Trades Piece of Her Brain for End to Seizures

Sept. 2, 2010— -- Holes drilled in her head, wires inserted into her brain, the single mother got the good news: the abnormalities in certain areas of her brain had been pinpointed and, if surgically removed, might end her increasingly frequent seizures.

But there were enormous risks -- potential damage to her memory, other critical functions, even the possibility she could be "cured" for a brief time by surgery, only to have the problem surface in another part of the brain and her seizures resume.

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Then Kristy MacDonald, 30, thought about her 6-year-old daughter, Mychaela. Now that MacDonald was incapacitated by her seizures more frequently, the young child was more often in the role of caring for her mother than a child should be. The high-stakes gamble was worth it.

"God, I'm scared," MacDonald said before undergoing the surgery she desperately hoped would correct the problem without the troubling complications.

Three years ago, MacDonald, a medical secretary from Barton, Md., suddenly began suffering epileptic seizures. They were frightening to family members who witnessed them, including MacDonald's aunt, Karen Bothwell, and her mother, Peggy Spataro.

"Her head would just turn, I mean almost like 'The Exorcist,' I mean really, it was just really that scary," Bothwell said.

Despite a daily regimen of medication to treat them, MacDonald's seizures were becoming more frequent and she was suffering as many as two a week. While her family kept an eye on her at all times, young Mychaela was most closely affected.

"Right now, life is Hell," MacDonald said. "This is my baby. She's 6 years old. And she's always watching out for Mommy."

Hoping for a better life, MacDonald turned to the West Virginia University Health Sciences Center in Morgantown, W.Va.

Dr. Julian Bailes, chief of neurosurgery at West Virginia University, has been operating on brains for more than two decades. He told MacDonald he needed to explore what was going on inside her brain to decide how to correct the mental misfires that might be causing the seizures. The plan was to drill holes in her skull, threading electrodes through them and into the hippocampus, the part of the brain that houses memory. Doctors planned to later monitor her 24 hours a day at WVU's Epilepsy Monitoring Unit until MacDonald had enough seizures to give them the information they needed to decide the best next step for treatment.

Wires Inserted In Brain, Mom Is Monitored During Seizures

"The brain's in this closed box - the skull. We've got to penetrate it," said Bailes, who estimates he's performed thousands of brain surgeries over the years but still finds the work fascinating. "I'm going in for deep brain information."

For MacDonald, the thought of having her skull drilled and her brain probed in anticipation that damaged parts can be removed was as frightening as the cure was promising.

"Any surgery is nerve-wracking, but when it comes to your head and putting little holes in my head, into my brain, that's scary," MacDonald said. Still she was hopeful that the drastic measure would help her regain control of a life taken over by epilepsy.

Her family, meanwhile, prepared for the possibility that a seizure-free MacDonald may not be the same loved one they know. Dr. Bailes was concerned that epilepsy surgery on MacDonald would come with a major risk: MacDonald could lose her memory.

The process of putting electrodes deep into MacDonald's brain began with drilling holes into her skull.

"This is the entry point above the left ear, to track the trajectory down to get to the hippocampus," Bailes said. "The electrode is now being placed through the guide."

Wires to transmit her brain wave information were then cemented to MacDonald's skull to prevent them from moving or being pulled out.

With the wires securely attached to her brain, MacDonald was moved to the Epilepsy Monitoring Center and kept under surveillance for two weeks. During that time, she suffered several seizures.

"This is the head turning, head jerking," Dr. Adriana Palade told WVU's Epilepsy Team as they watched monitors recording MacDonald's her brain activity and assessing her seizures in real time to determine precisely where they're coming from in the brain.

After two weeks of monitoring, the medical team had enough information to recommend surgery to remove a part of MacDonald's brain suspected of triggering the seizures. The damage was tracked not to the hippocampus but to the amygdale, the part of the brain largely responsible for controlling emotions.

"Here we're right at the temporal lobe, and here if you see this right here this shouldn't be there. We think that seizures may come from here and it's the portions of the brain that will come out and leaving the hippocampus where the memory stays will be left behind," Palade explained.

Surgery Threatens Memory Loss, Inability to Speak

"It's not going to affect my memory?" asked a shaken MacDonald.

"No, no," assured Palade.

Bailes said MacDonald would be able to function without her amygdale on the left side of her brain because it was simply not working properly. A functioning amygdale is the seat of spirituality and symbolism.

"Amazingly, the human brain has redundancy, and we endeavor not to take out the part that's critical for those functions," said Dr. Bailes. "It's never fun in a way to take out a part of the brain, but in epilepsy, we think there are some parts that aren't working right, and parts that are generating the seizure. So, that part needs to go!" Still, Bailes said, no surgery is considered risk-free.

"It's a very high stakes place, the dominant temporal lobe, where your speech and language is located," said Bailes. "If you can't speak or understand, for most people, life is not worth living."

On the day of her surgery, MacDonald said she was looking forward to a life uninterrupted by epilepsy.

"Maybe I will be able to get my life back," MacDonald said. "They say it's not going to affect my memory, if it was going to affect my memory, I wouldn't do it. I have my baby to worry about. She's my top priority."

MacDonald was wheeled into the operating room and surgery preparations began as planned but the doctors suddenly encountered a snag. A large vein that supplies blood to the entire left side of MacDonald's brain was in the way, lying in the exact spot where Bailes planned to cut.

"This is going to be hard. The vein should be further posterior shouldn't it?" Bailes asked his colleagues. "I mean look at it…"

"I don't think you can take it," another doctor agreed.

"This vein.. if taken by the surgeon, or injured by a surgeon… could have perhaps led her to be unable to speak again, or unable to understand the spoken or written word," Bailes said. "We're limited I think by this big vein which may control her speech. I don't feel comfortable taking that vein."

While the surgical team plotted the best way to overcome the obstacle, MacDonald's family nervously awaited word of how the surgery was progressing.

"We are all just, frazzled," said her aunt, Bothwell.

"If I talk to her and she knows who I am, I will be happy," said her mother, Spataro.

Brain Surgeons Suddenly Confronted With Obstacle

Nearly four hours into the surgery, Bailes was still looking for the best path to the part of McDonald's brain he planned to remove.

"This is sort of like going through a bowl of Jello... with some veins and arteries in it," Bailes said. He persevered and eventually found a way around the vein.

"I had to go to Plan B, and, and change my trajectory and my extent of removal," said Bailes. "We got the anterior part of the temporal lobe, and the amygdale, the important part, out. But from my point of view it seemed to go well. Time of course, will tell."

And so time did. One hour after surgery, MacDonald woke up and was put through a basic test. She passed with flying colors: She wiggled her toes. She remembered her name.

Some 36 hours later, she was ready for a visit from her little girl. As Mychaela sat on her Aunt Karen's lap, they both gave MacDonald a "thumbs up" on her memory, post surgery.

As much as their report pleased Bailes, he was cautiously optimistic about what the future holds for MacDonald.

"Only time will tell. It's very possible that you do your best at removing that part, and then the seizures actually can begin to originate from an area adjacent, or an area remote. So, you just don't know. You take your best educated prediction of where you can believe the seizure's originating, and where you can safely remove, and, so far, she's doing well," Bailes said.

MacDonald's mother said she was happy to take her daughter's progress one day at a time. " I thank God, the doctor, now she will have a normal life. Her and Mychaela can be happy, she can be happy, and but Kristy's back."

Two months after her surgery, MacDonald remains seizure-free.