Thursday, March 05, 2009

Girl had left brain hemisphere removed to treat epilepsy

I hope it is a good news.

Hemispherectomy - "
The first such operation on humans was done by Walter Dandy in 1923*. In the 1960s and early 1970s, hemispherectomy involved removing half of the brain, but this resulted in unacceptable complications and side effects in many cases, like filling of excessive body fluids in the skull and pressuring the remaining lobe (known as hydrocephalus). The first successful operation was done by Dr. Ben Carson at world renown The Johns Hopkins Hospital. Today, the functional hemispherectomy has largely replaced this procedure, in which only the temporal lobe is removed; a procedure known as corpus callosotomy is performed; and the frontal and occipital lobes disconnected."

* at John Hopkins University

"Suffering from seizures, her daughter, Brooklyn Bauer, had undergone different treatments and tried different medications for more than three years with no success. Her speech and motor skills were extremely delayed. She walked on her knees and spoke in two-word phrases.
Now after surgery and recovery, Brooklyn is in kindergarten. She has come a long way from the time when she was heavily medicated and lethargic, and has even become a spokesperson for the Epilepsy Foundation's Northern Illinois region.
Nelson remembered how her daughter's seizures were barely visible, but she had that sense as a mother that they were happening. "She would show facial twitches and her eyes would glaze over. She was on Valium all the time, had little energy, slept a lot, and missed so much preschool because of doctor visits and hospital stays,” Nelson said. (emphasis mine)
When it became clear that Brooklyn was not making progress, Jessica brought her daughter from Rockford to Comer Children's Hospital, where pediatricians discovered just how extensive the seizures were.
EEG scans showed Brooklyn was experiencing nearly constant epileptic activity every one to two seconds -- whether she was awake or asleep. The left hemisphere of her brain showed significant damage with little positive brain function. The injury was related to brain hemorrhaging that occurred when she was born 12 weeks premature.
Michael Kohrman, MD, a pediatric epileptologist and associate professor of pediatrics and neurology, said that after a child fails with two or three anti-seizure medications, there is little chance that another medication will work. However, he still desperately wanted to give Brooklyn relief.
Kohrman, along with David Frim, MD, PhD, chief of neurosurgery, reviewed her case and concluded that Brooklyn's brain would function better without the left hemisphere. The right hemisphere of Brooklyn's brain was healthy.
"The seizing tissue in Brooklyn’s brain had lost its capability to function productively, so disconnecting or removing it paradoxically allows the remaining brain to function better,” Frim said. “Once we identified Brooklyn as a candidate for surgery, we were able to move within two months to complete all testing and perform the surgery.”
Everyone involved recognized the gravity of the surgery and the need to support the family. Patti Ogden, APN, a nurse practitioner and epilepsy coordinator for the Children's Hospital, was instrumental in managing the many details related to Brooklyn's diagnostics, surgery and medical treatment--acting as a key point person for physicians and the girl's family. She educated Jessica about the diagnosis, procedure, and Brooklyn's subsequent care. “When we’re asking to cut away part of your child’s brain, it’s essential to gain the family’s trust,” Ogden said.
Lead surgeon Frim, along with the pediatric neurology team, performed a functional hemispherectomy: removing most of the brain’s left temporal and occipital lobes, and severing all neuronal connections from the left parietal and frontal lobes to the healthy right hemisphere and to other parts of Brooklyn’s body. Within a few weeks after surgery, her speech returned, her personality blossomed, and her motor skills gained strength.
Kohrman explained, “The left hemisphere of Brooklyn's brain may still be active electrically, but it can no longer communicate with, or harm, the rest of the brain.”
November 2008, two years after surgery, was a milestone and good indication that Brooklyn has gained remarkable function. After her medications were readjusted, Brooklyn's seizures are under control. She's even running now--something her family never thought would be possible. (emphasis mine)

