Jacksonville, FL — Around the age of 2, Jacksonville’s Aliyah Walker developed Rasmussen’s encephalitis, a rare, chronic inflammatory disease that usually affects only one hemisphere side of the brain. It usually causes frequent and severe seizures, loss of motor skills and speech, paralysis on one side of the body (hemiparesis), inflammation of the brain (encephalitis), and mental deterioration. Aliyah was experiencing all of these symptoms.
Since Aliyah’s seizures were not responding to anti-seizure medication and her function was worsening, her pediatric neurologist and epileptologist Raj Sheth, MD, with Nemours Children’s Specialty Care, Jacksonville, reviewed MRI scans that showed that, over the years, her brain was shrinking on the left side. “This process was slow and insidious, but unrelenting in its progression,” said Dr. Sheth, director of the Pediatric Epilepsy Center at Wolfson Children’s Hospital. “Already, she had weakness on her right side, difficulty in speech fluency, and a serious risk of injury due to falling. Her condition would only worsen with time.”
Dr. Sheth knew there was only one option left for eight-year-old Aliyah: brain surgery. He consulted with University of Florida-Jacksonville pediatric neurosurgeon Philipp Aldana, MD, chief of neurosurgery at Wolfson Children’s Hospital.
“The concept with any seizure surgery is to take out the part of the brain causing the abnormal electrical discharges so it doesn't spread to the healthy parts of the brain and cause a clinical seizure,” explained Dr. Aldana. “If you can’t take out a large portion of the brain then you must disconnect the affected part of the brain from the other parts of the brain. I liken it to electricity, where you cut the wires so the electrical signals don’t spread. This is what we did in this case.”
“The hoped-for outcome was the elimination of seizures and prevention of further progression,” said Dr. Sheth.
Called a hemispherotomy, this major brain surgery involves cutting the fibers that go from the left side of the brain to the rest of the patient’s body, down the brainstem and spinal cord, as well as cutting through parts of the temporal lobe that frequently causes seizures. “We preserve blood flow to the part of the brain left behind, but it is no longer functional,” explained Dr. Aldana.
He added, “Many of her functions had already partially moved to the right side of her brain in an amazing process called neurononal plasticity, which is the ability of the brain, particularly a young child’s, to create new neural pathways to the healthy side of the brain, which takes on the functions of the damaged hemisphere.”
Following the 10-hour surgery, Aliyah was hospitalized in the Pediatric Intensive Care Unit at Wolfson Children’s Hospital. She then was transferred to Brooks Rehabilitation Hospital for therapy to help her return to her best possible function.
Dr. Sheth said, “Because we have a strong pediatric epilepsy program in Jacksonville, and a pediatric neurosurgeon skilled in epilepsy and seizure surgery, Aliyah and her family were able to stay near home for her procedure and recovery rather than having to travel to Miami or Atlanta for this very advanced, major brain surgery.”
“Aliyah is expected to be seizure-free and lead a relatively normal life,” said Dr. Sheth.