially in dark environments,” says Anastasios N. Angelopoulos, study project lead in Humayun’s research laboratory at the Keck School. “Through the use of AR, we aim to improve the quality of life for low vision patients by increasing their confidence in performing basic tasks, ultimately allowing them to live more independent lives,” Angelopoulos said.
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
The AR system overlays objects within a 6-foot wireframe with four bright, distinct colors. In doing so, the glasses provide visual color cues that help people with constricted peripheral vision interpret complex environments, such as avoiding obstacles in dimly lit environments. To accomplish this, researchers used a process called simultaneous location and mapping, allowing the AR glasses to fully render the 3-D structure of a room in real time. The glasses then translated this information into a semitransparent colored visual overlay, which highlighted potential obstacles with bright colors to help patients with spatial understanding and depth perception. This technology can work on commercially available devices. According to Humayun, while major cost and technical issues remain, this type of assistive technology could eventually become more practical for everyday use in the near future.
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— Mark Humayun, MD, PhD
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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I firmly believe that you can’t be a top surgeon if you’re only well-versed in current techniques. A true top surgeon actively develops new techniques and devices to stay at the forefront of medicine. To this end, USC Surgery has worked hard to establish a culture in which research is enabled and promoted as a continuous, active focus.
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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Our division of clinical research includes research coordinators, data managers, and regulatory and budgeting specialists. This allows our researchers to turn to the division for everything: feasibility of grant applications, budgeting and team-building. The division works with our surgical faculty to test new devices, drugs and treatments, ensuring that our patients benefit from the latest advances and our surgeons stay on the leading edge of their specialties. Progress leaps forward when surgeons, medical doctors and basic scientists collaborate. We make a point of hiring top surgeon-scientists who constantly work toward new breakthroughs. Their curiosity means they are ready to fight any disease that comes their way, and it’s driven by deep compassion. This culture of research has been a major contributor to our outstanding performance in the 2019–2020 U.S. News & World Report rankings, with cardiology & heart surgery coming in at 11 in the country, gastroenterology & GI surgery at 13, and pulmonary & lung surgery at 33. We’re proud of these rankings, but we look at them the same way we look at our research breakthroughs: This is only the beginning.
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USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
KeckMedicine.org/epilepsy (800) USC-CARE
At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
Vaughn Starnes, MD, is the chair of the Department of Surgery at the Keck School of Medicine of USC, and chief of cardiovascular surgery at Keck Medicine of USC.
Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
Return Home
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
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In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
Learn more or schedule an appointment:
KeckMedicine.org/sportsmed (800) USC-CARE
The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
Kremer Johnson Photography
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
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Professional, amateur and student athletes in the LAX area have a new option for treatment at the Toyota Sports Performance Center, where Keck Medicine of USC’s expert orthopaedic surgeons partner with the Los Angeles Kings and Meyer Institute of Sport.
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Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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Officials celebrated a new partnership on Sept. 4, as Keck Medicine of USC, the Los Angeles Kings and Meyer Institute of Sport held a ribbon-cutting for the Toyota Sports Performance Center in El Segundo, a new sports medicine and athletic rehabilitation center. The facility, formerly known as the Toyota Sports Center, is located at 555 N. Nash St. and will provide services to the LA Kings, youth sports teams and the surrounding communities. “As we set out for a new vision at our facility, our goal was to create the premier sports science operation. It was imperative to support our teams here with the Kings and AEG with the best in the world,” Kings Sports Chief Operating Officer Kelly Cheeseman said. “We are thrilled to extend our services to the LA Kings, as well as members of the South Bay Community,” said Jay R. Lieberman, MD, chair and professor of orthopaedic surgery at the Keck School of Medicine of USC and chief of orthopaedic surgery at Keck Medicine. “The clinic location in the Toyota Sports Performance Center offers convenient access to our highly regarded faculty, who are committed to providing the best possible care to athletes of all levels.”
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Jonathan Russin, MD
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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Reprinted with permission from the LA Kings.
