DOCTOR'S VIEW ARCHIVE
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
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
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.
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