A British family who traveled to Omaha with the hopes that a skilled
neurosurgeons hands would help their daughter, returned to England yesterday
in high spirits.
Katherine Kendall, 18, and parents Nigel and Anna Kendall of Surrey,
England, came to Omaha Sept. 1, to seek the help of the only one surgeon
in the world they knew of who might be able to help their daughter — Arun-Angelo
Patil, M.D., UNMC/NHS neurosurgeon.
The Kendalls desperately searched around the world for something that
might stop Katherines severe seizures. They found only one neurosurgeon
that would attempt a rare procedure their daughter needed. Dr. Patil is
unique in that he performs multiple-subpial cortical transection (MST)
on both sides of the brain, whereas among the few neurosurgeons who perform
MST, perform it only in limited areas and on one side of the brain.
Dr. Patil has performed the procedure on more than 100 patients, of
which more than half were performed on both sides of the brain.
The Kendalls, who live about 35 miles from London, had exhausted almost
all hope of getting their daughter cured from the severe epileptic seizures
that plagued their lives, until a London neurosurgeon mentioned Dr. Patils
work. It was a glimmer of hope.
Professor (Charles) Polkey told us there was only one person in the
world who could help Katherine, said Nigel. And that was Dr. Patil and
his team in Omaha.
Around the age of eight years old, Katherine began suffering from severe
epileptic seizures. Ultimately, the seizures got so bad that her learning
ability was affected.
With a developmental age of only four- to five-years-old, she was confined
by the constant seizure activity she suffered, exhausting her both physically
and mentally.
By the time Katherine came to Omaha, she had lost most of her speaking
ability. They were looking forward to meeting with Dr. Patil.
Several days after they settled into the Lied Transplant Center, Dr.
Patil performed two, 12-hour surgeries, five days apart on Katherine. He
transected or made about 1,000 cuts through circuits, or fibers, in her
brain. The intended result was to essentially prevent the occurrence of
seizures.
Dr. Patil said most surgeons tend to remove part of the brain in order
to stop seizures. Unfortunately, since Katherine’s seizures originated
from very large areas of the brain and from both sides, removal of brain
tissue was not an option because it would have resulted in extremely severe
disability or even death.
Theres an alternative operation that we do here and that operation
does not involve resection, it involves transection — just breaking the
seizure circuits. Its a long, tedious boring operation because you have
to go every four millimeter and break the connection. Because we dont
resect, you dont lose function.
Dr. Patil said he doesnt consider doing transection on both sides of
the brain anything particularly unique. No other centers have reported
doing the dual transection. The procedure was developed by a Chicago neurosurgeon
years ago.
MST was invented by neurologist, Dr. Morrell. Most surgeons perform
this procedure only in areas they can not remove. Dr. Patil has used this
procedure as a primary procedure, because, it does not destroy brain function
and it is effective.
The procedure stops seizures by disrupting the seizure circuits. Because
it preserves brain function, it can safely be performed on both sides.
It is however, a long and tedious operation because the circuits have to
be disrupted at four millimeter intervals.
Other than that, Dr. Patil said he doesnt consider doing transection
on both sides of the brain anything particularly unique.
All we know is it works. If it works on the critical area, then rather
doing a resection why not do on both sides of the brain, Patil said.
Dr. Patil has submitted the results of transection surgery on about
100 patients to a peer-reviewed journal.
Although it will be one to two years before it is known if the surgery
is completely successful (defined by an absence of seizures), Dr. Patil
and the family are encouraged.
Ideally, you probably want to wait for a year or two before you can
say the operations successful, however, we know that she had several bad
seizures a day before the operation, Dr. Patil said. I think in the last
four or five days at least, she has not had any seizures. There were a
few flurries that she had from time to time but they were not serious after
the operation and those have stopped.
Were seeing good results early, said Dr. Patil. I think she will
do very well.
Of the 50-60 patients Dr. Patil has done transactions on about 55 percent
are freed from seizures.
The Kendalls have noticed changes in Katherine already. Where before
Katherine had blank expressions, was silent, and rarely smiled, shes now
energetic, smiles a lot, and is affectionate, something Anna and Nigel
didnt see before surgery.
The most remarkable thing thats happened since surgery is her personality,
Nigel said. Whereas before the surgery we had a child who just wasnt
tactiledidnt like being kissed, didnt like having someone sitting close
to her on the sofa, and didnt like being hugged. Now weve got a child
who makes a fuss over you, she wants to kiss you, hug you. She has a completely
different personality.
Theres a lot of new things happening with her, Nigel said. If she
continues the way she is, shes really going to start to improve and be
able to be educated and start being a normal teenager, thats if being
a normal teenager is advisable. Before, there were too many seizures to
absorb anything.
Day-by-day I can see skills coming back, Anna Kendall said. Its
a delight. This surgery was the only chance she had. Hopefully, it will
give her a life worth living. Its what weve been fighting for.
Anna said when Katherine regained her speech following surgery, the
first thing she said was, I love you, mommy.
The Kendalls say Katherine is much more active, walks more steady and
looks up instead of at her feet, and her appetite has come back as well.
She eats like a horse, said Nigel. Ive never known Katherine to
eat so much. You dare get your fingers anywhere near her or shell have
em. Shes just trying to catch up.
Nigel said about 3,000 children in the United Kingdom live with the
same kind of epilepsy as does Katherine. The Kendalls are hopeful that
surgeons in England and all over the world will adopt the surgery to help
families like theirs. The path is open for others to follow, said Anna.
If Katherine is cured by this, then were going to spread the word
and say, well this is curable and that you need not be hopeless anymore,
that there is a light at the end of the tunnel, Nigel said.
After returning to England, Katherine will continue to attend a special
school for rehabilitation, with the hope she ultimately will be able to
resume living with her family full-time.