On July 31, 14-year-old Coco (pseudonym) looked at the cotton candy-like clouds in the blue sky outside the flight cabin and found inner peace that she had never felt before.

Twenty days ago, her family brought her to China from Ulaanbaatar, Mongolia. It is at SAHZU that Coco underwent a successful brain surgery that finally solved the family's longstanding worry.

First Onset at Age 8 and Conservative Treatment Since Then

When Coco was 8 years old, she had sudden dizziness and blurred vision one day. The episode lasted for 2-3 minutes. Then, Coco began to have twitching in both upper limbs. Her parents rushed her to a local hospital, where she was diagnosed with right temporal lobe tumor and epilepsy.

From that day on, the family has been following doctor’s order to take pharmacological therapy, because Coco is “too young for surgical treatment”. For many years, Coco was on a single medication, but the seizures still came 1-2 times a month.

However, as she grew older, Coco became more aware of her frequent epileptic seizures, which caused her deep distress affecting her personality.

Coco's cousin learned about SAHZU Epilepsy Center in June this year and reached out to SAHZU. Her requests were responded by Dr. WU Chenghan, a physician of SAHZU Epilepsy Center, who told Coco and her family that surgical management for tumor-associated epilepsy is common at SAHZU. Roughly 10,000 patient-visits were handled here every year. SAHZU was able to provide treatment for Coco and welcome them to come.

So, the family decided to travel all the way from Mongolia to Hangzhou to seek treatment.

Travel for 2261km for a Hope

Upon admission, Coco's high-resolution MRI shew that the tumor had reached 43*43mm in size; and her video EEG helped doctors find a clear lesion and potential epileptic foci. Based on the examination results, the medical team designed a personalized, precise and minimally invasive surgery plan for Coco.

"Epilepsy sometimes can cause delayed brain development in children. Many of our patients have impaired intelligence due to the lack of proper early treatment. But Coco is a lucky girl. Her brain function has not been significantly affected yet. " Dr. WU said.

To help Coco adjust to the new environment, doctors sometimes would encourage her to talk about non-disease-related topics during her hospital stay. For example, doctors asked Coco “what is your favorite cartoon". Coco said it was the cartoon movie “Coco”. That’s how conversation got started.

The nursing team has also arranged a bed beside the window for Coco to cheer her up with scenery view of Hangzhou city.

In just a few days, Coco has built up a good connection with the medical team and even invited them to have a tour in Mongolia.

Immediate Treatment Reduces Brain Damage Caused by Epilepsy

The surgery was scheduled on July 19. Before the surgery, Dr. ZHU Junming, the chief neurosurgeon, explained to the family: "Sometimes, epilepsy still occurs after the tumor is removed. So, we are tackling two problems at one time here. Firstly, we need to remove the temporal lobe tumor. Secondly, we have to manage the refractory epilepsy."

In the surgery, doctors first carefully excised the tumor surrounding the inferior anastomotic vein, also known as the vein of Labbé, without impairing any of the blood vessels, in order to avoid serious post-operative complications such as cerebral edema or massive cerebral infarction.

In the second step, frequent epileptic waves (spikes) of neuron discharges were detected around the tumor with intraoperative cortical EEG monitoring. The possible potential epileptic foci were therefore removed, and a clean cut-out was confirmed by EEG again. Four hours later, the surgery was successfully completed.

"Since the surgery was performed in a minimally invasive approach, less damage was made and the patient recovered quickly. She was able to get out of bed the next day and discharged a few days later. After the epileptic foci was removed, there is about 90% chance that she won't have another seizure. The outcome was close to a cure." Dr. ZHU said.

However, in Dr. ZHU’s opinion, if Coco could have the surgery earlier, she would have much less brain damage.

Seizures are caused by abnormal neuron discharge, which may lead to neuron death in serious cases, greatly affecting brain development. Some might hold this stereotypical idea that child is too young for surgery. "Early and accurate diagnosis and treatment after the first onset of epilepsy would reduce the brain damage caused by the disease." Dr. ZHU urged.

Low-Grade Epilepsy-Associated Tumors

Low-grade epilepsy-associated tumors (LEAT) encompass a wide range of tumor types. Composed of neuronal and glial cells with different degrees of differentiation, these tumors are usually slow-growing and tend to be classified as WHO Grade I-II. They often present with epilepsy difficult to be controlled with medications and more commonly seen in children and young adults. LEAT is the second most common cause of epilepsy surgery in pediatric patients following Focal Cortical Dysplasia (FCD). Because of its slow-growth and weak proliferative capacity, LEAT rarely becomes malignant. The primary goal of the surgery therefore is seizure control. Data from SAHZU Epilepsy Center show that 85% of its patients can achieve prolonged periods of time being seizure-free after surgery.

About SAHZU Epilepsy Center

Established in September 2012, SAHZU Epilepsy Center is one of the first CAAE (China Association Against Epilepsy) recognized national EEG training bases and one of the first "comprehensive epilepsy centers" in China. At present, there are multiple sub-specialties/departments in the center including epilepsy, functional neurosurgery, neurological foundation, neuroimaging, neuropsychology, nuclear medicine and nutrition etc. A number of bedrock doctors have received systematic training in the internationally renowned epilepsy centers. The team works closely together to provide individualized treatment for drug-resistant epilepsy, focusing on comorbidities of epilepsy, preoperative evaluation and surgical treatment, neuromodulation therapy, and ketogenic dietary therapy.

In terms of research, breakthroughs in basic and clinical researches made by the center, especially the study of the mechanism of drug resistance in epilepsy, have been published on international journals such as Epilepsia, Journal of Neurosurgery, Journal of Neurology, Neurobiology of Diseases, Neuroscience, and Neuroscience, etc. They have also made some breakthroughs in the mechanism of drug resistance in epilepsy.