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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KeckMedicine.org/epilepsy (800) USC-CARE
The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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Learn more or schedule an appointment:
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
George Nune, MD
Science at Its Best
At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
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50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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Keck Medicine of USC speech pathologist Brenda Capobres Villegas specializes in the rehabilitation of patients with head and neck cancer (HNC.) HNC survivors deal not only with a life-threatening disease but altered facial features and functional problems involving speech, chewing, swallowing, vision, smell and taste. According to the American Cancer Society, a half-million Americans are survivors of oral, head and neck cancer, and 60,000 new cases are diagnosed each year. Fourteen years ago, Villegas founded the Head and Neck Cancer Support Group for Keck Medicine’s USC Caruso Department of Otolaryngology – Head and Neck Surgery. “I just felt it wasn’t enough me seeing them for speech therapy or swallow therapy two times a week.,” she explains. “They really needed psycho-social support and peer support.” “The area where you swallow and eat and breathe is very small,” explains Delton Shilling, a former professional singer who was diagnosed with tonsil cancer in 2003. “Everything is going through that tiny space in your throat, and these treatments can have a major effect on your lifestyle and your social abilities.” Some members—like Shilling—keep coming years after they’ve been cancer-free, pain-free and resumed a relatively normal life. Though he can no longer sing, Shilling attends many concerts. He loves to travel. In September, he visited friends in Idaho. In July, he and a lady friend cruised the rivers of France. “The physical activities, I’m fine with that,” he says. “The social part is what’s difficult.” Shilling goes to keep up with latest HNC developments. Leading Keck Medicine clinicians, including Shilling’s own doctors, Uttam Sinha, MD, and Dale Rice, MD, regularly present new findings at the meetings. Survivors, their families and caregivers find a space to tell their stories, ask questions and build out their networks. For Shilling, dining out is a delicate balancing act between chewing, swallowing and speaking. Surgery, radiation and chemotherapy left him with weakened neck muscles and damaged his salivary glands, resulting in constant dry mouth. (He never leaves home without cough-drops.) People sometimes stare at his throat stoma — the product of a tracheostomy performed in 2014 after an allergic reaction triggered a vocal cord spasm, cutting off his air supply. When it comes to self-care, Shilling stays proactive. Every five days, he performs a self-dilation to expand his throat. Bi-monthly physical therapy sessions keep his neck muscles limber. “If I stopped doing these exercises, there’s a strong chance my throat would close up, and I would have to go back on a feeding tube,” he says. The HNC Support Group is an integral part of Shilling’s self-help toolkit. “I’m a big fan,” he says. “It’s always on a positive note. We don’t go in all ‘poor me, woe is me.’ Dr. Sinha and Brenda always emphasize quality of life. That’s where they’ve helped me, and where we can help each other.”
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
Improving Access to Advanced Care
Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
Helping Each Other
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
Freedom from Worry
“The area where you swallow and eat and breathe is very small,” explains Delton Shilling, a former professional singer who was diagnosed with tonsil cancer in 2003. “Everything is going through that tiny space in your throat, and these treatments can have a major effect on your lifestyle and your social abilities.” Shilling goes to keep up with latest HNC developments. Leading Keck Medicine clinicians, including Shilling’s own doctors, Uttam Sinha, MD, and Dale Rice, MD, regularly present new findings at the meetings. Survivors, their families and caregivers find a space to tell their stories, ask questions and build out their networks. The HNC Support Group is an integral part of Shilling’s self-help toolkit. “I’m a big fan,” he says. “It’s always on a positive note. We don’t go in all ‘poor me, woe is me.’ Dr. Sinha and Brenda always emphasize quality of life. That’s where they’ve helped me, and where we can help each other.” The group meets on the first Saturday of every month, and walk-ins are welcome.
by diane krieger
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If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
I said, ‘Let’s go.’ This was my chance to get better.
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The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
Science at Its Best
50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
Improving Access to Advanced Care
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“What small thing can I do today to improve my health in the future?”
