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NeuroLogic - Seizure Surgery Surprise

NeuroLogic Winter 2013

Seizure Surgery Surprise

Date: January 1, 2013

Working together with the pediatric neurology team, Adam Hartman and George Jallo helped a little girl overcome a debiltating seizure disorder.
Working together with the pediatric neurology team, Adam Hartman and George Jallo helped a little girl overcome a debiltating seizure disorder.

After Kelley Philhower began suffering seizures at age 5, her family took her to a medical center near her home in Ohio. Following tests there, a neurologist gave her the grim news—she had Rasmussen’s encephalitis, a rare inflammatory condition resulting in intractable seizures and a progressive deterioration of one side of the brain. The diagnosis was bad enough, says Kelley’s mom, Nancy Philhower, but how the neurosurgeon gave her the news made it even more jarring: “His words were, ‘She’s going to have the left half of her brain removed, and she’s going to walk, act and look like a stroke victim,’ which hit us like a brick wall. Needless to say, we didn’t like that approach at all.”

Philhower immediately began searching the Internet for a treatment center well-experienced in treating Rasmussen’s, and “Johns Hopkins” kept popping up. She called. Yes, we can take care of Kelley, pediatric neurologist Adam Hartman and pediatric neurosurgeon George Jallo said, but her diagnosis and treatment options would be determined by a multidisciplinary group of pediatric neurologists, neurosurgeons and neuro-immunologists, among other specialists.

“It’s a pretty comprehensive look at what’s going on,” says Hartman. “Because of our experience and the full spectrum of services we offer here, we’re not necessarily committed to a single treatment.”

Kelley’s evaluation included imaging studies to precisely localize the affected part of her brain to determine how its removal would affect her functions. The group recommended intravenous immunoglobulins (IVIG) or surgery. Even though studies have reported some good effects of IVIG on seizures and neurological functions, the immunotherapy does not eliminate seizures in most cases. With the surgery, called a hemispherectomy, Hartman explained, Kelley would be seizure-free, but she would temporarily lose the use of her right arm and leg and, likely, her ability to talk because the affected left hemisphere is dominant for language. Those functions would be restored, though probably not completely, through rehabilitation and the plasticity of the young brain—the ability of its remaining half to take over what was lost in the surgery.

“We’ve seen Mother Nature flip the language function over to the other side,” Hartman explains. “But rehabilitation, like the presurgery evaluation and surgery itself, is critical. To help parents through this process, we connect them with other families who have gone through the surgery, rehabilitation and postsurgery life back in the community.”

In the meantime, Kelley’s seizures had increased in severity and frequency—to every 15 minutes or so—and the family chose surgery, which Kelley underwent with surprising results. Undergoing rehab services at Johns Hopkins’ famed sister institution The Kennedy Krieger Institute, Kelley was walking with a therapist within a week and on her own by three weeks. “Her language has increased a ton,” says her mom, “and she’s not had a single seizure since the surgery.” Now a 7-year-old in first grade, she adds, Kelley is extremely active, playing basketball and swimming.

“She’s definitely been handed a second chance by Drs. Jallo and Hartman, who are two of the most attentive doctors I have come across, and believe me, I have come across a lot of doctors over the last two years,” says Philhower. “They are very caring individuals with immense knowledge—and big hearts, too.”

For information: 410-955-7337

Articles in this Issue

Brain Cancer Genetics

Pediatric Teamwork

Advances in Autoimmune Disease