Teen's Onset of Epilepsy Linked to Prior Brain Injury

By Jean Yaeger

In 2013, Ann Marie Woodruff was involved in a severe traffic accident that crushed her skull. Eight years later, her ongoing path of recovery took a new twist when she had a seizure and was diagnosed with epilepsy.

November is Epilepsy Awareness Month, a time to highlight the disorder that happens when the brain’s electrical activity misfires – a seizure. People with a traumatic brain injury (TBI) are at higher risk for developing epilepsy weeks or sometimes years after their brain injury, as in Ann Marie’s case. 

Ann Marie was 7 years old when she was involved in the wreck. The trauma to her brain caused serious complications:

• Removal of forehead bone, to give space for her injured brain to swell
• Reconstruction of her forehead with a titanium plate  
• Physical, speech and occupational therapy during three months of hospitalization
• Problems with reading comprehension, headaches and noise sensitivity
• Then at age 16 … the epilepsy diagnosis

Despite all those challenges, the Euless 18-year-old is now a high school graduate and a licensed driver. She’s following her dream by working at a kennel and attending dog grooming school. The anti-seizure medication she takes causes some sleepiness but has kept her epilepsy under control.  

"Epilepsy stumped us for a few months, but she is such a determined girl that she was not going to let epilepsy keep her down or define who she is or wants to be," said her mother, Carla Woodruff.

According to the Epilepsy Foundation, seizures can result from a change in the chemical environment around the brain cells after bruising/bleeding in the brain, or a skull fracture. Early treatment with medication reduces the chance of additional seizures.

Ann Marie fits the higher-risk category for developing epilepsy because she lost some tissue in the frontal lobe of her brain, said Cook Children’s neurology nurse practitioner Erin Davis, APRN, CPNP. Ann Marie sees Davis every six months to manage her epilepsy. When she meets with families in neurology, Davis uses the analogy of file cabinets to explain how the brain stores memories and other functions. 

“It’s all organized,” she said. “And when you have a traumatic brain injury, they all get knocked over. You have to spend time lifting each one back up and then putting the files back in.”  

Ann Marie has come a long way in putting those file cabinets upright thanks to perseverance, a sense of humor, and the skill of her providers at Cook Children’s. “I have spent the last 10 years doing so many things to improve myself and not just be the girl with a brain injury,” she said. “It hasn’t been easy. But I know I’m worth it.”

This is her story.

The Injury

In the second grade, Ann Marie lived in the West Texas town of Anson. She took karate class in Abilene, about 25 miles away. Her dad, Bill Woodruff, picked her up from karate on Jan. 29, 2013, and began driving home. Ann Marie sat in the back buckled into a high-back booster seat. It was dark and dusty, which reduced visibility on the highway.

Bill Woodruff didn’t see the stopped 18-wheeler that was blocking both lanes. Their crew cab truck slammed into the semi’s trailer and went under it. The impact killed Ann Marie’s dad. She took a blow above her right eye, and her skull was shattered.

Paramedics rushed Ann Marie to a hospital in Abilene. She had multiple injuries – including a liver laceration and broken leg -- but the most urgent priority was to relieve pressure from the swelling of her brain. Doctors in Abilene performed a craniectomy, removing most of her forehead bone from ear to ear. Later that night a helicopter transported Ann Marie to Cook Children’s Medical Center in Fort Worth.     

Admitted to the pediatric intensive care unit, she remained in a coma for several weeks. Therapy began once she woke up.

“She had to relearn everything … how to walk, how to talk, who she was,” Carla Woodruff said.

Ann Marie’s brain shifted as the swelling and fluid began to subside. Measurements were made via CT scan, and a manufacturer in Germany created a metal device to fit the exact size and shape of her missing bone.

In the meantime, Ann Marie wore a hardshell helmet to protect her head in case she fell or something bumped into her. The next step: Placing a titanium plate across the gap in her forehead.  

Reconstructive Surgery and Therapy

Seven weeks after the accident, Ann Marie went back into surgery for a cranioplasty, to replace the missing part of her skull. Cook Children’s neurosurgeon Richard Roberts, M.D. followed the incision made when the bone was taken out. Peeling back the skin was a slow process because her scalp was so thin.

Dr. Roberts installed a plate custom-made for Ann Marie and built from titanium, which resists infection. The plate contains hundreds of tiny holes.

“What winds up happening is tissue from underneath and tissue from the scalp can grow together through the holes and help anchor the plate,” he said.  

He described Ann Marie’s recovery as amazing given the extent of her injury.

“If you look at the original CT scan you would think it would be difficult to survive,” Dr. Roberts said. “The hard work and dedication of Ann Marie and her mom and the whole hospital laid the foundation for success.”

That hard work included speech, physical and occupational therapy during her stay at Cook Children’s. As a nurse practitioner, Davis coordinated various aspects of her care. Exercises were designed to feel like play. Those sessions aimed to repair Ann Marie’s attention span, impulse control and other thought processes. For patients with TBIs, intensive rehabilitation soon after injury can help the brain to rewire, Davis pointed out.  

Speech therapy six days a week helped Ann Marie to regain language, focus, and skills such as problem-solving. Speech pathologist Renee Lavelle, MS, CC, SLP in the Neuro Rehab Unit helped Ann Marie learn to eat, starting with liquids and moving to solid foods. “She was easy to work with. She would try anything,” Lavelle said.

Ann Marie remembers little about being hospitalized. But she does recall feeling feisty enough to warn the nurses that she knew karate.

When she was discharged three months after arriving at Cook Children’s, Ann Marie could walk with assistance, feed and dress herself, and respond to simple questions. She continued speech therapy on an outpatient basis and returned to Cook Children’s for annual checkups.

“Over the years every time I see her, she’s better and better,” Davis said. 

Adapting and Achievements

The mental fog continued to lift after Ann Marie left the hospital. But reading comprehension remained a particular struggle. She eventually enrolled in Novus Academy in Grapevine, which serves students with learning differences. She made good grades and thrived in the alternative setting, graduating in May 2023.

It takes a little longer for the pathways of Ann Marie’s brain to process information.

“When asked a question, I usually can’t just answer. I must think about it and see if my brain has stored it somewhere,” she said. “It isn’t always there.”

But she has found new tricks for learning, especially through touch and music. She took up the piano, guitar and trombone. She also loves caring for animals. Her mom describes Ann Marie as kindhearted and hardworking. And she’s resilient when challenges arise, like the news that she needed medication for epilepsy.  

As Ann Marie puts it … Being stubborn comes in handy. Don’t let hurdles stop you from pursuing your goals, she advises. She hopes to someday work at a zoo or wildlife refuge.

“Sometimes it takes a little more grit, but you can do it,” she said. “Don’t give up on your dreams just because something is hard. It is worth everything you must put into it.”

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