Teenager With Epilepsy Looking Forward to Driving After Complex Craniotomy

Isaac Diaz, age 18, was tired of epilepsy and cerebral palsy ruling his life. The thoughtful, gentle, yet self-determined teen simply wanted to do what teens do—be independent, get a job, play sports, and, most important, learn how to drive.

“I just wanted to do things without having to worry that a seizure was going to ruin it,” says Isaac.

When his seizures started coming more frequently out of nowhere at age 15—first every six weeks, then four weeks, then weekly—he took the initiative to research a solution: an extremely complex surgery offered by neurosurgeons at Stanford Medicine Children’s Health.

Identifying epilepsy when he was a baby

Stanford Children’s took care of Isaac early on when he was a baby. The first time was when he was just a few days old after he suffered a stroke during birth that injured a large area of his brain. He returned at 13 months, when he experienced a significant seizure episode. That was when he was diagnosed with cerebral palsy—a brain disorder that impairs motor function—and epilepsy.

“Cerebral palsy affects one in every 345 children and is a result of an injury (stroke) that occurs to a baby’s brain during either pregnancy or delivery. Thirty percent to 50% of children with cerebral palsy, like Isaac, go on to develop epilepsy (recurring seizures),” says William Gallentine, DO, pediatric epileptologist, neurologist, and neurophysiologist.

Staying true to himself growing up, despite challenges

Through the years, Isaac received care for his conditions from his community neurologist. During early to mid-childhood, he took medicines to control his seizures, which he had infrequently.

As a child, Isaac wore both a leg orthotic and hand brace to help with his cerebral palsy and hemiplegia (his left side was paralyzed). When Isaac was in elementary school, he endured a lot of bullying, but his twin brother, Isaiah, always looked out for him, and so did his older brother, Jr., and older sister, AJ.

While the bullying hurt, it didn’t break his caring spirit or deter him from what he wanted to do: play sports. Despite his disability, Isaac played basketball and soccer and practiced tae kwon do.

“Isaac is very considerate. Of all four kids, he is always the first one to offer to help,” say his mom, Jazmin, and dad, Gabriel.

In middle school, Isaac made a decision to no longer wear his foot orthotic and chose to wear his hand splint at home only—his braces were a target for bullying. He also used his self-determination to play video games with his friends, despite having a left hand with limited mobility.

“I adapted to playing video games with one hand and using my chin; I got good at it. My friends would say, ‘Dang, dude. You’re better than me,’” Isaac says.

High school starts, and the seizures return

At around age 15, Isaac’s seizures returned with a vengeance. What was once controlled became uncontrolled. Isaac had to quit sports and be homeschooled because he wasn’t sure when a seizure would come. He had to set aside getting his learner’s permit and put several other activities on hold.

“Out of nowhere, Isaac had a massive seizure attack, which started a trend of more and more frequent seizures,” Jazmin says.

The family tried medicines again for a few years, but they didn’t help. When Isaac was 17, they returned to Stanford Children’s. Isaac was seen by the Pediatric Epilepsy Center.

“Isaac was having very frequent, difficult-to-control seizures that were really impacting his daily life,” Dr. Gallentine says.

The Pediatric Epilepsy Center at Stanford Children’s is a level 4 center—the highest-ranked care center for medical and surgical evaluation and treatment of complex epilepsy. The large epilepsy care team has nine pediatric epileptologists (neurologists specializing in epilepsy and seizure disorders) and four pediatric epilepsy neurosurgeons, plus registered EEG technologists, neuroradiologists, neuropsychologists, and dietitians. It has highly advanced technology and is considered a leading pediatric epilepsy center in the United States.

“We take care of children not only regionally but all over the nation and world with complex epilepsy. Our multispecialty team provides state-of-the-art care, and we work together closely. By taking into account everyone’s expertise, we determine the best care approach for every patient,” Dr. Gallentine says.

The Pediatric Epilepsy Center provides every type of treatment available for epilepsy—something only a handful of large pediatric centers across the nation can do. The large neurosurgery team specializes in minimally invasive approaches to treat brain tumors, craniosynostosis, epilepsy, and other brain conditions.

“We can offer everything from robotics, laser, and interoperative MRI surgical platforms to advanced neuromonitoring to optimize outcomes. We choose from a wide variety of treatments and offer the one that best fits the patient and family,” says Vivek Buch, MD, an epilepsy neurosurgeon.

Mapping Isaac’s brain for a successful outcome

Before knowing what treatment to offer, the Stanford team needed to first understand Isaac’s brain. This included figuring out not only where exactly the seizures were coming from, but also what was the function of the brain tissue around that area. To do this, they performed a minimally invasive, highly precise procedure called a stereoelectroencephalography (SEEG). This procedure involved placing electrodes (sensors) using robotic assistance (ROSA) into 18 places in Isaac’s brain to record his brain activity. It required that he be hospitalized for a couple of weeks.

