Optimism follows brain surgery

Girl shows signs of movement, speech.

The Associated Press

The day after a 15-year-old girl had half of her brain removed to stave off debilitating seizures, she began showing the first tentative but encouraging signs of movement and speech.

Doctors at Johns Hopkins Children's Center in Baltimore upgraded Amber Ramirez, a freckled Lincoln, Neb., teenager suffering from a rare form of epilepsy, from critical to fair condition Wednesday morning. Doctors said that a groggy Amber, who had undergone a nine- hour operation Tuesday, opened her eyes, groaned and even brushed them away after they tickled her to test motor functions.

Amber's responses Wednesday prompted her neurologist, John M. Freeman, to deliver an optimistic prognosis despite previous concerns that the teenager might be too old to have a full recovery. Freeman predicted that Amber would be able to walk within a month and, most likely, regain her ability to talk after many months of rehabilitation.

"Amber is doing exceedingly well," Freeman said. "I am very optimistic about her state right now, and I am optimistic about her future. But I don't have a crystal ball, and I don't like to predict things I can't control."

Just as important: Since the surgery, Amber hasn't suffered one of the violent seizures that sometimes struck a dozen times a day. To stop them and the relentless disintegration of her brain that is a symptom of her disease, known as Rasmussen's encephalitis, Amber opted for a radical surgical procedure performed 30 to 40 times a year in the United States.

Teams of doctors and nurses, headed by neurosurgeon Benjamin Carson, removed the left half of Amber's brain Tuesday in a procedure known as a hemispherectomy. The brain's left side controls speech and delicate motor skills, but Amber's reactions Wednesday and earlier tests suggested that some of those abilities had transferred to her right hemisphere before surgery.

Before the operation, Freeman tried to determine how much speech had moved to the right side of Amber's brain. While she extended her right arm and spoke, he injected her with a tranquilizer that numbed the left side of her brain. She was still talking when her right arm went limp, though not with the same skill.

Doctors once believed the ability to speak wouldn't migrate to the right brain after the second year of a child's life. While that has been proved incorrect, Freeman said, Amber will likely have a more difficult time recovering her speech than if she had undergone surgery at an earlier age.

One of Amber's best friends, Kaci Caves, had the same surgery in November 1996 and is in the process of regaining her speech. The two met four years ago when they had appointments at Johns Hopkins on the same day. Kaci, who was 13 when she had her surgery, is a junior at Jenks High School in Tulsa, Okla., where she attends regular classes.

"The older you are, the harder it is to develop, and the longer it takes," Freeman said. "It is a very frustrating time for Kaci, and it will be for Amber and her family. We expect Amber's speech will return."

Both Kaci and Amber were diagnosed with Rasmussen's encephalitis, a degenerative brain disorder that acts with the vigor of a virus and can lead to paralysis, mental retardation and death. Doctors estimate that only 1,000 people worldwide suffer from Rasmussen's; half of the 80 hemispherectomies conducted at Johns Hopkins have been done on those with the disease.

When Amber learned she had the disease, she was a 9-year-old who loved softball and other outdoor activities. Her symptoms started with numbness in her right leg that gradually became so severe that she needed a wheelchair.

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