Modern Imaging Techniques Make Surgery Possible for People with Intractable Epilepsy
Jayna Doll, 4 months, bonds with mom Sunshine Glynn. Photo by: Phil Dwyer/Bellingham Herald
For the first month of her life, Jayna Doll knew no peace.
A merciless barrage of epileptic seizures swept her tiny body — more than 20 a day. Medication brought little relief.
“Every day, she had more and more seizures,” recalls her mother, Sunshine Glynn. “They lasted anywhere from two to four minutes and they were pretty hard to watch. A nightmare, really. It was hard to bond with her. She did very little besides eat and have seizures.”
As the days passed, Glynn and her husband, Jaime Doll, grew more and more concerned about their daughter’s future — and more and more convinced that surgery was her best hope.
Yet brain surgery is rarely an option for infants until they are at least 3 months old. “Everybody said, ‘Too young, too young, too young,’” Glynn recalls.
Then Seattle Children’s neurosurgeon Dr. Jeffrey Ojemann entered the picture. After Jayna was admitted to the hospital following an hour-long seizure, Ojemann concluded the threat to her development posed by the relentless seizures outweighed the risks of early surgery — a choice that wouldn’t have been possible without modern imaging technology.
“Our surgical techniques haven’t changed a lot in the last 20 or 30 years, but our ability to know ahead of time what to expect has been an absolute revolution,” says Ojemann. “With more precise imaging, we can avoid important areas of the brain while still being able to operate on problem brain tissue. It’s opening a whole new set of opportunities for people to have surgery.”
Surgery is often the last resort for patients whose seizures cannot be controlled by medication. In some cases, surgeons remove tissue from the area where the seizures are believed to originate. In others, they “disconnect” that area from the rest of the brain. Either way, the key is to pinpoint where to operate and where to steer clear — a process known as brain mapping.
Without a map showing the source of the seizures, surgeons can’t operate — and children with intractable epilepsy can’t escape the potential of serious developmental damage.
Born with hemimegalencephaly, a rare brain malformation in which one hemisphere is larger than the other, Jayna’s seizures were coming from multiple sources in her brain’s abnormally large right hemisphere. After using a conventional MRI to map the nerve pathways transmitting her seizures, Ojemann surgically disconnected them, effectively stranding the seizures on an island with no escape and no way to cause harm.
Jayna’s operation, performed when she was just 28 days old, quelled her seizures and ended the Bellingham family’s ordeal. Now 4 months old, Jayna is alert, interactive and content. “Our quality of life is 100 times better,” says Glynn. “Without Dr. Ojemann, I would be standing here in tears watching my baby have seizures every day.”