A 10-year-old Brigham City boy is expected to leave Primary Children's Medical Center Monday - less than two weeks after undergoing rare surgical separation of the two hemispheres of his brain to reduce epileptic seizures.
Dustin Howard, the first child to undergo the procedure in Utah, will likely leave behind longtime possessions - a helmet and face mask.They'll no longer be needed; his surgery was successful.
Since his operation Nov. 22, Dus-tin hasn't suffered one "sudden drop seizure." The seizures strike quickly and involve total loss of muscle control.
The traumatic seizures plagued the youth several times a day before the operation at the pediatric hospital. Unable to halt them with medication, Dustin had been required to wear the head gear for protection.
His mother was tethered to her child. It was dangerous to leave him alone.
"He is doing better than anyone expected. Results as positive as Dus-tin's aren't expected for weeks," said Dr. S. David Moss, the pediatric neurosurgeon who performed the surgery.
Dustin's three-hour operation, a corpus callosotomy, made medical history in Utah. The surgery also established Primary Children's Medical Center as a major pediatric epilepsy center _ one of the few in the United States
The surgical technique has a long history in adults, but only in the past five to eight years has it been used for children whose seizures cannot be controlled with medication. Until this year, children in the Mountain West were required to travel to large epilepsy centers in Los Angeles or Seattle for surgery.
"Kids with epilepsy often had been doomed to wait until they were teenagers, or until the seizures had burned themselves out," said Moss, an assistant professor of surgery at the University of Utah Medical Center. The "burning out" process, he said, was about as effective as allowing a fire to burn out of control in Yellowstone Park. It has serious residual effects, including brain damage.
But surgery had given pediatric epileptics new hope.
Surgery, Moss said, can involve removal of a surface part of the brain, or a lobe, or the entire hemisphere to reduce the risk of seizures.
In Dustin's case, Moss split the brain in half by using a laser to sever about two-thirds of the connecting fibers that pass from one half of the brain to the other.
Moss said the corpus callosotomy procedure was necessary because the child's seizures were not localized to a single spot, or even to one hemisphere. They were in both hemispheres and would pass back and forth, escalating on each other to cause the "drop attacks" that would often result in severe injuries to Dus-tin's head and face.
The surgery was a team effort between Moss and Dr. Jack Madsen, a pediatric neurologist, who monitored the brain waves during the procedure. Working together, the team determined when to cut _ and, equally important, when to stop severing fibers.
"The delicate balance is to divide just enough to stop the seizures from spreading side to side, but not enough to cause neurologic deficit," Moss said.
If the brain halves were totally disconnected, the patient would have some perception problems but could adapt, the physician said.
For example, such a person would need not only to see a ball with both eyes, but touch it with both hands to identify it. In extreme cases, some people can pay attention on only one side of the brain. The result: They would eat the food on only one side of their plate, or put their coat on only one arm.
"This is not expected to occur in seizure-surgery cases," Moss said.
Dustin, son of Ron and Vena Howard, isn't in danger of suffering such side effects. But he will never be 100 percent normal.
Epilepsy can result from many causes, including brain tumors and head injuries. Often the cause is unknown.
Doctors believe Dustin's epilepsy was caused by mild hydrocephalus, an abnormal accumulation of fluid in the skull. He was born with the condition, but it was not detected at the time.
Mrs. Howard said Dustin was developing normally until two months before his second birthday, when he had his first seizure. Shortly before he turned 3, he had a lengthy seizure that left him brain-damaged and partially paralyzed on his right side.
Physicians are optimistic that the surgery will greatly reduce his mild seizures and eliminate the "drop attacks." Already there have been improvements in his speech and attention span.
"His life will be more palatable," Moss said.
Between 75 percent and 80 percent of the patients who have had the operation have shown improvement _ encouraging news to many Utahns. Moss estimates that 4,000 to 5,000 Utahns have severe epilepsy disorders that require medication. About 20 percent of them would benefit from some kind of surgery.
"I don't see anything but bigger developments along these lines and Primary Children's is the perfect place for it," Moss said.
Moss, who performed surgery similar to Dustin's in Chicago, said the operation is planned for another child in January.
"The only time surgery is appropriate is if seizures cannot be controlled by medication, because surgery does require removing part of the brain or doing something permanent to the brain function," he said.