LOS ANGELES (January 26, 1999) -- Mary Kate Welsh was just eight months old, scooting around in her baby walker, when the accident happened. Her walker struck the fireplace hearth and tipped over, dumping Mary Kate -- head first -- onto the hard brick. Her epilepsy, and subsequent seizures, started not long after that blow. "My parents almost lost me," she related. The seizures continued, on and off, for the next 33 years. Finally, thanks to state-of-the-art diagnostic and surgical advancements, Mary Kate's seizures may now be no more than memories.
In December 1998, Mary Kate underwent multiple subpial transections of the language cortex and a selective hippocampectomy, both performed while she was awake by neurosurgeon Michel Levesque, M.D., Director of the Neurofunctional Surgery Center at Cedars-Sinai Medical Center. This relatively rare surgical approach was undertaken after extensive studies determined that Mary Kate's increasingly frequent and disruptive seizures were arising from the language cortex and spreading to the hippocampus, a seahorse-shaped segment of the brain that controls language, memory and learning.
"This is the first surgery performed at Cedars-Sinai, while the patient was awake, to disconnect the language cortex without affecting speech," explained Dr. Levesque. "The results are very encouraging, since we've learned we can successfully operate on a seizure arising from the language area of the brain through multiple subpial transections, a procedure performed using microinstruments to 'slice' the language cortex in four millimeter increments."
For Mary Kate, the results are nothing short of miraculous. She's experienced no seizures since the surgery and feels wonderful -- and extraordinarily thankful. "I tell people, if Dr. Levesque was a religion, I'd join," said Mary Kate, laughing. "He's the best."
Though Mary Kate, now 33, had experienced some extended periods without seizures, they always seemed to return and typically with greater intensity. The epilepsy that began during infancy seemed to abruptly end at age five, then resumed during her freshman year of high school. Mary Kate remembers a "ringing sound" then that would herald her seizures, which have changed in nature over the years.
"I typically would just stare into space," described Mary Kate, adding that she sometimes blacked out or would remain aware but unable to speak. "I've been fortunate -- I didn't fall down on the floor or tear my clothes off or anything." But there have been some close calls and frightening moments. When the seizures started up in high school, her sister awoke to find blood coming from Mary Kate's mouth. The paramedics were called. "My sister said I was having a convulsion, but I really don't remember," Mary Kate explained.
Seizure medicines helped control the episodes for awhile, but as time went on Mary Kate required increasing amounts of medication. At one point, while living in Boston, she was taking several types of anti-seizure medications simultaneously.
When she moved to California in 1990, the seizures virtually stopped for almost three years then resumed with greater frequency and velocity. Mary Kate was experiencing two to three seizures a day, some lasting as long as three hours. (The typical seizure spans only 30 seconds to one minute, she explained.) At that point, after "trying everything," Mary Kate made an appointment with Cedars-Sinai neurologist Clarke Espy, M.D.
"I felt like Dr. Espy was the first neurologist I'd come across who knew what he was doing in terms of my case," Mary Kate recalled. "After years of treatment, you're able to recognize and differentiate between the doctors you feel comfortable with and have confidence in."
As her seizures became increasingly uncontrollable, Dr. Espy consulted with Dr. Levesque. It was determined that surgical intervention was necessary. Prior to her surgery, Mary Kate spent two and a half weeks in Cedars-Sinai's Telemetry Unit, where electrodes attached to her head tracked the site of her seizures using electroencephalogram (EEG) and video monitors. These tests indicated that there were abnormal signals in the speech cortex that corresponded with the onset of the seizures, which then traveled to the hippocampus. Prior to surgery, a Wada test, which utilizes sodium amobarbitol to put one side of the brain to sleep for testing, determined that Mary Kate's right hippocampus had the capacity to "take over" the functions performed by the left side.
Following the surgery, she spent four days recuperating before returning home shortly before Christmas. "I'm so happy, but I feel like knocking on wood," Mary Kate admitted. "Everything is going so perfect."
Mary Kate's prognosis is "excellent," said Dr. Levesque. She's looking forward to enjoying the rest of her life to the fullest . . . and returning to the Irish dancing she loves. "It's the best form of exercise!" she stated emphatically, displaying the enthusiasm she applies to life in general these days.
For media information and to arrange an interview, please call 1-800-396-1002.
AVAILABLE FOR INTERVIEWS:
Michel Levesque, M.D., Director Neurofunctional Surgery Center,Cedars-Sinai
Medical Center
Mary Kate Welsh, Patient