Geriatrician USC Concierge Medicine
Eric Tan, MD
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
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Don Millici
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
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As our lives become busier and more complicated, it can be difficult to find time for physical fitness and preventive measures to keep from getting sick or injured. But even one small improvement in daily activities can make a big difference in the long run. Two physicians from Keck Medicine of USC, both experts in their field, weigh in on the Big Question:
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On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
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Candace Pearson
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
— Khashayar Pirouzmand
Protecting the Protectors
Jonathan Russin, MD
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After more than five years of taking care of thousands of C-suite executives and busy professionals at Keck Medicine’s downtown Los Angeles private practice, I developed the following hypothesis: if you leave your physical activity and nutrition to chance, you will develop a chronic disease by age 60. How many of us treat our automobiles better than ourselves with regular maintenance, premium fuel and fancy accessories? Fundamental laws of nature explain that the universe tends to move from ordered behavior to disorder and uncertainty. That’s right: the default pathway for our health is for it to get worse — unless you actively reduce chance. To eliminate chance in my life I have created the Life Operational Score, a tool designed to encourage and measure the benefit of exercise done per hour worked while at work. I have a whiteboard in my office on which I document exercise done, push-ups and squats, per hour, per day. Every Monday morning, I review my exercise log which affirms whether or not I contributed to my life score. I encourage everyone not to leave our physical activity and nutrition to chance.
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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There are never enough hours in the day. From work obligations to family activities, it can be difficult if not impossible to find time to focus on ourselves. While all of us would like to be able to spend an hour each day at the gym or exercising, it is not always practical given our busy schedules. Just as saving a dollar here and there can lead to a significant savings over time, the same thing is true with physical activity. Small changes to your daily routine can add up to long term benefits to your health. An easy thing to do is walk whenever you can. Park a little farther than you usually do. Take the stairs instead of the elevator or escalator. Stand and move instead of sitting around. Instead of spending your break on the computer or phone, take a walk around the building or outside to get some fresh air. These minor changes to your routine will help you feel better and pay dividends over time.
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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Gregory Taylor II, MD, MBA
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
Foot and Ankle Specialist USC Orthopaedic Surgery
— Khashayar Pirouzmand
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“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
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My days are very dynamic because I never actually know what I’m going to be walking into. I wear different hats, sometimes as the primary nurse, a resource nurse, a relief charge nurse or even as a nurse preceptor, training the new nurses that come through the unit. I like that I am able to help in so many different ways and I love that I still can provide direct patient care.
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— Khashayar Pirouzmand
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On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
the storm
Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
Jonathan Russin, MD
What might people not know about you?
Nursing takes a lot of patience, but if you are truly passionate about nursing, it’s the most fulfilling job you could have. You have to be inquisitive and flexible, which I know can be challenging for a lot of newer nurses. But when you see a patient get admitted with a critical condition and two, three or four days later leave the ICU because of the help you’ve been able to provide, that is an incredible motivator to keep coming back to the job.
Patience and Passion
USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
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Paul Kangethe, MSN, RN, was not supposed to be working in a hospital.
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Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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Candace Pearson
For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
Kremer Johnson Photography
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
Science at Its Best
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George Nune, MD
Do you have any advice for potential nurses?
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
I have a master’s degree in nursing administration, so I have considered doing administrative work. I participate in several projects and committees around the hospital and for the unit, always with the focus of improving processes and making things easier for my fellow nurses. But pulling myself away from direct patient care would be a challenge because I love what I do. I also was the 2017 Nurse of the Year and the 2018 Nurse Humanitarian of the Year for Keck Medical Center of USC.
Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
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The one-time computer major had taken a class to be a certified nursing assistant on the weekends as a way to make a living while attending college, but he found a passion for working with patients and a desire to do more for them. Now, with more than a decade of being a registered nurse, he spends his days doing what he loves as a nurse in Keck Hospital of USC’s 5 West cardiothoracic ICU.
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I said, ‘Let’s go.’ This was my chance to get better.
The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
KeckMedicine.org/epilepsy (800) USC-CARE
— Khashayar Pirouzmand
Don Millici
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Shortly after marking its 10-year anniversary, Keck Medical Center of USC had another milestone to celebrate: being ranked No. 16 on the U.S. News & World Report 2019-20 Best Hospitals Honor Roll.
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What if a patient isn’t a candidate for tumor resection? The USC Comprehensive Epilepsy Center calls on a variety of leading-edge techniques such as responsive stimulation devices and other neuromodulators — essentially pacemakers for the brain — that work to prevent seizures at their source. The center was involved in early clinical trials that led to approval of the devices.
