DOCTOR'S VIEW ARCHIVE

Why Remove Half A Brain?

BALTIMORE, MARYLAND-Epilepsy is a general term for a group of disorders that feature recurrent seizures. Seizures are sudden abnormal electrical firings in the brain. Seizures can lead to violent erratic spasms (convulsions ) of the muscles of the body as well as altered consciousness.

Some children with severe forms of epilepsy can have many seizure episodes daily. There lives can be affected by body movement difficulties, medications, impaired intellectual function, and dependency upon family and caregivers.

In the past thirty years at Johns Hopkins Medical Institutions, 58 children with severe epilepsy had half of their brains surgically removed in order to eliminate the misfiring areas. The results of these operations were reported by Eileen P. G. Vining M.D. and colleagues in an article in PEDIATRICS (1997;100:163-171).

The removal of the diseased half of the brain (medically termed hemispherectomy) of these children with intractable, recurrent seizures was successful, in terms of seizure relief, for over 2/3 of the patients.

All procedures were also considered by both physicians and parents as successful in relieving the "burden of illness." The burden of illness was defined as the effect of the combination of recurring daily seizures, intellectual and movement disabilities, medications, and family and environment limitations.

Amazingly, after the procedures, the childrens' movement disabilities improved and memory and personality as well as sense of humor were maintained!

Hemispherectomy is performed only in children severely affected by epilepsy in whom smaller brain operations would not be adequate. The authors of the report emphasize that this form of surgery "should never be performed until both parents understand the potential complications of the surgery and the nature of the expected residual handicaps, and can accept any of the potential surgical outcomes." These potential outcomes include death, which occurred in 7 percent of patients. The authors also recommend that the procedure only be performed in a limited number of centers. These centers must have an experienced team of surgeons, neurologist specializing in epilepsy, psychologists, and a network of parent support personnel, including social workers.


Last Editorial Review: 12/31/1997