Saturday, April 6, 2013

The First Hemispherectomy by Dr. Ben Carson

After watching a show about Dr. Ben Carson, I had no idea he was responsible for re-introducing the hemispherectomy after many failed attempts.  In 1985, Dr. Carson performed the first successful hemispherectomy on a four year old Denver girl who was having 120 seizures a day due to her epilepsy.  Thanks to the success of the operation to stop her seizures, it was reported in 1993, that this little girl, then 12, was taking tap dance classes. What a remarkable story.  What was also interesting was the simulated surgery that showed what it took to remove the left hemisphere as well as showing how detrimental having epilepsy can be.  I hope it makes some think about what epilepsy is and how it can really affect any one of us.

Here are excerpts from an article I found:
"My philosophy is to look at a patient and ask, 'What is the worst that could happen if we do something'? " he explained during a rare free moment in his modern, uncluttered office. "It's usually that the patient ends up seriously debilitated or dead.
"Then I ask, 'What is the worst that could happen if we do nothing?' And it's usually the same thing. So with that as a background, I figure it's always worth trying to do something, if there's any chance at all that doing something might end up helping."
This attitude led Dr. Carson, in 1985, to revive the surgical procedure known as hemispherectomy, the removal of half the brain in a child who is plagued by seizures that do not respond to drugs. The hemispherectomy, first developed in the 1930's, is an operation of epic consequence, performed in the hope that the remaining one can orchestrate thought, speech and movement for the whole body.
After several hundred unsuccessful attempts, the procedure fell into disfavor in the 1970's, not because of the dysfunction resulting from the loss of brain tissue, but because of the nearly inevitable post-surgical complications, including bleeding, infection and problems with the cavity left behind.
But when Dr. Carson met Maranda Francisco, a 4-year-old girl from Denver who was racked by 120 seizures a day, he decided that medicine had advanced sufficiently to give the measure another try.
"The chief of pediatric neurology here, John Freeman, felt that Maranda was a perfect candidate for a hemispherectomy, which he had seen performed a few times while he was at Stanford," Dr. Carson said. "So I did a lot of reading on the subject, and it seemed to me the complications were mostly things we could handle now."
The odds against success were great, but Dr. Carson figured it was worth taking a chance. "I reasoned that she was having so many seizures that she had no life, so there was not really anything to risk," he said. "And there might be a whole world to gain."
Maranda is now a healthy 12-year-old who takes tap-dancing lessons. Like most of the other hemispherectomy patients at Hopkins -- 44 in all, which the hospital believes is more than at any other center in the country -- Maranda got her speech back immediately after surgery, probably because her right hemisphere had already taken over language function from the badly damaged left hemisphere.
The main physical consequences of the loss of half a brain -- paralysis of the opposite side of the body -- was corrected in Maranda's case by several months of physical therapy. Most of the other children have had similar restoration of speech and movement.Dr. Carson estimated that 80 percent of the hemispherectomies done at Hopkins have significantly reduced or eliminated the patients' seizures.
"We can only do this operation on young children, because their brain cells haven't decided what they want to be when they grow up," Dr. Carson said. This flexibility, which neuroscientists call "plasticity," explains why certain brain cells take over the functions of damaged or missing cells.
To read more on this article, click on the Dr. Ben Carson link.

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