July 13, 2023 "Epileptologist"

Our appointment with Dr. Qian-Zhou Yang, Pediatric Epileptologist at UNC, was extremely informative. It took over an hour because she was very thorough, which we appreciated. She reviewed SOME of his complex medical history and even took the time to watch the short video clips of his seizures. In her little exam she was quick to notice that his right eye was his dominant one even though he is left handed. She confirmed his diagnosis of poor peripheral vision and his left eye turning inward. As she viewed his MRI's and EEG's on the computer, she pinpointed and explained everything alarming. She pointed out the large, white area of hydrocephalus, which we have seen numerous times before. Then she pointed out the gray spots both inside and outside the white area. This is polymicrogyria, which I had never seen. They are scattered all over his brain but more being on the left. The white area should not have ANY gray spots in it. She said they believe the gray areas are what seizes. Since there are so many gray areas in his brain it will be very difficult to pinpoint exactly where his seizures originate. To complicate things even further, one gray dot could be misfiring and soon the others will decide to copy it, like the old saying "one bad apple can ruin the entire bushel." 

The language center is usually on the left side of the brain. Since he is able to talk just before he has a seizure, this makes her suspect they begin in the right hemisphere. His eyes go the left during some of his seizures which is a second reason for suspecting onset in the right hemisphere. She said all seizures are like sparks that can turn into a fire. So if he has little sparks they are small seizures from one area of the brain. A full body convulsion seizure would be the fire, meaning it has spread into larger areas of the brain.  

She concluded that his seizures are likely focal onset with secondary generalization. However, with diffuse polymicrogyria and multifocal sharps there are many potential culprits. His current medication, Lacosamide, is a good choice for focal seizures (one area of the brain). Since he has multifocal (many areas of the brain) she believes he needs a low dose of a broader spectrum medication like Zonisamide as well. If he has any breakthrough seizures while taking these two medications, she recommends admitting him into the hospital (Phase 1) for about a week. During this stay he would be attached to the EEG, taken off his medication, and monitored by continuous video in hopes to capture and record seizures. She discussed the many other phases needed before they would consider epilepsy surgery. 2-PET CT with sedation, 3-MRI brain with and without contrast, 4-Resting state functional MRI brain, 5-Neuropsychiatry testing before and after surgery, 6-Neurosurgery appointment, 7-Stereo EEG hospital stay (implant probes in brain) to record more seizures, 8-Recommendation for epilepsy surgery. There are three types of epilepsy surgery; laser therapy, neuropace implant device, and resection. It sounds like a long, tedious process but they want to be as precise and accurate as possible in finding the small area of brain where the seizures are coming from. Seizure networks are like tumors. Over many years, they settle into the brain and become harder to control. They also spread to other irritated parts of the brain. Usually, the earlier a child has epilepsy surgery, the more likely they will have a seizure free outcome. Younger children also recover more quickly from brain surgeries than adults. Please help me pray that together, these two medications will keep him seizure free so he doesn't have to go through all of that!!!