TMC PULSE

T M C » P U L S E | J U LY 2 0 1 8 28 Saving Umair Texas Children's Hospital performs a novel endoscopic epilepsy surgery H is parents describe it as a miracle—a gift from God. Just six months ago, Umair Majeed, now 12, was suffering from debilitating seizures multiple times a day. But last November, Sandi Lam, M.D., a pediatric neurosurgeon at Texas Children's Hospital, performed an endoscopic hemispherotomy as a surgical treatment for Umair's worsening epilepsy. A first for both the surgeon and the hospital, the innovative, minimally-invasive approach to the procedure has only been reported by two other institu- tions worldwide. Sitting in their living room in Conroe, Texas one evening in late May, Umair's father, Ashif Majeed, and mother, Bushra Majeed, spoke about their son's transformation since the successful operation. Although the family was fasting for Ramadan, they had set out food for guests—dates and yogurt-covered raisins, walnuts and Gatorade, and a large box of chocolates their young- est had won in a fundraiser for their mosque. They were eager to share every detail and overwhelmed with gratitude for their son's renewed health. "There have been no seizures, or any symptoms of seizures, either," Ashif said. "Before, he was having seizures, headaches and vomiting all the time. The situation was becoming more complicated. First, it was once a month, then once a week, then every other day, then in a single day, five times, so it was a really scary situation for us." To make matters worse, Umair's epileptic episodes would often result in physical injuries. He had to wear a helmet because of his fre- quent unpredictable falls from sei- zures; during Hurricane Harvey, he broke his arm after having a seizure in the bathroom, and clinicians at Texas Children's Hospital The Woodlands had to guide a frantic Bushra by phone around the flooded roads so that she could reach the emergency room. His medications, it seemed, were no longer effective. Ashif, a veterinarian originally from Pakistan, explained that Umair had suffered a stroke at birth that damaged the left side of his brain and rendered the right side of his body weak. But until 2014—the first time Umair was paralyzed with a seizure—the effects of this right- sided weakness were a manageable part of his daily routine, so his level of disability had been minor. As his episodes worsened, however, physi- cians at Texas Children's Hospital became convinced that surgery was Umair's only shot at a normal life. "We wanted to give a better life to him," Bushra said. "There was no solution except for surgery. They were increasing the doses of medi- cine, but it wasn't helping." Another option Because Umair's seizures originated from just one side of his brain—the side that had been damaged by a stroke when he was a baby—he was an ideal candidate for a surgery in which one side of the brain is either removed (called a hemispherec- tomy) or completely disconnected from the other side (called a hemi- spherotomy) in an effort to detach the rest of the brain and the body from the problematic area causing seizure activity. Seizures arising from the diseased side of his brain would no longer be able to spread to the unaffected half of the brain, thus allowing the healthy side of the brain to function to its full potential. Hemispherectomy and hemi- spherotomy surgeries have been performed for decades by select neurosurgeon specialists. They typically involve a large, question mark-shaped incision on the top and side of the head through the scalp, and are frequently associ- ated with a long recovery, swelling, postoperative pain, substantial blood loss and, often, the need for a post-surgical shunt to help drain accumulated fluid. But Lam, one of just a few spe- cialists who has performed a large Umair Majeed, 12, was the first patient at Texas Children's Hospital to undergo an endoscopic hemispherotomy for the treatment of his epilepsy. B y A l e x a n d r a B e c k e r We wanted to give a better life to him. There was no solution except for surgery. They were increasing the doses of medicine, but it wasn't helping. — BUSHRA MAJEED Mother of epilepsy patient, Umair Majeed e p i l e p s y t r e at m e n t s

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