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GIRL WITH HALF A BRAIN. Fredric M. Menger, Emory University, Atlanta, GA, USA

This is the true story of a girl, let us call her Alice, who has dealt successfully with half a brain. It all started when Alice was in kindergarten and had a mild seizure that made her unable to talk and to lift her right arm. She started taking an anti-epileptic drug, phenobarbital, and returned to school. But a couple weeks later Alice had a serious “grand-mal” seizure, sending her to the hospital where a CT scan showed a large portion of her brain’s left hemisphere had wasted away, leaving a large dark spot on the scan. The doctors were mystified because there was no history of difficulties during her birth or a subsequent head injury. Despite an elevated phenobarbital dosage, Alice’s condition kept getting worse. She stopped eating with her right hand, she fell to the ground frequently, and her seizures became more frequent and intense. Multiple neurologists diagnosed her as having epilepsy for which there is no cure. All they could do was alter the drug regimen, but soon Alice experienced a hundred episodes a day, preventing her from attending school. Further CT scans showed that voids in Alice’s left hemisphere were spreading. Since this never occurs with cerebral palsy, at least this one particular affliction could be ruled out as a cause. Finally, one of the clinics proposed that she was suffering from extremely rare disease called Rasmussen’s encephalitis.

Rasmussen’s encephalitis is so rare that there has been no substantial research carried out by pharmaceutical houses (who are attracted to diseases requiring millions of people taking daily doses for their entire lives). One theory has it that the brain decay in Rasmussen’s encephalitis is a self-destructive immune response to an unknown antigen. The antigen might be a slow-growing virus or bacterium, although no one has ever been able to detect and identify it. And most puzzling of all, only one half of the cerebrum (either left or right) is totally destroyed, whereas the other half remains unaffected.

Alice’s mother, in a heroic search for information on Rasmussens’s encephalitis, finally came up with the name of another girl who, after being surgically treated for the disease at Johns Hopkins Hospital in Baltimore, was now free from seizures. This operation involved complete resection (removal) of half the brain. This is a particularly tricky surgery because the remaining functioning half of the brain can be easily damaged. And if even a small sliver of the diseased brain remains, the seizures can persist as strongly as before. One can imagine the fear the mother had in deciding whether to allow such a 12-hour surgery on her daughter, but Alice was now in a catatonic trance, and the mother was left with little choice.

After the operation Alice’s brain stem swelled, and she drifted into a coma that lasted for weeks. She eventually woke up, however, and after nine months she could walk again, albeit with a limp. The side of her body originally controlled by the diseased hemisphere of her brain was now taking directions, at least partially, from the healthy hemisphere. This is referred to as brain plasticity. In the ensuing three decades Alice has done well, the secret of which, she believes, lies in her teaching herself to be happy. She said that happiness was the one thing she could control, a wonderful philosophy.

I wish to end this report on a humanitarian rather than technical note. The late Fred Rogers was an American television personality and host of the popular pre-school TV series “Mister Rogers’ Neighborhood.” Alice loved Mr. Rogers. In fact, it was observed that during Rogers’ half-hours shows watched by Alice she seemed to almost never have seizures. Alice’s mother contacted Mr. Rogers and explained the concern over her daughter. Mr. Rogers then called Alice daily and even traveled from his home in Pittsburgh to Baltimore to visit Alice. She was in a coma at that time, but he sang to her nevertheless. America is a great country not because of its size, or its wealth, or its military, but because of people like Mr. Rogers. All countries can make similar claims.

Ref.: J. Hamblin, “If Our Bodies Could Talk”