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Stanford Report, April 3, 2002

Packard's Brain and Behavior Center of Excellence opens door to normal life


This is the second in a series of Medical Center Report articles profiling patients from each of the six Centers of Excellence at Lucile Packard Children's Hospital.

Today, 11-year-old Gabrielle Davis can keep up with most girls her age. But at the height of her battle with epilepsy, she suffered up to 120 debilitating seizures a day. She couldn't go to school, play outside or even watch TV. "I didn't get to do anything but stay in bed," said Gabrielle.

To make matters worse, doctors at an East Bay hospital were not even convinced Gabrielle had a medical problem at all since her seizures were so unusual. With arms outstretched, wrists flexed and nose in the air, 5-year-old Gabrielle appeared to be doing her best Madonna impersonation: striking a pose, not having a seizure. But in her mind, she was experiencing the sensation of falling and was panic-stricken.

Gabrielle Davis, shown here with her mother Heidi, once suffered as many as 120 seizures a day, making it impossible for her to do anything but stay in bed. After treatment at the Center for Brain and Behavior at Lucile Packard Children's Hospital, she's down to about one seizure a month.

Gabrielle's mother, Heidi Davis, said she tried in vain to convince doctors this was abnormal behavior for her child. "They said she was faking and that we were bad parents," she recalled. That's when the Davis family first met Donald Olson, MD, now the director of Lucile Packard Children's Hospital's pediatric epilepsy program and assistant professor of neurology and pediatrics.

From 120 a day to one a month

Over the years, medication brought the number of Gabrielle's seizures down to seven a day -- still far too disruptive for her to function in mainstream classes at school. But after successful brain surgery performed at Packard Children's Hospital in December 2000, Gabrielle now has only about one seizure a month. "She's jumped three grade levels in one year," said Heidi Davis. "She has just thrived."

Gabrielle's dramatic recovery was made possible by Olson; neurosurgeon and Stanford Hospital chief of staff Larry Shuer, MD; and a team of specialists who are part of the hospital's Center for Brain and Behavior. The center treats children with a variety of disorders, from anorexia to cancer, bringing together physicians and researchers from neurology, neurosurgery and child and adolescent psychiatry.

"These disorders influence every aspect of a child's life, including interactions with family and the school community," said Gary Steinberg, MD, PhD, co-director of the center. "The collaboration between the three departments enables us to treat the entire person and their social situation."

A map of the brain

The surgical treatment of epilepsy is a complicated undertaking, requiring a highly coordinated, multidisciplinary team of specialists. Every Monday at Packard, nearly 30 physicians, nurse practitioners and other staff gather to determine which patients make good candidates for corrective brain surgery.

Epilepsy, the most common neurological disorder in children, is accompanied by seizures -- electrical storms in the brain. Uncontrolled seizures can lead to severe intellectual deterioration and psychological problems. Removing the part of the brain from which the storm originates can stop them.

Olson brought Gabrielle's case to the epilepsy group in November 2000. Before surgery to remove a part of her brain could be done, however, she had to undergo a complex procedure called brain mapping. Mapping pinpoints the precise origin of seizures to make sure the tissue removed won't impair the ability to talk or move.

To make the map, Shuer placed a grid of electrodes directly onto Gabrielle's brain. Wires protruding from the skin recorded her brain waves while a video monitor captured any seizures she had. The data told doctors exactly which part of the brain could be safely removed. Additionally, mild electrical shocks delivered through the electrodes temporarily deactivated current in very specific parts of the brain. By asking Gabrielle questions when the current was interrupted, neurologists could determine whether crucial functions would be lost if that part of her brain was removed.

This uncomfortable procedure lasted a full week. Throughout it and the subsequent surgery, Gabrielle had the support of her parents and the hospital's child-life specialists. "It can be a scary thing for a child, but Gabrielle breezed through it," said Debra Monzack, a specialists who worked with her.

The center is one of a few places where Gabrielle could receive the treatment to help her live a normal life. "You have to have all the personnel, the technology and dedicated hospital rooms with cameras and EEG equipment," Shuer said, outlining the complexity of her treatment. "You just couldn't do this in a community hospital."

In its race to rescue a child, Packard's pulmonary center draws on innovation (2/20/02)

Lucile Packard Children's Hospital