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The center serves as the academic anchor to the USC Epilepsy Care Consortium. “This unique partnership is composed of nearly a third of all the certified epilepsy centers in our state,” says Charles Liu, MD, PhD, professor of clinical neurological surgery and neurology at the Keck School and secretary of the consortium. “This maximizes patient access to the resources of an academic medical center while minimizing travel.” The patient’s local neurologist remains the main point of contact, while Keck Medicine specialists assist with care management through teleconferencing. “If a patient needs more advanced care than is available in their community,” Christi Heck, MD, says, “they can come here and we can co-manage that care with their local doctor.” The center also addresses the transition that teen and young adult patients must make from children’s services to adult care. “There’s a very big gap between being a child with epilepsy and being an adult with epilepsy,” Heck says. The transition clinic includes a navigator who reviews each case and directs the patient to the services they need.
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Science at Its Best
George Nune, MD
In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy. It's kind of amazing.
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I said, ‘Let’s go.’ This was my chance to get better.
Khashayar Pirouzmand and his golden retriever puppy, Zomi, enjoy a day at the park. | Kremer Johnson Photography
If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.
50 million people worldwide are diagnosed with epilepsy. One of the most common neurological disorders, it is characterized by unpredictable electrical activity in the brain and recurrent seizures. Doctors believed Pirouzmand’s tumor was too close to the language areas of his brain to operate, so he began taking two anti-seizure medications. They didn’t stop his seizures, which started escalating. Each time, he lost the ability to put words together or make sense of them. He tried finishing his university entrance exam, but couldn’t. The next year, his seizures again kept him from completing the exam. Pirouzmand’s dream of traveling to America to study engineering seemed nearly impossible.
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At the USC Comprehensive Epilepsy Center, patients with the neurological disorder receive the highest level of care, backed by innovative research.
Little did he know that in a few years, Pirouzmand would find himself at the USC Comprehensive Epilepsy Center, designated a level 4 center by the National Association of Epilepsy Centers. The highest accreditation possible, this distinction indicates the center’s capability to treat the most complex cases. When he finally arrived in Los Angeles two years ago, he saw a community physician for his epilepsy prescriptions who recommended he go to Keck Medicine of USC for help. Within the USC Comprehensive Epilepsy Center, a multidisciplinary medical team provides the most advanced care for patients with complex issues, including those who experience uncontrolled seizures, severe side effects from medication or who want to get pregnant while having epilepsy. The team includes board-certified epileptologists, neurosurgeons, neuroradiologists and psychologists, along with epilepsy nurses, occupational therapists and nutritionists. “Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
The first step: capturing the electrical impulses in Pirouzmand’s brain. The center is equipped with the most advanced imaging and diagnostic technologies, including video electroencephalographic monitoring (EEG), an invaluable tool to diagnose epilepsy symptoms, using non-invasive electrodes attached to the head. Pirouzmand spent a week in Keck Hospital of USC, as his medical team gradually withdrew him from all medication to trigger and track his seizures. This would enable them to characterize what type of seizures he was having and where they originated within the brain. Jonathan Russin, MD, assistant professor of clinical neurological surgery at the Keck School, likens the on-the-scalp video EEG to “trying to listen to a conversation through a wall.” Nune and Russin escalated the testing to the next level: phase II intracranial EEG monitoring to more accurately locate the area where seizures began and those areas which are essential for speech production. This higher-level brain mapping is like “being inside the room listening to the conversation,” Russin says. Russin implanted a very thin mesh of electrodes over the surface of the brain in the relevant region. His typical seizures were then recorded over the course of several days as Pirouzmand dutifully did physics homework and watched documentaries in the intensive care unit (ICU). Nune then electrically stimulated the various brain areas under this mesh to determine which disrupted the ability to speak in his native Farsi. These would have to be preserved during surgery.
