Matters of the brain

When Nicholas Moix came into the world 20 months ago, he was accompanied by a rare, baffling medical affliction.

Nicholas' brain was malformed, causing the child to experience seizures almost imperceptible to the causal eye but not hidden from an examination by his mother.

Alarmed, the baby's parents, Kelly Moix, a nurse at Conway Regional Medical Center, and David Moix, a Conway police officer, alerted physicians who immediately ordered sophisticated assessments of the child.

The investigation revealed that the left side of the tot's brain was larger than the right side. He was a victim of a condition that is almost defies pronunciation -- Hemimegalencephaly.

It is, doctors at Arkansas Children's Hospital reported, an extremely rare phenomenon. The baby's life was in jeopardy and an operation was imperative to give Nicholas a chance at life.

The young parents were devastated at the news. They had strong suspicions that something was amiss with their only child since, besides his seizures, he demonstrated other abnormalities, especially the fact that the right side of his body was immobile.

Now they were to contemplate a horrifying prospect -- a dangerous surgical procedure on Nicholas' brain. It was viewed as a life-saving move as well as life-threatening.

After agonizing, prayerful consideration, the parents gave the doctors the word to proceed with whatever course of action they felt essential.

The Moix family faced a medical curiosity in which the right side of their son's brain had formed normally while the left side had not.

"It is a freak of nature in the migration of the brain," said Mrs. Moix, who offered the view that medical people have no idea why this condition occurs. "It is a one-in-a-million occurrence."

SEIZURES TO SURGERY

Nicholas was four days old when Mrs. Moix noticed the seizures in her baby she had considered normal.

A battery of tests that followed revealed the malformed nature of his brain.

"Talk about a blow in the face," the baby's mother said. "The news was horrible."

The baby was given Phenobarbital, a crystalline powder used as a sedative and antispasmodic in an effort to control his seizures.

But at this juncture, doctors had little information about Nicholas' condition.

The worst-case scenario, Mrs. Moix said, would be to proceed with surgery if the medication was not an efficacious remedy.

Nicholas' condition worsened at this point. The Little Rock hospital was reluctant to give the baby experimental drugs, suggesting instead that the parents take their son to a Dallas hospital were experiments on Hemimegalencepaly were being conducted.

There, Nicholas was given a drug called Vigabatrin, which had proved effective in some cases during the hospital's experimentation studies.

The drug had minimal effect on Nicholas, however, even though his seizures were reduced from about 25 to l0 a day. This was not considered acceptable and an operation was in the offing.

Under the trained hand of Dr. Frederick Boop, a pediatric surgeon at Children's Hospital, the Moix baby withstood the delicate operation. Nicholas was nine weeks old at the time.

The procedure in this case is termed a hemispherectomy, Mr. Moix said.

"In it they leave part of the brain as a cushion for the right side of the brain so that it doesn't get jostled around. But all connections on the left side of the brain are cut, making it nonfunctional."

"It is a new procedure," the tot's mother said. "We're lucky to be living at this time because only a short time ago this operation would have been impossible."

CATCHING UP

Most of Nicholas' brain on the left side was removed, but because he is so young, the brain has time for the right side to possibly take over some work the left side would have done. His brain is still forming and maturing. "The right side will be able to take over the function of the left side." his mother said.

She said Nicholas had a difficult time during surgery. "We almost lost him. He had a problem with bleeding and he was given blood constantly. He also was on a ventilator."

The surgeons had to call a halt before the operation was completed because of the bleeding, Mrs. Moix related.

As it was, it took more than six hours. "We were, however, assured the operation was successful," she said.

Nicholas presents a picture of a normal kid, except for the braces on both legs, the special glasses prescribed for him (the operation luckily did not cause blindness, which was a strong possibility), the paralysis on his right side, his inability to walk, and his reluctance to crawl.

"Doctors say he will be behind in his development but eventually he will catch up," Mrs. Moix said.

Before the operation, Kelly and David Moix were told their child would in all probability be blind after the procedure. "We were faced with the choice of having a blind child or a dead child. We opted for life and the operation went on."

"It was the easiest and yet the hardest decision we've had to make; actually we had no choice. We don't know what kind of life he will have or even if he will be able to live independently, but from what we're seeing now it looks really good."

(Staff writer Fred Petrucelli can be reached by phone at 505-1256.)