Brendan Randolph focuses on the lane in front of him, takes a few steps and lets the ball fly down the lane. He waits to see where it lands and then turns back, grinning with satisfaction: With all ten pins down, it’s a strike. Bowling is one of his favorite pastimes, and he’s thrilled to be back at it. That’s no small feat for this 17-year-old, who underwent brain surgery just a few months ago.
Running out of options for epilepsy
Brendan began experiencing seizures within just a few hours of his birth and was diagnosed with epilepsy, believed to be the result of a stroke. As the years progressed, so did the condition. Approaches such as the ketogenic diet and an implanted vagus nerve stimulator were of little help, and high doses of medications left him in a fog.
Worse, the seizures were becoming even more frequent. Brendan’s parents, Joanne and Chris, learned that — like about one-third of people with the condition — their son had medically refractory epilepsy, which doesn’t respond well to drugs. “It was out of control,” remembers Joanne. “We were quickly running out of options.”
For kids with medically refractory epilepsy, surgery is often the only possibility for relief. To determine the area of the brain where seizures are originating, patients must undergo multiple monitoring tests, the first phase of which is noninvasive. If the results are promising, the child moves on to the second phase, which typically involves the placement of electrodes on the surface of the brain.
But when Phase I monitoring at Brendan’s local hospital in Michigan couldn’t identify the origin of his seizures, his physicians determined that he probably wouldn’t be a good candidate for surgery. They suggested the Randolphs contact Dr. Phillip Pearl, co-director of the Epilepsy Center at Boston Children’s Hospital. “All of my research showed that Boston Children’s is number one in pediatric neurology and neurosurgery, so we felt really comfortable coming here,” says Joanne.
A difficult time
Yet two more pre-surgical workups in Boston also had vague results. Dr. Pearl and his team thought that surgery might reduce Brendan’s seizures and dosage of medications, but the second phase of testing — which includes subdural intracranial seizure monitoring — was daunting. This approach involves surgically opening the skull and placing a grid of electrodes on the surface of the brain. It’s a lengthy operation with a long recovery time, and it can’t always locate deep seizure origins. “It was more invasive and involved than we wanted to undertake at the point,” explains Joanne. “We put the idea of surgery on hold.”
The next few years were increasingly difficult for the Randolph family. Soon, Brendan was experiencing between 30 and 40 seizures a month, and his quality of life was plummeting. “It’s been very difficult for him,” says Joanne. “He changed so much with the seizures and all the meds. It was hard to watch.” She and Chris reached back out to Dr. Pearl — they were ready to revisit the thought of surgery.
A less-invasive testing approach
A fourth Phase I workup revealed no more than the first three, but this time, something was different. Neurosurgeon Dr. Scellig Stone explained that surgery might offer some palliative benefits: It wouldn’t most likely eliminate Brendan’s seizures, but it might help make them more manageable. Even better, there was now a less-invasive approach to Phase II testing.
In this procedure, known as stereoelectroencephalography (SEEG) electrodes are fed on tiny wires through trajectories drilled into the skull. These electrodes can reach deeper into a child’s brain and can present a better opportunity for clinicians to determine the source of seizure activity. At Boston Children’s, SEEG is now performed with the aid of a robotic arm, which allows for precise placement of the electrodes and trims operating room time in half. The Randolphs jumped at the opportunity.
No average teen
Even with these advances, SEEG can be difficult for children — it requires an inpatient stay while physicians monitor seizure activity. And Brendan is no average teen: Clinicians placed 23 electrodes in his brain — far more than typically needed — and monitored him for two weeks rather than one. Despite these challenges, he remained relatively laidback throughout the experience. “He never even complained,” says Joanne. “I couldn’t have done what he did.”
This August, based on the Phase II findings, Dr. Stone performed surgery. A resection of the right medial frontal lobe of Brendan’s brain aimed to reduce the number of seizures, while an anterior callosotomy removed two-thirds of his corpus callosum to stop seizures from spreading to other parts of his brain.
Leaps and bounds
Before the surgery, the longest Brendan had gone without having a seizure during the past six years, was eight days. And while Dr. Stone was correct — the procedures haven’t cured his epilepsy — he recently celebrated an incredible 48-day seizure-free streak, and his parents are cautiously optimistic that the next stretch will be just as long. They’re already noticing some differences in his personality, as well. “He’s become very curious, smiling and asking tons of questions,” says Joanne. “It’s like the fog is lifting.”
As Brendan returns to school this fall, he’s continuing to excel in speech and occupational therapy — and can’t wait to return to playing his favorite sport, basketball, in a couple of months. “We’ll see what the future holds,” says Joanne. “But right now, he’s progressing by leaps and bounds every day.”
Learn about the Epilepsy Center.