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The academic medical center, which includes Keck Hospital of USC and USC Norris Cancer Hospital, also was ranked among the top 5 hospitals in California and top 3 hospitals in Los Angeles. “Keck Medical Center achieving Honor Roll recognition after only a decade of operation illustrates the health system’s remarkable growth and steadfast commitment to providing world-class, research-driven academic medicine,” said Tom Jackiewicz, MPH, CEO of Keck Medicine of USC. “We are extremely proud to have earned this distinction among a list of storied medical institutions; however, it’s the trust our patients place in us each and every day that allows us to succeed.” The Best Hospitals rankings and ratings are released annually to assist patients and their doctors in making informed decisions about where to receive care for life-threatening conditions or common elective procedures. U.S. News evaluated more than 4,500 medical centers nationwide across 16 specialty areas and nine procedures or conditions. Only 165 hospitals (approximately 3%) were ranked in at least one specialty. Keck Medical Center and others named on the Honor Roll posted high scores across many of these areas of care. At No. 4 (tie), urology was the medical center’s highest-ranked specialty, making it the highest-ranked urology specialty in Southern California. Eight additional specialties — geriatrics (No. 6), ophthalmology (No. 11), cardiology & heart surgery (No. 11), gastroenterology & GI surgery (No. 13), nephrology (No. 13), neurology & neurosurgery (No. 16), cancer (No. 21, tie) and pulmonology & lung surgery (No. 33) — also placed in the nation’s top 35, and orthopaedics was rated as High Performing. Keck Medical Center also was rated High Performing (the highest rating possible) in eight of nine evaluated procedures and conditions: heart bypass surgery, aortic valve repair, heart failure, hip replacements, knee replacements, lung cancer surgery, colon cancer surgery and abdominal aortic aneurysm repair.
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USC Health is a publication of Keck Medicine of USC. Permission to reprint articles is available on request.
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Jonathan Russin, MD
Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication.
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Protecting the Protectors
“Patients come to us because they need a higher level of care,” notes Christi Heck, MD, medical director of the center and professor of clinical neurology at the Keck School of Medicine of USC. That level of specialty is necessary because epilepsy can be extremely challenging to diagnose and treat, in part because it has a wide range of potential causes, including genetics, prenatal injury, meningitis, strokes, tumors and traumatic brain injury. More people die of epilepsy (50,000) each year than from breast cancer (40,000). This includes people who develop SUDEP or “sudden unexpected death in epilepsy,” as well as those who die from seizure-related drownings or burns. Pirouzmand initially met with George Nune, MD, assistant professor of clinical neurology at the Keck School. Nune changed Pirouzmand’s medications to see if that would halt the seizures. “Approximately one-third of patients have medically refractory epilepsy, which can’t be controlled with medication,” Nune says. Nune asked Pirouzmand if he was interested in surgery, which held the potential to remove the source of his epileptic seizures. “I was very excited,” Pirouzmand says. “It seemed like an adventure for me. I wanted to try it.”
The Calm
On an ordinary February day, 18-year-old Khashayar Pirouzmand was breezing through the physics questions on an important exam at his high school in Iran, excited because doing well could help him get into a top university. Two hours in, without warning, his life changed dramatically. Very suddenly, he felt a strange pressure in his brain. He raised his hand and tried to say he wanted to go outside, but couldn’t put the words together. He took a deep breath and glanced at his paper. He could no longer solve the problems he had done only minutes before. Pirouzmand left the classroom with the test unfinished. By the time he reached home a half hour later, he could speak again. He told his family something had happened to him, but he didn’t think it was serious. He chalked up the incident to the stressful exam. The second time, about two months later, he was talking to his aunt when he heard a high tone in his ear, felt pain in his jaw and passed out. He woke up in an ambulance. After tests at a local hospital, doctors gave Pirouzmand the news: He had epilepsy, most likely caused by a small tumor on the left side of his brain.
Pinpointing the area responsible for language as accurately as possible for each individual is essential “because once patients have been having seizures for so long, their brain often has reorganized itself,” Russin notes. Armed with the results, Russin could proceed. His goal was to remove as much of Pirouzmand’s tumor as possible, while avoiding delicate tissue. “You’re talking about potentially curing somebody of their seizures and changing the trajectory of their life,” he says. “If our patients have the courage to undergo these procedures, it’s our responsibility to do the job right with the least amount of risk.” Pirouzmand was more than ready. “I said, ‘Let’s go.’ This was my chance to get better.”
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For Pirouzmand, surgery gave him his life back. He occasionally hears a high tone in his ear (an “aura” or warning of a potential seizure), but the seizures no longer come. He is on two medications for now, a precaution for the first few years after surgery. Pirouzmand has started driving again and he is hard at work studying for his university degree. During his treatment at Keck Hospital, he realized the specific field he wants to pursue — electrical engineering. Being in the hospital, with electrodes implanted in his brain, he felt like a living-breathing embodiment of science at its best. “In one moment, engineering and neuroscience and medical school were all combining to cure the patient — me — of epilepsy,” Pirouzmand says. “It’s kind of amazing.”
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