Sitting at her dining room table, Brooke Ripper smiles as she talks about her dreams of traveling to Italy, Greece or "somewhere tropical," her classes at Point Park College and the antics of her naughty orange kitten, Archie.

Seemingly drawn by his name, 4-month-old Archie jumps into her lap, his gaze lasering in on the cupcakes on display just a few inches away.

It's hard to imagine that four months ago, the 22-year-old was immobilized with countless sensors inserted into her brain as she underwent the third in a series of extremely rare resection surgeries to put an end to the epileptic seizures that had plagued her since her senior year at Canon-McMillan High School in Canonsburg. The seizures were so subtle and unusual that they stymied doctors for about two years before Ripper was diagnosed with a form of epilepsy.

But then Ripper parts her long chestnut hair — that is finally starting to grow back, she said, laughing — to reveal the massive winding scar over the titanium plate protecting her healing brain.

Very few people in the world have undergone a similar surgery, a corticectomy in which surgeons remove gray matter from the brain but leave the white matter intact, said Thandar Aung, a UPMC neurologist. Of course, every brain surgery requires exceedingly precise technique, but when performed on someone whose dependence on her other senses is heightened — Ripper has been legally blind since the age of 1 — an even higher level of accuracy is essential.

"Brooke's surgery was unique due to its involvement with the Rolandic sensory cortex, a critical area of the brain that controls motor and sensory functions," said Aung. As the surgical epileptologist for Ripper's procedures, Aung was responsible for charting the path for the surgeon who physically performed the resections, neurosurgeon Jorge Gonzalez Martinez, at UPMC Presbyterian in Oakland. While Gonzalez Martinez performed incisions millimeter by millimeter, Aung tracked and mapped Ripper's brain and seizure activity in real time via intraoperative monitoring, to ensure that only the areas responsible for causing the seizures would be removed, without compromising her motor abilities.

The surgery is considered so rare "because of the precise nature of the location, the complexity of the brain's function in that area and the fact that the surgery was conducted with a high degree of caution to avoid significant deficits," Aung said in an email.

Ripper's first surgery, on Sept. 17, involved the placement of an invasive EEG electrode in the brain. The next two surgeries, on Sept. 19 and Oct. 1, were resections of the brain tissues. These carry extreme risks, including bleeding and swelling in the brain, Aung said.

"The risk of sensory loss was ... very detailed given Brooke's dancing background and also for the visual challenges. During the surgery, anything could have happened, thus, the worst-case scenario such as losing the motor function" was an enormous concern to the medical team, Aung said.

When the seizures began

Ripper clearly remembers the first time she felt muscle weakness suddenly come on. She felt very heavy and "I had no control over my body at all," she said. Her muscles, especially on the right side of her body, would stiffen during these episodes, often causing her to fall unexpectedly.

"I could tell, walking around the (high school) halls, up and down the steps, I could tell something wasn't right," she said. She remembered wishing she was home and feeling safe. Seizing in school, she said, "is tough. You don't want to stand out in any way like that."

The nature of the episodes eluded doctors for so long because "the seizures were complex and not easily identifiable through standard diagnostic methods, as they didn't always present in typical ways," Aung explained. Ripper's seizures were subtle and easily misinterpreted as other neurological issues.

And so, Ripper kept working her part-time job at Sonic — not on rollerskates, she said with a laugh — and continued dance classes at Dance Extensions Performing Arts Center in Canonsburg, where she'd been taking lessons since age 4. After graduating high school, she enrolled at Pittsburgh Technical College, where she maintained a 4.0 grade point average for two years.

One of her professors at PTC — which closed permanently in June — suggested the weakness and heaviness she'd been experiencing could be seizures. And finally, doctors began zeroing in on a firm diagnosis, explained Aimee Ripper, Brooke's mother.

According to the Centers for Disease Control and Prevention, about 2.9 million adults — about 1% of the U.S. adult population — and about 456,000 children aged 17 and younger have active epilepsy. In 2019, the average annual health care spending for epilepsy and seizures alone was $24.5 billion in the U.S., per the CDC.

A complicated surgery

It soon became clear that surgery was the best option.

"Anti-seizure medications were either ineffective or had intolerable side effects," Aung said. "The more medication we put into Brooke," the more side effects — nausea, dizziness — she suffered.

The possible negative outcomes of surgery that the medical team revealed were, Aimee Ripper said, terrifying: death, infection, paralysis among them. If the surgeons removed too much brain tissue, her daughter might never speak again.

Countless appointments, for blood tests, brain scans and more, followed. Ripper said her skin was constantly bruised from blood draws.

This was necessary to pinpoint the exact location of the seizures, Aung said. Additionally, Ripper's visual impairment added another layer of complexity to both the surgical planning and recovery process. Ripper's retinas are folded, which severely compromises her depth perception, peripheral, distance and near vision, her mom said.

As a result, the surgical team needed to plan her surgery in a way that would avoid any further complications related to her vision and come up with a specialized rehabilitation plan, because she relies on other senses so heavily, Aung said.

After the final surgery, Ripper immediately could tell something was different upon awakening, she said. The seizures had vanished. But her recovery had just begun.

She spent weeks in rehab at UPMC Montefiore in Oakland to relearn skills — feeding herself, walking safely with lingering numbness in her right leg and foot, regaining the dexterity to write her name with her formerly dominant right hand, which now tingles and tires easily.

Once home from the hospital, she yearned to return to her dance classes. While urging safety, the doctors agreed and said it would help her regain strength and muscle control.

"I didn't do across-the-floor leaps or anything, but it was still nice to see everybody," Ripper recalled of a recent visit. The doctors had warned her that she may never regain some of her motor skills.

"I will do everything I can to get back to where I was before. And if it doesn't come back, then I will take that over what I was feeling before. I can live with that."

Humor during recovery is vital, both mom and daughter agree, like when Ripper accidentally closes her numb foot in a door.

"We're finally at the end of the storm. And we're working through it," she said.

'I just want to bring awareness'

After the surgery, Ripper, with her partially shaved head exposing a jagged scar, said she has received plenty of stares from passersby at grocery stores and restaurants. She tries to look at it as an opportunity for people to ask her questions about her incredible health journey.

"I want to be an advocate for not only people who have eyesight issues, but also other people struggling with epilepsy. ... I just want to bring awareness to other people who are struggling."

Ripper plans to speak about her health challenges Feb. 22, at a comedy benefit night organized by her former dance and school teachers and family friends. The "Benefit for Brooke," to help the family with medical costs, is slated for the Slovene National Benefit Society Lodge 138 on Latimer Avenue in Strabane. (Find more information at https://bit.ly/3CJL5GI.)

Ripper said she's thankful for her strong support system: Visits and messages from friends and family were vital.

"There was a lot of days where I just didn't want to progress. And I just thought, 'It would be easier to stay where I'm at, just lay in bed and do absolutely nothing'."

But then mom would come in with her favorite pepperoni pizza bagels from nearby Sciulli's Pizza, or her longtime dance instructor Betsy Shuttleworth would arrive with a hand-crocheted gift. College friends chatted with her via video and visited between classes.

When she's frustrated at her slow recovery progress, or when her daily migraines kick in, mandating rest before finishing her homework, she tries to remind herself of how far she's come and where she still wants to go.

"I'm not gonna let anything stop me. I have a big life to live, and I have a lot of things I want to do."

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