Only the - Cook Children's

various scans, including a single-photon emission CT (SPECT), positron emission
tomography (PET), CT and MRI. Paugh then merges these scans to develop a
detailed brain map, giving the surgical team a view of every angle of the brain.
Unlike 2-D imagery, this 3-D model provides more precise location of the abnormal
brain tissue that’s causing seizures.
This technology can reduce the amount of electrodes used during surgery, allow
doctors to see a more precise location of eloquent brain function (i.e., speech or
motor function) and ultimately lead to more successful operations. The 3-D image
pinpointed the area of seizure origin in Micheal’s brain and showed the region of the
brain responsible for speech.
For Micheal and his family, the technology gave them hope of ending 10 long
years of anguish and fear that included three different stints in a mental hospital.
Micheal was a unique case. Years of uncontrolled seizures had made both of
his temporal lobes abnormal. The best surgical candidates have only one area of
abnormality; Micheal had two. The odds of becoming seizure free decrease when
multiple regions are involved.
“With all the history of behavior problems and evidence of bilateral temporal
lobe abnormalities, Micheal was not the best surgical candidate,” Dr. Perry said.
“Removal of one bad temporal lobe does not guarantee that the other damaged
temporal lobe will not cause seizures. With 3-D imaging, we were able to show that
the left side was the worst side and the true area of seizures onset. We never found
a seizure that came from the right side. We also knew the left side of his brain was
his dominant hemisphere and where language function resides. After we placed
the electrodes on his temporal lobe, I was able to map out where his language was
located. We were able to do a detailed surgery that removed the tissue that caused
seizures, but stopped short of involving an area responsible for speech.”
Without surgery and with the temporal lobe on the left side of Micheal’s brain
already bad, Dr. Perry believes that eventually the right temporal lobe would have
worsened. Without surgery, Micheal would have had a hard time maintaining a job
and probably would not finish school because of missed days due to his psychiatric
problems and seizures. His parents feared that Micheal would spend the rest of his
life in some type of facility.
Weighing their options, including that Micheal’s behavior could become worse, the
Driggars family did not hesitate. They felt the risk was worth the possible reward and
Micheal made the final decision. “I want the old Micheal back,” he told his parents.
With the detailed information from the 3-D image in hand, neurosurgeon David
Donahue, M.D., was able to remove the left temporal lobe without harming Micheal’s
ability to speak.
Since the operation, the old Micheal has returned. He has not had a seizure since
the operation and his depression and angry outbursts are gone.
“It was like a weight had been lifted off of us,” Brandy said. “For 10 years, Micheal
was miserable. All he ever wanted was to be normal. He said, ‘I want to be able to
drive one day. I want to do all those things that other kids do. What I thought was
amazing was that after our first visit with Dr. Perry, we were in the car on the way
home and Micheal said, ‘Mom, I think God sent us to Dr. Perry.’”
Nowadays, Micheal shows an interest in art, music and working out. At a recent
visit to Cook Children’s, Micheal flexed his bicep, and showed off his recent weight
loss. He has a new focus on appearance that he shares with most 15-year-old boys.
After receiving deserved compliments for his muscles, Micheal flashed a big grin.
Behind Micheal’s smile there’s an experienced and dedicated team of
neurologists, neurosurgeons, neuroradiologists, neuropsychologists, nurses and a
software bio-engineer which make up the Cook Children’s Comprehensive Epilepsy
Program.
“For so long he did not smile - he had one emotion, only anger,” Brandy Driggars
said of her son. “Now he has the huge smile on his face, and he laughs a lot.”
Micheal before surgery.
Sample 3-D image.
Micheal after surgery and all smiles again.
www.cookchildrens.org | Summer 2011 7