All hemispherectomy patients suffer at least partial hemiplegia on the side of the body opposite the removed or disabled portion, and may suffer problems with their vision as well.This procedure is almost exclusively performed in children because their brains generally display more neuroplasticity, allowing neurons from the remaining hemisphere to take over the tasks from the lost hemisphere. This likely occurs by strengthening neural connections which already exist on the unaffected side but which would have otherwise remained small in a normally functioning, uninjured brain.[1] One case, demonstrated by Smith & Sugar, 1975; A. Smith 1987, demonstrated that one patient with this procedure had completed college, attended graduate school and scored above average on intelligence tests. Studies have found no significant long-term effects on memory, personality, or humor after the procedure[2], and minimal changes in cognitive function overall.[3] Generally, the greater the intellectual capacity of the patient prior to surgery, the greater the decline in function. Most patients end up with mild to severe mental retardation, which is usually already present before surgery. When resectioning the left hemisphere, evidence indicates that some advanced language functions (i.e., higher order grammar) cannot be entirely assumed by the right side. The extent of advanced language loss is often dependent on the patient's age at the time of surgery. Wikipedia

This is the first time I came across with hemispherectomy as you can see by the sources and content of the post. I don't know what to think. As I said I hope it is a good news.
Hemispherectomy Foundation physicians.


Radagast said...

Remind me - is this the Dark Ages?


Ana said...

I saw a documentary about the marvellous discoveries of brain mapping.
I saw the physician, that is at the Hemispherectomy Foundation, created to help patient's family members but the link I left is fool of smiling faces of physicians, talking...
On this documentary they said, and showed the brain image where I could see that the whole part of the left brain has been removed.
On the internet it's said that it was only some parts.
The girl they said was fine could not move raise her right arm...
This sounds totally experimental for me.
As if they decided to do in this girl one test.
I wonder how many they most have done that is not documented.
I wish I could rely on these people but I think of this as barbarian.
They don't know enough of the brain and the body to do such a thing.
They always convince a family that it's "the last resource" and amazingly enough the family is always poor.
She is still on medications.
Only by tests seizures was really detected...
This story is not well told for me.
Is Hopkins creating a tradition on hemispherectomy? The first one in 1923 was done there.
I'm sure something else would have been proposed if she wasn't at Hopkins.

Ana said...

Funny that Mr. Obama has demanded test for "Traumatic Brain Injury" in soldiers coming from Iraq.
I wonder if the girl... Okay! I'm going to far.
But after I posted this thing I felt so terrible that I had to search a nice thing to post and found the "Fire Rainbow".

Mark p.s./Mark p.s.2 said...

Just an anecdotal story, there is a diet of extreme high fat content , like eating butter, that can stop certain kinds of epilepsy.

Which I would try before this surgery.

Ana said...

According to Hopkins they only do it when everything has been tried.
I don't know...

Radagast said...

Ana wrote:
"According to Hopkins they only do it when everything has been tried..."

Hmmm. Not everything, I imagine. "Don't break something you can't fix," is a good maxim, I think. And I can't see how these surgeons would be able to replace her brain, were they to discover that they'd removed something absolutely critical to her existence.

It's ridiculous, it really is. It's not necessary to formulate theories about the brain's functions, and then engage in massively invasive, irreversible experimental surgery. For fuck's sake! Any person can tell one why they are behaving, as they are, one only has to ask. But asking questions, like most other skills is someting that is never nurtured (in fact it's discouraged, from what I can tell), from birth. The consequence being that by the time we reach adulthood, the idea that such a skill even exists is absurd. And yet it's very real, which is why a good counsellor doesn't just listen, and diagnose, as a shrink would. (S)he directs the discussion, in accordance with the client's needs, (as stated by the patient, and not the counsellor).

It's not rocket science, and yet it might as well be. The brain functions on the basis of binary logic, as far as I can tell. If one knows that, one knows everything.


Ana said...

"Today, Drs. Freeman and Vining and their colleagues are investigating promising new treatments for Rasmussen's syndrome, which might one day make hemispherectomies obsolete."

What do you think about that?
It is at the "Hemispherectomy Foundation" a site done by physicians, I mean by family members, to support family. This is their medical board:

I think you're right when you say that when these children get old they will have problems.
I believe that they are doing it as a research with no concern with these kid's health.
Why do it in children who suffers from epilepsy?
I have many questions about it.
Unfortunately there are no physicians I can address them to.
Ana, indignant