June 8, 2010 – post 1

The Plan Going Forward

Lisa’s primary doctor, Dr. Kotagal, came by this afternoon to talk to us.

The team met this morning and reviewed Lisa’s case. Their suggestion is to go ahead with the surgery and remove part of her right temporal lobe. Since it’s on the right side and she is left-side dominant, it should not affect memory nor language. The function of the right temporal lobe seems to be a bit controversial and mysterious – more on that in a separate post.

Dr. Kotagal let Jean and me see the MRI and CAT results. He also showed the 2005 and 2008 MRIs side by side with the 2010 MRIs. We saw that the right side is significantly different than the left. There is some scarring (also called hippocampal sclerosis) evident.

The team is saying that the area is already affected and not functioning as it should. The is based on the tests and also on Lisa’s neuropsych tests in 2005 and 2008. It’s reassuring to us and to Lisa. They’re basically proposing that “we want to remove tissue that is already not working and that is probably causing the seizures”. They did say that tissue like this is a known epilepsy source in patients, so that’s another strong argument for the operation.

Dr. Kotagal also said that her case is “not straightforward”, which is exactly what we say but it’s good to hear it from a doctor. He said that in a more ‘typical’ case, the success rate with this kind of surgery if 70-80%, in Lisa’s case it’s more like 60%. She will probably continue to have auras and will remain on medication for the rest of her life, but the primary seizures should be under control.

The scans also showed some abnormalities in frontal and occipital lobes, but not enough to be concerned about.

Dr. Kotagal also let Lisa see the MRIs which was unexpected and “interesting” (her word) for her.

They have scheduled an MEG test for tomorrow – this is a magnetic EEG which will show more detail than the EEG she’s currently hooked up to. They decided that implanting the grids would not givem them much more information, so it won’t happen. This is good because it will avoid 2 pretty significant surgeries (one to put them in, one to take them out).

We did ask the question about whether it would have an impact on her migraines and he said the jury is still out on that question, it might and it might not.

It won’t have any negative effect on her ability to drive, though, which is great.

The only down side we see right now is that they might have to take more tissue than they anticipate which might affect her vision. She may lost some upper left side peripheral vision. Lisa has a friend who had a surgery that was a bit deeper in the occipital area and she lost the entire left field vision from each eye, but she’s adjusted to it and told Lisa that it isn’t that bad.


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