Epilepsy


Sometimes the seizure activity, while lateralized to one side of the brain, is not sufficiently localized for removal of only a small focal area. More extensive surgery may be both necessary and helpful. Sometimes we have to take out extensive amounts of the brain or even one half of the brain, hemispherectomy.
Yes, it is possible to remove one half of the brain and still have a child of normal intelligence whose only disabilities are difficulty using the arm on the opposite side and a hemianopsia, meaning that he can’t see off to that side of his body. Such children are able to go to regular schools. When older, they can hold full-time jobs and live virtually normal, independent lives. Hemispherectomy is rarely performed, only perhaps ten to twenty times a year in this country. It is mentioned here so that you will know that it does exist and that in very carefully selected situations—when the child has severe damage to only one side of the brain, and already has damage to motor function on the other side of the body, and experiences uncontrollable seizures—a heroic operation such as this can be done. It can be life-saving and allow an otherwise profoundly handicapped child to lead a far more normal life, one free of seizures.
Rarely, or so it seems, a child is born with major abnormalities on only one side of the brain or sustains damage or inflammation (Rasmussen’s syndrome  to just one hemisphere of the brain. If your child’s seizures are consistently coming from one side of the brain and do not respond to medication, it may be worth discussing the possibility of hemispherectomy with your physician.
Hemispherectomy is not a procedure for everyone, not even for everyone with damage to one side of the brain. It is major surgery that should only be done in a small number of epilepsy centers with experience with the procedure. The outcome for the child depends primarily on the normality of the remaining hemisphere. Indeed, it seems from these children that no brain tissue on one side is preferable to the constant electrical interference coming from abnormal brain tissue. It appears that this constant electrical interference impairs the function of the good side. Beth is a good example.
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Parents rightfully wonder and worry about their child’s future. Marriage and grandchildren are a part of that future. Not so long ago, marriage of persons with epilepsy was prohibited by law in many states. The eugenics movement, relying on a U.S. Supreme Court decision and on the principle that “one generation of imbeciles is enough,” was able to implement these laws. Fortunately, the erroneous rationale behind these laws was disproved and the laws abolished. Ironically, we are only now beginning to gain significant information about the genetics of the epilepsies. Many misconceptions and misbeliefs still abound, for example, about the effects of pregnancy on epilepsy and about the effects of epilepsy and its treatment on a fetus. Physicians themselves often give outdated answers to these questions.
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LIVING WITH EPILEPSY: MARRIAGE, PREGNANCY, AND CHILDRENParents rightfully wonder and worry about their child’s future. Marriage and grandchildren are a part of that future. Not so long ago, marriage of persons with epilepsy was prohibited by law in many states. The eugenics movement, relying on a U.S. Supreme Court decision and on the principle that “one generation of imbeciles is enough,” was able to implement these laws. Fortunately, the erroneous rationale behind these laws was disproved and the laws abolished. Ironically, we are only now beginning to gain significant information about the genetics of the epilepsies. Many misconceptions and misbeliefs still abound, for example, about the effects of pregnancy on epilepsy and about the effects of epilepsy and its treatment on a fetus. Physicians themselves often give outdated answers to these questions.*264\208\8*

A spastic hemiparesis is a form of cerebral palsy that affects only one side of the body. It is caused by damage in the opposite side of the brain by a stroke, bleeding into the brain, trauma, or a problem in the brain’s development. The arm is usually more affected than the leg; there may be major problems with the use of the hand. Such children will usually be able to learn to walk with a limp. Since the damage is focal (onesided), these individuals are less likely to have mental retardation. Although we do not understand all of the factors that cause one person’s damaged brain to provoke seizures while another’s does not, and cannot predict which child will have seizures and which will not, in general we do know that a child with a hemiparesis whose CT or MRI scan shows brain damage is more likely to have seizures than one who does not have these problems. We treat the seizures as we do other focal seizures. Unlike the child with a spastic quadraparesis, the child with a hemiparesis may be a candidate for focal epilepsy surgery to remove the damaged tissue causing the seizures if they are uncontrollable.
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COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: SPASTIC HEMIPARESISA spastic hemiparesis is a form of cerebral palsy that affects only one side of the body. It is caused by damage in the opposite side of the brain by a stroke, bleeding into the brain, trauma, or a problem in the brain’s development. The arm is usually more affected than the leg; there may be major problems with the use of the hand. Such children will usually be able to learn to walk with a limp. Since the damage is focal (onesided), these individuals are less likely to have mental retardation. Although we do not understand all of the factors that cause one person’s damaged brain to provoke seizures while another’s does not, and cannot predict which child will have seizures and which will not, in general we do know that a child with a hemiparesis whose CT or MRI scan shows brain damage is more likely to have seizures than one who does not have these problems. We treat the seizures as we do other focal seizures. Unlike the child with a spastic quadraparesis, the child with a hemiparesis may be a candidate for focal epilepsy surgery to remove the damaged tissue causing the seizures if they are uncontrollable.*199\208\8*