When a teen’s treatment stopped working, he determined to attempt a surgical procedure that would cease his episodes for good

When Isaac Klapper was 10 years previous, he began having common, day by day episodes that precipitated his head to twitch and his eyes to show to the aspect. 

His pediatrician really helpful a neurologist, who identified Klapper with a motion dysfunction and prescribed treatment. For 5 years, that saved the episodes at bay — however when he was a sophomore in highschool, they returned, interrupting day by day life and throwing his prior prognosis into query.

Klapper spent the remainder of his highschool profession lacking out on milestones. He could not drive, due to the possibility he’d have an episode behind the wheel. It affected his social life and his capacity to focus at school, as a result of he at all times puzzled when the following one would possibly strike.

“It was fairly devastating,” mentioned Klapper. “It was exhausting to deal with. I simply did not need to go wherever as a result of I used to be afraid of 1 occurring.” 

Meanwhile, his mother and father, Karen and Mark Klapper, watched him wrestle and looked for solutions. A neurologist of their house metropolis of Toledo, Ohio was attempting “treatment after treatment,” Mark Klapper mentioned. After two years, there was no change, so the Klappers determined to look elsewhere for solutions. A motion specialist mentioned Klapper did not have a motion dysfunction: Instead, he was having frequent seizures. The household went to the Cleveland Clinic, the place he was identified with epilepsy. 

Dr. William Bingaman, a neurosurgeon and the vice-chairman of the neurological institute and head of the part of epilepsy surgical procedure at Cleveland Clinic, had a brand new suggestion for treating Klapper’s seizures. Instead of extra medicines, he needed to attempt a surgical method, which, if profitable, would cease the seizures for good. 

Saying sure to mind surgical procedure was one of many best selections of his life, mentioned Klapper, who’s now 18. 

“It was actually a reduction to only make a name, with out hesitation,” Klapper mentioned. “I used to be like, ‘I am unable to stay like this anymore.'” 

Treating epilepsy with surgical procedure 

Epilepsy takes many various types and ends in a number of sorts of seizures. Klapper was having focal seizures, that are extra minor episodes when electrical exercise comes from one a part of the mind, mentioned Dr. Kerri Neville, a pediatric neurologist at University of Michigan Health C.S. Mott Children’s Hospital, who was not concerned in Klapper’s care. The seizures can embrace indicators like jerking or twitching actions, modifications in imaginative and prescient or different senses, and cognitive or temper modifications, relying on what operate the affected a part of the mind controls. 

Because of how broadly epilepsy can current, it may be “very, very difficult” to diagnose, Neville mentioned. A motion dysfunction is not an unusual misdiagnosis, she mentioned. Once epilepsy has been identified, medical doctors can begin utilizing medicines to try to deal with it: There are about 30 medicines that exist to deal with epilepsy, and about two-thirds of individuals can get full management of the situation with one or two of these choices. However, for the remaining third, seizures are nonetheless an issue. 

That’s the place surgical choices just like the one Bingaman advised are available in. The surgical possibility used relies upon the place the seizure exercise is positioned, amongst different elements, Bingaman mentioned. That’s discovered with mind scans and imaging. 

The scans confirmed that Klapper had a “grape-sized abnormality” in his mind, Bingaman mentioned. The abnormality was in his left cingulate gyrus, a significant a part of the limbic system that helps course of feelings, regulate conduct and management computerized motor capabilities, and is “sort of buried in the course of the mind,” Bingaman mentioned. The abnormality might have been one in all two issues: cortical dysplasia, which suggests cells migrated unusually throughout mind improvement, or a mind tumor. The solely option to decide the reason for the abnormality was to take away it. 

Expanding entry to surgical remedy for epilepsy 

Both Bingaman and Neville mentioned that whereas surgical remedy for epilepsy could be efficient for sufferers who do not reply to treatment, it isn’t a generally used possibility. Epilepsy impacts between 2 and three% of the U.S. inhabitants, Bingaman mentioned, and of these sufferers, about “40% or so could also be surgical candidates.” But solely about “two to a few thousand” operations are executed per yr, Bingaman mentioned, with the Cleveland Clinic alone dealing with about 500 circumstances yearly, regardless that there are “one million individuals which are candidates for surgical procedure proper now.”  

“It’s extremely underutilized,” Bingaman mentioned. 

There’s nobody cause why this feature is not used extra typically, Bingaman and Neville mentioned. Epilepsy could be misdiagnosed, as in Klapper’s case. It might also be exhausting to seek out the area of the mind the place the seizure exercise is originating. Doctors could not know to suggest surgical procedure, Bingaman mentioned. Patients could also be cautious about present process mind surgical procedure, and taking place the surgical route will also be costly and time-consuming for sufferers and their households, particularly if they do not stay close to a middle that does these operations often, Neville mentioned. 

Operating and discovering solutions  

On March 8, 2024, Klapper was wheeled into surgical procedure. The operation to take away the abnormality took about 5 hours, Bingaman mentioned. 

“It was a very lengthy 5 hours for us,” mentioned mother Karen Klapper. “It was a really lengthy, scary few hours. It was a tough day for us.” 

Once the abnormality was eliminated, it was delivered to pathologists for testing. They have been capable of decide that the abnormality was cortical dysplasia — not a mind tumor. That meant that now that the abnormality had been eliminated, Klapper probably would not have any extra seizures. 

Since then, Klapper has been seizure-free. More mind imaging and scans confirmed that the abnormality is gone, and now he is turned his consideration to making use of for schools.

“It felt actually good to know that this most likely going to remain for the remainder of my life, like I’m not going to have to fret about this,” Klapper mentioned. “I can simply actually give attention to the longer term and the way I’m not going to be tied down by this anymore. I can simply exit and begin my life.”