Epilepsy surgery ends child’s seizures
"They gave my son the world," says Maleeda Meffley, mother of 9-year-old Dallas. "He can say his ABCs and he knows his colors again." She takes a deep breath, then adds, "They gave me my little boy back."
At age 4, Dallas Meffley began experiencing atonic seizures, more commonly known as "drop attacks," in which his head would suddenly drop down to his chest. "We knew there was something wrong early on," explains Mrs. Meffley. "As a baby he was so fidgety, so hyper. He didn’t want to be held and he hardly talked. At first he could do his ABCs and count…and then he couldn’t."
As time passed, the number of attacks Dallas experienced each day increased alarmingly. Eating dinner became a strain – Dallas’ head needed to be held at all times so he wouldn’t crack it on the table. A helmet was out of the question – he hated having anything on his head and would tear it off.
The Meffleys took Dallas to his pediatrician, who immediately suspected seizures. An EEG confirmed it. "We couldn’t believe how horrible it was – page after page coming out of that machine," comments Mrs. Meffley on the results of the test. Dallas was having 200 seizures a day and they occurred around the clock.
A neurologist was consulted and an MRI was performed. Nothing showed up on the film. Medications were tried with no effect. A vagus nerve stimulator was implanted, sending electrical signals from the vagus nerve up into the areas of the brain thought to be involved in causing his seizures. No results were evident.
Another neurologist was consulted and more medications were tried. Nothing. Dallas was put on a ketogenic diet. The high fat, low carbohydrate diet, which has been of some benefit to other patients with epileptic seizures, did change the pattern of Dallas’ seizures, but it didn’t lessen the frequency.
By this time Dallas was 6 years old. He hardly ate and his body had become frail. He was mean-tempered and irritable. He couldn’t stand to be held or touched. Driving anywhere was impossible – a car seat couldn’t contain him. Dallas hardly slept – the tiniest noise woke him and his seizures would begin again. The Meffleys also got little sleep, "That time is a blur now," Mrs. Meffley notes grimly. "We were literally confined to the house for those years."
By age 7, no medical treatment had helped and the exact cause of Dallas’ epilepsy was still unknown.
Finally, Dallas’ third neurologist recommended the Meffleys contact the Cleveland Clinic. The family met with Ajay Gupta, M.D., a specialist in pediatric epilepsy and epilepsy surgery evaluations, who reviewed Dallas’ original MRI results.
"We’ve developed special protocols that can study the brain by sectioning it millimeter by millimeter," says Dr. Gupta. By sectioning the brain image using different imaging techniques and orientations, neurologists can find subtle and small abnormalities that may otherwise be missed on standard brain MRI techniques.
These findings are then matched to the clinical and EEG data to determine precisely the zone of seizure onset in the child’s brain. Dr. Gupta notes, "Picking up on these abnormalities also depends on the observer’s experience and knowledge."
Further brain mapping or placing electrodes on the surface of the brain may be needed if the area of seizure onset is close to certain brain regions that affect motor or speech functions.
During his assessment, Dr. Gupta determined that Dallas’ left temporal lobe had never finished forming. This, he surmised, was the root of Dallas’ seizures and hyperactivity. Surgery, he thought, could make the difference.
Dr. Gupta and William Bingaman, M.D., a neurosurgeon specializing in the surgical treatment of epilepsy, explained the procedure as well as the risks involved. Dallas would have a temporal lobectomy, in which the small section of his brain thought to be responsible for the seizures would be removed.
"It was the hardest decision we’ve ever had to make." Mrs. Meffley shakes her head at the memory. "But when you see your son seize 200 times a day - at that point his whole brain was seizing. He was exhausted. He had no life, no friends."
Just before his eighth birthday, Dallas had his first surgery. A week later he needed a second surgery. But it worked: a few days after his second surgery, Dallas became completely seizure free.
For about a year he suffered from severe migraines, which were caused by some fluid still left on the brain. After the fluid was reabsorbed, the migraines became less frequent, and then disappeared.
Two years later, Dallas remains seizure free.
"He can do colors again and count to 10!" exclaims Mrs. Meffley. "He’s so calm now, and he has a smile for the first time."
The family still makes the three-hour drive to the Clinic to see Dr. Gupta, but the need for follow-up visits has diminished. Dallas receives regular speech and occupational therapy, learning, for example, how to cut with scissors and trace his name. While he did lose the peripheral vision in his right eye as a consequence of the surgery, Dallas has adapted well.
"He can get out now - he has real friends. And he wants to be held a lot – finally!" Mrs. Meffley laughs, "He’s making up for what he missed in all those lost years." She smiles, "We are, too."
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 2/1/2006