Neurosurgery to Cure Epilepsy

An exceptionally complex neurosurgical procedure was conducted at Schneider Children's in a 2-year-old girl who suffered from epilepsy, the first of its kind to be conducted in a child in Israel. Today, a few months later, her epileptic seizures have stopped completely and the youngster is doing well and continues rehabilitation.

Bissan Nahaesh, 2½, from Nazareth, who has two older brothers, had a standard birth without any congenital disorders following (normal) genetic tests throughout the pregnancy. Already in her infancy, it was clear that Bissan suffered from weakness on the left side of her body, but her parents did not relate any great importance to this and believed that this would right itself on its own. In addition, from a cognitive point of view, Bissan advanced according to all anticipated stages for her age. However, when she was 4 months old, Bissan started to have spasms in her left hand that spread to convulsions on the entire left side of her body – until there was complete paralysis on her left side and she started having seizures on her right side. After a series of tests, Bissan was diagnosed with epilepsy.

Epilepsy, known as "the falling disease", is a chronic disorder in the electrical activity of the nerve cells in the brain, which leads to seizures. An epileptic attack is manifested by uncontrolled bursts when normal communication between the nerve cells for thought, reason, movement, and more, are disrupted. The disease is relatively common and can appear at any age. The dominant symptoms are loss of awareness, blurred vision and unconsciousness. According to data of the Israeli Society for Epilepsy, there are 90,000 sufferers in Israel, of whom about one-third are resistant to medication.

Following the diagnosis, Bissan's parents understood that the life of the entire family was going to change from one end to the other, because this is a disease that affects function, and over time, each seizure causes more and more damage to the body's organs. Bissan's condition deteriorated for which she had to be hospitalized regularly. However, the incidence and severity of her seizures just increased.

As time went by and her condition did not improve, doctors realized that the only way to help Bissan was through unique and complex surgery at Schneider Children's, which was little seen before in Israel in adults, and would constitute the first of its kind in children. Doctors hoped to decrease the number and incidence of her seizures and provide an improved quality of life and joy for the family.

About 6 months ago, Bissan and her parents met with Dr. Ido Ben Zvi, senior neurosurgeon and head of epilepsy surgery at Schneider Children's, who explained the procedure to them. Shortly afterwards, the 6-hour operation took place, and within a few days, there was already an improvement in her condition and the seizures stopped altogether. To reinforce the effect of the surgery, Bissan was administered medication, which was gradually eased. She is currently undergoing rehabilitation at Beit Levenstein to improve her motor movements and cognition which were damaged due to the frequency of the convulsions.

Dr. Ben Zvi, who operated on Bissan and is conducting follow-up care, noted that "Bissan suffered from a rare syndrome that caused convulsions for which there was no medication, and without any appropriate solution, she would have slowly lost her cognitive ability. This was an operation not seen often in Israel and never before in children called "hemispherotomy" and is performed only in cases where the entire hemisphere (and in Bissan's situation, just the right side) is involved in the seizure, and so it is impossible to perform any excision. During the surgery, we disconnect the electrical fibers that join the damaged hemisphere to the healthy half, thus stopping the seizures altogether (70% of cases) or significantly reducing their incidence and severity. This is an extremely complex procedure, perhaps the most complex in the realm of neurosurgery, that requires broad and the most precise anatomical knowledge."

Rihan, Bissan's mother, said that " life before the operation was impossible. When Bissan was at home, we had to watch her around the clock. Each time she was hospitalized as her epilepsy was out of control and threatened her life, my husband and I would take turns staying next to her. One of us stayed in the hospital, and the other juggled between work and our other two children at home. Dr. Zuabi, Bissan's doctor, told us that there is a brain surgeon at Schneider who specialized in epileptic surgery and he could help us. We were under pressure because this operation requires opening the skull, but the doctor explained to us that Bissan was living with a ticking bomb in her head and the more the seizures occurred, the more her development would be delayed. She also said that this operation was our only option. Since the surgery, she has not had one convulsion. This is truly an unbelievable miracle."