Featured Research

from universities, journals, and other organizations

Bold Three-stage Brain Operation For Intractable Seizures Appears Promising

Date:
May 7, 2006
Source:
New York University Medical Center and School of Medicine
Summary:
A boy plagued by seizures since he was 2 months old rarely experiences seizures now and his development has improved dramatically thanks to a bold three-stage brain operation being performed at NYU Medical Center.

Sadly, none of the treatments for epilepsy -- anti-seizure medications, a procedure called vagus nerve stimulation, a special diet -- could quell the electrical storms in the young boy’s brain. Caused by a rare genetic disease called tuberous sclerosis, the seizures began when he was only 2 months old. By the time he was 5, he was having more than 10 a day. The seizures left him with the developmental capabilities of a 1-year-old child.

Related Articles


Today the boy rarely experiences seizures and his development has improved dramatically thanks to a bold three-stage brain operation being performed at NYU Medical Center by pediatric neurosurgeon Howard Weiner, M.D., Associate Professor of Neurosurgery and Pediatrics at New York University School of Medicine.

This child’s case study is part of a report in the May issue of the journal Pediatrics that describes 25 children with tuberous sclerosis who have been operated on by Dr. Weiner over the last six years. It is the largest report of epilepsy surgery in young children with the disease by a single surgeon in the medical literature.

The youngest child was 7 months old, and the oldest 17. They initially were evaluated extensively by a team of physicians that included Dr. Weiner and Orrin Devinsky, M.D., Professor of Neurology, Neurosurgery, and Psychiatry and Director of NYU’s Comprehensive Epilepsy Center. The evaluation included an overnight stay in a special inpatient pediatric epilepsy unit at NYU’s Tisch Hospital, equipped with 24-hour electroencephalography (EEG) and video monitoring to correlate the children’s behavior with unusual brain activity.

After the evaluation revealed that seizures were affecting many areas of their brains, the team determined that the multi-stage operation would be necessary. Nearly all of the children underwent three separate brain operations over a 2-1/2 week period. Some of the operations lasted as long as nine hours. During the entire period the children remained in Tisch Hospital, where their parents could sleep next to them.

Two or more years after the operations, 17 of the 25 children were free of seizures or had only mild non-disabling attacks. Six children still experienced more severe non-disabling seizures but the number of such seizures was reduced by more than 90 percent. In two children the number was reduced by 50 percent to 90 percent. Despite the risks of brain surgery, Dr. Weiner and his colleagues report that the multiple surgeries did not cause serious infections or permanent damage to the brain.

“At some centers multiple-stage surgery would be considered aggressive, but we have established that this type of surgery is safe,” says Dr. Weiner. “Certainly this type of surgery should only be reserved for the toughest cases—children with tuberous sclerosis who are having uncontrolled seizures in association with developmental delay or even regression.”

Tuberous sclerosis produces tubers on many organs in the body, including the skin, kidneys, lungs, and eyes. In the brain, the hard calcified growths cause seizures. Mental retardation, autism, and other developmental problems can occur in as many as two-thirds of individuals with the disease, according to the National Institute of Neurological Disorders and Stroke. Children with tuberous sclerosis typically have more than two tubers but some may have up to 20 in their brain, says Dr. Weiner.

Many children with the disease aren’t usually considered candidates for brain surgery because it is difficult to identify which tubers are causing seizures using electroencephalography (EEG), which records electrical activity in the brain through electrodes placed on the scalp. The seizures in these children are spreading so quickly that by the time the electrodes pick up the abnormal nerve firings, it is no longer possible to determine where they originated. Other noninvasive imaging techniques cannot accurately pinpoint where seizures begin.

To overcome this problem, neurosurgeons place electrodes directly on the brain itself, which requires removing a portion of the bony cranium and cutting through the dura mater, the tough fibrous tissue covering the brain. The implanted grid of electrodes, attached to an EEG machine, is used to continuously monitor seizure activity over several days, providing a map for the surgeon to the location where the seizures arise. In the second operation, the surgeon removes the seizure-causing tissue in the brain.

Dr. Weiner takes the operation one step further. He places another set of electrodes in the brain after the second operation in order to locate any other areas that may be causing seizures. So children are again monitored with a grid of electrodes over a period of days, and then undergo a third operation to remove any tissue that still may be causing seizures.

Despite the promising results so far, Dr. Weiner says that it hasn’t yet been demonstrated that there is a “direct correlation between freedom from seizures and developmental normalcy.” However, he adds, “it is important to treat children as early as possible because persistent seizures are associated with a host of serious learning and developmental problems.”

The report in the journal Pediatrics is entitled “Epilepsy Surgery in Young Children with Tuberous Sclerosis: Results of a Novel Approach.” The authors are Dr. Weiner, Dr. Devinsky, Chad Carlson, M.D., Emily Ridgway, M.D., Charles M. Zaroff, Ph.D., Daniel Miles, M.D., and Josiane LaJoie, M.D.


Story Source:

The above story is based on materials provided by New York University Medical Center and School of Medicine. Note: Materials may be edited for content and length.


Cite This Page:

New York University Medical Center and School of Medicine. "Bold Three-stage Brain Operation For Intractable Seizures Appears Promising." ScienceDaily. ScienceDaily, 7 May 2006. <www.sciencedaily.com/releases/2006/05/060507211301.htm>.
New York University Medical Center and School of Medicine. (2006, May 7). Bold Three-stage Brain Operation For Intractable Seizures Appears Promising. ScienceDaily. Retrieved October 25, 2014 from www.sciencedaily.com/releases/2006/05/060507211301.htm
New York University Medical Center and School of Medicine. "Bold Three-stage Brain Operation For Intractable Seizures Appears Promising." ScienceDaily. www.sciencedaily.com/releases/2006/05/060507211301.htm (accessed October 25, 2014).

Share This



More Mind & Brain News

Saturday, October 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Academic Scandal Shocks UNC

Academic Scandal Shocks UNC

AP (Oct. 23, 2014) A scandal involving bogus classes and inflated grades at the University of North Carolina was bigger than previously reported, a new investigation found. (Oct. 23) Video provided by AP
Powered by NewsLook.com
Working Mother Getaway: Beaches Turks & Caicos

Working Mother Getaway: Beaches Turks & Caicos

Working Mother (Oct. 22, 2014) Feast your eyes on this gorgeous family-friendly resort. Video provided by Working Mother
Powered by NewsLook.com
What Your Favorite Color Says About You

What Your Favorite Color Says About You

Buzz60 (Oct. 22, 2014) We all have one color we love to wear, and believe it or not, your color preference may reveal some of your character traits. In celebration of National Color Day, Krystin Goodwin (@kyrstingoodwin) highlights what your favorite colors may say about you. Video provided by Buzz60
Powered by NewsLook.com
First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

Newsy (Oct. 21, 2014) A medical team has for the first time given a man the ability to walk again after transplanting cells from his brain onto his severed spinal cord. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins