Tackling a short circuit of the brain
Drug-resistant epilepsy that leaves millions socially and professionally debilitated, can sometimes be effectively addressed with surgery
Tanya was seven when she began to see sparks of violet in front of her eyes. "You're watching too much TV, I kept telling her," her mother confessed, ignoring the symptoms for a few months until the descriptions became vivid. "She would talk to us about purple lions dancing on trees and butterflies jumping on hot air balloons made of candy," her father added, pulling out a few drawings of their daughter; the art of the visual auras she perceived.
They thought the child had a creative spark until one day, while she was painting a pink sky, her right hand began to shake violently. I saw her clench her teeth, froth at the mouth, and fall to the ground. She cut her forehead with the corner of the table and jolted in blood till the tremors subsided. "What lasted less than a minute seemed like a lifetime to me," the mother described an episode from two years ago.
Tanya was taken to a local hospital where they stitched her up and gave her medication. After a couple of hours, she was fully conscious, back to being her chirpy self, with no recollection of why she was in hospital. An EEG showed epileptic activity, but the MRI was seemingly normal. Her discharge was planned for the next day, but she had another such episode. Since then, she suffered fits every week, despite being on four strong anti-epileptic drugs.
The couple had made the rounds of doctors, tried homeopathy, Ayurveda, and even medical marijuana. They had to stop her from going to school and couldn't leave her alone because they couldn't tell when the attack would come. "Look at her, bruised all over," she said.
While I perused the reports, Tanya nudged her dad: "Papa, two orange fish are riding a golden horse!" I looked up and saw her convulsing, her father holding onto her to prevent her from falling, but unperturbed as if this was now routine. In the last few weeks, she had suffered daily episodes, sometimes several times a day.
We admitted her and carried out an advanced high-resolution MRI dedicated to picking up abnormalities in epilepsy, as well as a PET scan, which showed hyper metabolism adjacent to the visual and language area of her brain. "We have to disconnect the area of the brain generating the seizures from the rest to prevent it from spreading like an electric current. We have to stop it from short-circuiting," I explained.
Not many are aware that surgery can cure drug-resistant epilepsy in select cases, and Tanya had a good chance because the puzzle fit. All tests pointed to a single region in the brain as the source for seizures. Over time, because of neuroplasticity, the brain could compensate for lost function, in her case, mostly related to vision.
It is estimated that more than 65 million people live with epilepsy worldwide. It's mind-boggling to imagine that one person in every 26 will develop epilepsy at some point. Unfortunately, even now, both children and adults with epilepsy suffer prejudice and stigma. The former are labelled possessed, while the latter tend to remain unmarried, see higher rates of unemployment, experience discrimination in seeking and maintaining employment, and tend to feel ashamed at work and in social life. On the brighter side, famous and accomplished individuals like Vincent Van Gogh, Neil Young, Theodore Roosevelt, Lewis Carroll and Charles Dickens, lived with a seizure disorder which they overcame.
A few days later, we made a large opening in Tanya's skull to expose her pristine brain. From how angelic it looked, it was tough to imagine that it could create havoc within. We placed a malleable electric grid over its surface to record where the seizures came from and went ahead with the disconnection in step-wise fashion. Once complete, we placed the grid back to record any more seizure spikes. It was completely silent. She made an excellent recovery. For the first time in two years, she had a week go by without a seizure. This extended to a month and then to an entire year and then two years. We could gradually wean her off some of the medication that made her drowsy, and she started doing well at regular school even after having missed a year.
I saw her recently at the clinic three years after the surgery. The wrinkles had been ironed out from her young parents' faces; now, they only creased when they smiled.
"What are you going to be when you grow up?" I asked her, as I examined her.
"I want to be an artist. But I'm angry with you because I don't see all the stuff I used to before."
I thought, not a worry. She would still make a splendid one. "Do me one favour," I said, "Gift me a painting the next time you come; I don't think I will be able to afford it at an auction."
The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals. You can reach him at email@example.com
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