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Focus on R. Edward Hogan, MD

R. Edward Hogan is an associate professor of neurology. His specialties include adult epilepsy and neurology.

Dr. Hogan sees patients at the Center for Advanced Medicine, Neuroscience Center, 4921 Parkview Place, 6th floor, Suite C, St. Louis, MO, 63110.

FOR AN APPOINTMENT, PLEASE CALL 314-362-7845.

What happened in the course of schooling to influence you to choose your specialty?

During my last year of medical school, I had a professor who sparked my interest in neurology. I enjoyed the basics of the specialty that included examining a patient, thinking about the problem and seeing how the brain worked. My mentor was very influential when it was time to make a decision, and that’s how I ended up in neurology.

My interest in epilepsy began during my clinical rotations. Seizures give an in-depth look into how the brain functions. From a physician’s perspective, it’s fascinating on so many levels – from studying the basics of how medicines work in controlling seizures, to the more abstract areas of consciousness. I also liked th

e fact that there are now many effective treatments for patients with epilepsy.

Can you define epilepsy?

Epilepsy is a disorder, and seizures are a symptom. Seizures may be symptoms of other medial disorders, as well. The definition of an epileptic seizure is more specific. It is an intrinsic, recurring problem in the brain that is clinically defined by an electroencephalogram (EEG), which measures the electrical activity or brainwave patterns.

What brought you to Washington University?

As my career evolved, my interest in neuro-imaging grew. Because of the resources and opportunities here, I had collaborated with people at Washington University while working at St. Louis University. When the time came to take another step in my career, I knew the environment here and was very happy to be offered this opportunity – just a few miles away.
R. Edward Hogan, MD



Which aspect of your practice is most interesting?

The most interesting aspect is inpatient monitoring. The evolution of video acquisition and computers over the last 20 years has made it practical to simultaneously record video and EEG on a routine basis. A patient’s history and description of symptoms will give some idea of what might be going on, but from a neurologic perspective, it’s unusual to directly observe dynamic symptoms in action. Inpatient monitoring includes constant video and EEG recording of a patient while in the hospital. It is extremely helpful to have the tools to see the correlation of the EEG and video when someone has a seizure.

What new developments in your field are you most excited about?

From a diagnostic point of view, the video EEG is very useful. We now also have many other ways to measure brain function with different types of neuro-imaging tests. These modalities include, among others, PET (positron emission tomography scans), SPECT (single positron emission computed tomography), and MRI (magnetic resonance imaging).

Clinical PET scans localize the part of the brain that generates seizures by measuring metabolism of glucose. The scan is typically performed between seizures.

SPECT allows us to look at blood flow or profusion to the brain during a seizure. The challenge of SPECT is that it must be done during a seizure --this is made possible with inpatient video and EEG monitoring. When the patient is having a seizure, he or she is immediately given a blood flow tracer. The tracer is taken up in the brain – proportionately to how much blood flow there is to that region, for the minute or two after the administration of the blood flow tracer. This snapshot of information tells us which parts of the brain are activated and deactivated during a seizure.

Newer MRI technology has made it possible to look at changes in brain activity by measuring blood oxygen level dependent (BOLD) signal. We’re able to see the oscillations in brain signals using MRI scans which indirectly measure cerebral blood flow. The test is performed between seizures, and holds great promise to improve our understanding of epileptic seizures as they relate to overall brain function.

It’s an interesting time to be involved in neurology, and especially epilepsy, because there are many new ways to look at the brain.

What research are you involved in?

I’ve been involved in multicenter trials to evaluate the use of anti-epileptic medications. The good news in epilepsy is that seizure control by medication is achieved for about 70% of the patients we see. We are still looking for different ways and medicines to treat the remaining 30%.

A question I’m frequently asked is, “Does having a seizure injure the brain?” We all lose neurons every day, that’s just the aging process. By using MRI to assess the brain, we can determine if seizures make that process happen faster. I’ve worked with several techniques to segment different structures of the brain with more precision. The goal is to see how epilepsy syndromes affect the distinct parts of the brain.
 
Another interest I mentioned previously includes MRI techniques that look at fluctuations in brain function. This has raised a lot of awareness of functional conductivity and how the brain works. It’s very fascinating because epilepsy affects the brain as a unit. There’s been a concept that seizures come from just one region of the brain. But what we are finding is even though this may be true to a degree, the seizures also affect the brain globally. With an MRI, we can look at how different parts of the brain interact with each other, and especially how epilepsy might affect functional conductivity, compared to patients without epilepsy.

Where are you from?

I was born in West Plains, Missouri. When I was six months old, my family moved to Springfield, Missouri. I claim Springfield as home, because that’s where I grew up.

Is there a particular award or achievement that is most gratifying?

It’s very gratifying to make a difference in someone’s life. Epilepsy is a high risk/high gain area – most people do great, but some people don’t. Having a seizure impairs an individual’s ability to drive for six months -- this can secondarily affect work and everyday activities that require driving a car. I’ve always been impressed with people who still have seizures, but are able to move forward and achieve a lot in life. It’s rewarding to help someone who has struggled with epilepsy for years and make a change for the better with the right medication or even surgery.

What is the best advice you’ve ever received?

I was blessed to be exposed to a variety of experiences in my life. My parents encouraged me to look for something I was interested in and build from that – they let me find my own way. It was a good path for me and I appreciated that advice. I’m very fortunate.

If you weren’t a doctor, what do you think you would be doing?

I’m thankful for what I have, but I do like sports – especially golf. If I had to choose something different from what I’m doing now, playing golf would be it.
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Copyright 2013 Washington University School of Medicine