“It’s a careful step-by-step process to create the safest, most detailed surgery plan possible,” Dr. Gallentine says.

The EEG was able to identify the seizure focus in Isaac’s brain: the deepest part of the posterior temporal lobe, near the area of his prior stroke. However, this area was extremely close to the visual pathways in his brain that enable Isaac to see.

“With Isaac, we were very interested in making sure we preserved his vision. He already had some vision loss as a result of the prior stroke, so any more damage could have really been detrimental,” Dr. Gallentine says.

In order to carefully remove the seizure focus and give the best chance at preserving his vision, it was decided that Isaac needed a highly complex surgery called a craniotomy—an operation where the skull is opened and lifted to expose the brain. A craniotomy would allow access to the part of Isaac’s brain that was damaged by the stroke at birth, the same area that was found to be the cause of his seizures now.

“We talked about less invasive laser surgery, which we do a lot of here at Stanford, yet we chose an open resection for his safety and for the best possible outcome,” Dr. Buch adds. “We always tailor our plan based on each individual patient’s needs and make a collective decision as epileptologists, surgeons, and patient and family, together.”

Undergoing a highly complex craniotomy

Because Isaac’s seizure focus was deep in his brain in a tricky area near his visual pathways, the surgery was very complicated. His neurosurgery team used all the data and images collected to guide them during brain surgery, including the stereo EEGs and image guidance (imaging navigation of the brain). These tools helped them map exactly where to operate to remove every bit of brain tissue that was firing abnormally. They also used specialized neuromonitoring (monitoring of the nerve pathways with sensors) to ensure that they didn’t disturb healthy brain tissue and to preserve his vision.

With neuromonitoring, all important pathways in the brain and spinal cord are studied continuously. The team mapped all of Isaac’s motor (muscle), sensory, and visual function in real time. By knowing how areas of his brain were functioning in the moment, they were able to carve a safe path to reach the areas that were misfiring.

“We wanted to remove enough tissue to give him seizure freedom, but not too much. You have to find that balance, and all the techniques we used did exactly that,” Dr. Buch says. “Isaac’s craniotomy was extremely complex, one that I imagine only a few epilepsy centers in the nation would attempt.”

To preserve as much vision as possible, the team used advanced techniques to outline the visual pathways and allow for a safe surgery.

“We mapped out his visual tracks in the operating room to avoid these pathways and resected (removed) as much of the abnormal area as we safely could,” says Laura Prolo, MD, PhD, a pediatric neurosurgeon at Stanford Children’s.

Neurosurgeons and neurologists worked together side by side to carry out the surgery. Dr. Gallentine, a neurologist, helped the team record electrical activity directly from Isaac’s brain to ensure that they had gotten all the tissue that was causing the seizures.

“We could then go back and resect some of those abnormal areas to increase the chance of seizure freedom,” Dr. Prolo says.

Isaac’s highly complex surgery took around six hours, and it was deemed a success. The team was able to remove all the tissue from the injured parts of his brain while protecting his vision.

“We couldn’t have asked for a better team of doctors. They allowed us to ask questions, big and small, and invited us to partner with them through the whole process,” Jazmin says.

Living seizure-free today, with an eye toward the future

It’s been three months since the surgery, and two months since Isaac last had a seizure. He had a seizure not long after the surgery, which can be expected due to the intensity of the surgery. At six months, his doctors will reassess his visual cognitive skills. If he passes that test, he can start driving.

“It’s encouraging that Isaac is doing so well right now. We are hopeful he will remain seizure-free long term and that he will be able to do all the things he wants to do in his life,” Dr. Gallentine says.

Isaac is currently a freshman at Mission College in Santa Clara, where he’s taking prerequisite classes and hoping to enter the culinary program. There’s no doubt that the determined, quick-to-smile young man will make his dream come true. He hopes to someday own a Mexican food truck and eventually open a restaurant.

“We are so grateful to have such great people at Stanford Children’s taking care of our son,” Jazmin says.

Jazmin appreciates all of the care that Isaac received at Stanford Children’s, and she gives a special shout-out to the nursing team, whom she calls “phenomenal,” and to the Hospital Educational Advocacy Liaisons (HEAL) program, which kept Isaac on track with his education and graduation.

Dr. Gallentine is impressed by the initiative that Isaac took to research and embrace the craniotomy. It’s something he rarely sees in teenagers.

“From the get-go, Isaac was very excited about the surgery being helpful. He took in all the information and actively participated in the decision to have surgery,” Dr. Gallentine says.

His parents were rightfully nervous, but Isaac’s willingness helped put his family at ease. They let Isaac lead with his positivity, and they supported him.

“Having the surgery and knowing it went as my doctors hoped makes me happy. If it works, I won’t be limited. I can simply live my life,” Isaac says. “And that includes driving.”