By Michelle P. Jordan
USC Department of Communication Sciences and Disorders
Howell, 5, is more than ready for kindergarten this fall. She can write
her name, count to 50, and recite her ABCs – pretty impressive for a
child who only has half of her brain.
At 15 months of age, Megan underwent a hemispherectomy, a surgery in
which the left half of her brain was removed in an effort to stop severe
recurring seizures. Aside from a noticeable weakness on the right side
of her body that hints at a problem, Megan functions nearly as well as
her peers. The question is how?
How has the remaining hemisphere of her brain been able to compensate
for the loss of skills, such as language, normally controlled by the
missing part? How can a better understanding of this process lead to
more effective therapy options for future patients?
Researchers at the University of South Carolina’s Arnold School of
Public Health are striving to find out the answers to these questions by
providing federally-funded, cutting-edge rehabilitation services not
offered anywhere else in the nation.
A stroke during birth left Megan suffering from as many as 80 to 100
seizures daily, said her mother, Shelly Howell, of Topeka, Kan. Even
though Megan was taking every anti-seizure medication safe for use in
children, her condition continued to worsen. By 15 months old, Megan
still could neither walk nor talk. Her body and her brain were too
occupied with seizures or drugged with medication for there to be room
“She could only sit up. She was like a zombie on the medications,” her
When Megan began to have grand mal seizures that lasted nearly seven
minutes, the point at which the brain begins to be deprived of oxygen,
Howell and her husband, Jeff, had reached the end of traditional
treatment options. Their choice: put Megan on an anti-seizure drug that
can be fatal to children, or have half her brain removed.
The Howells opted for neurosurgery and in 2002, Megan underwent a
hemispherectomy at the University of California Los Angeles. While the
seizures stopped immediately, and have not returned since, the difficult
road of recovery and rehabilitation was just beginning for the Howells.
The two primary hospitals that perform
this surgery, UCLA and Johns Hopkins University, are unable to offer
extended rehabilitation for patients recovering from a hemispherectomy.
USC is beginning to find ways to enhance the long-term rehabilitation of
Dr. Stella de Bode, an assistant professor in USC’s Department of
Communication Sciences and Disorders, knew Megan when her brain was
whole and her body was wracked with seizures. De Bode, a former faculty
member at UCLA, is the link that brought Megan and her mother to
Columbia for two weeks this summer to participate in de Bode’s study,
which is funded through a grant from the National Institute of Health.
De Bode and Dr. Stacy Fritz, a clinical
assistant professor in USC’s physical therapy program, are working
together to study the brain’s plasticity, its ability to reorganize and
reassign neural pathways, after a hemispherectomy.
The study is utilizing two promising
rehabilitation therapies – Locomotor Training and Constraint-Induced
Movement Therapy – to improve participants’ gait and motor control. The
goal is to determine which circuits in the brain help perform certain
though some areas, like the
cerebellum, decrease in volume, she said.
This Quicktime video, without sound, shows how technicians work with Megan on
the treadmill to correct her gait. Click
HERE to start the
to download the free Quicktime video plug-in.
Researchers have to understand the
broader structural implications of a hemispherectomy before they can
focus on the details to determine the most effective therapy strategies
to help children like Megan, de Bode said.
“All we know (about brain structure after
a hemispherectomy), we know from studies of rats and cats,” she said.
“After the removal of one hemisphere (from the animals), the remaining
hemisphere atrophies. We wanted to know, does this happen in humans? If
so, can we reverse it with therapy?”
What their research has shown is that, in
fact, the opposite occurs in humans. In people, the hemisphere that
remains actually increases in volume overall, even
“We have to understand why,” de Bode
said. “No one has ever looked at that before. It’s very technically
challenging to study the structural and functional aspects of such a
situation because the brain is deformed.”
It is due to this degree of difficulty
that USC’s state-of-the-art brain imaging equipment, like that found at
McCausland Center, has proven to be invaluable. But it’s not just
high-tech equipment and a challenging topic that sets this research and
rehabilitation study apart from others.
Unlike in many studies, participants here
receive a $2,000 stipend to help defray travel and hotel costs, but they
also take home something even more precious – functional improvements.
It’s a situation in which researchers and
participants both benefit, de Bode said.
“With one hand, I do research; with the other, I help families now, not
just 10 or 15 years down the road,” she said. “The families see benefits
now,” and research is advanced.
For Megan’s mom, that’s enough.
“If (USC’s research study) helps Megan
just the tiniest bit, then it’s worth it,” Howell said. “And if we can
help the university better understand hemispherectomies so we can help
other families, it’s worth it. Knowledge is power.”
For more information:
• Physician says procedure is relatively safe, offers patients a high
chance of becoming seizure-free
• Hemispherectomy guide, Encyclopedia of Surgery
Study confirms benefits of hemispherectomy surgery