Hannah's back in the saddle as brain surgery gamble pays off

Published on Saturday 20 December 2008 18:37

SHE cycles along the road with a smile on her face and beloved pet Lola in tow. Yet just a few weeks ago, such everyday activities were virtually impossible for nine-year-old Hannah Goodall.

The schoolgirl, who was born with cerebral palsy, was suffering up to 100 epileptic seizures every day, causing her to drop instantly to the floor. She was forced to wear a helmet to protect her head from injury and she needed adult supervision at all times.

But now Hannah can look forward to a brighter future following a rare brain operation at Great Ormond Street Hospital in London. In a procedure called a functional hemispherectomy, surgeons disconnected and disabled the part of her brain that was causing the seizures.

Hannah has now been free of seizures since the operation six weeks ago and hopes to return to her Edinburgh primary school early next year.

The radical brain operation is only carried out when all attempts to stop the seizures with drug therapy have failed.

Her mother Yvonne, an NHS researcher, said she and her husband Nick, a software engineer, had faced one of the hardest decisions of their life in agreeing to the operation.

"But everything that had been tried had not worked," she said. "Hannah had been on many different types of drugs to try to stop the seizures but none of them had been successful.

"The seizures were getting more frequent as she got older, so when we were told a hemispherectomy would have a 70% chance of success we felt there was really no option."

When Hannah was born a bleed in her brain resulted in cerebral palsy, a group of conditions that affect brain development and muscular co-ordination. It can also leave those affected prone to epileptic seizures.

In Hannah's case, the condition left her weaker on her right side and with difficulty in walking that she overcame with the help of a splint. At the age of four, however, she suffered her first small seizure, and a brain scan revealed evidence of damage. At five, she suffered a more serious seizure but the hope was that drugs would prevent them from occurring regularly. She started to attend South Morningside Primary when she turned six.

Yvonne said: "We just put her on the medication and Hannah just got on with her life. But the seizures started to get more frequent and she would just drop down. For a while they would happen in clusters, then she would be okay for a month and then there would be another cluster. They would really knock her out when they happened, but at least she was getting a break.

"Then when she went into Primary Two, it changed and the seizures became much more frequent, up to 50 a day. She started to decline cognitively and her learning was suffering."

Several types of drugs therapy, including steroids, were tried to prevent the seizures, but nothing worked. "In fact, it was getting worse." Yvonne said. "She had to wear a protective helmet because she was falling over so often and hurting herself. In the playground she had to have a classroom assistant with her at all times to stop her from falling.

"But throughout it all she managed to never let it get her down. People always tell me how she was always smiling. The staff and her friends at the school were all really great too, really supporting her throughout."

Seizures occur when the damaged part of the brain sends abnormal commands along nerve fibres. When Hannah was seven, the seizures increased to around 100 a day and were even occurring while she slept at night. Specialists in Glasgow referred her to Great Ormond Street and Hannah went on the waiting list for a hemispherectomy.

The operation is offered to children in whom the specific area of the brain that is causing the seizures can be identified and brain functions have naturally migrated to the healthy half. Although each operation differs, it usually involves removing a small portion of the temporal lobe and disconnecting the damaged part of the brain from the healthy section.

Surgeons will carry out the disconnection by severing the nerve fibres in the brain that carry the abnormal electrical activity to the rest of the body.

"The doctors thought Hannah might be an ideal candidate for surgery because there was a specific area of the brain that the seizures were coming from. With drugs there was very little chance that the seizures would stop. Surgery became the only option."

Last summer, Hannah was having seizures so often that she was exhausted and had to be admitted to hospital for three weeks. "She could barely walk," Yvonne said.

The six-hour operation took place six weeks ago and, so far, appears to have successfully stopped the seizures. "Hannah was a bit weak when she came out of hospital but by the time she got home she was wanting to jump about, even though she wasn't supposed to. Ever since she has been full of beans and she's really looking forward to having more freedom."

She attended her class Christmas party and hopes to be back at school next term. One of her teachers, Yvonne Moore, said: "It will be some time before we know how she will be in the future but we are all keeping our fingers tightly crossed. All of her classmates have also been wonderful over the years, supporting her in many ways. She is a very special little girl."