Case Notes

 Part 1:
There is constantly some form of electrical activity in the brain as this is how neurons are able to communicate with each other. As electrical impulses are conducted down the axon away from the cell body of the neuron (the soma), the axon generates an action potential (causing the release of a particular neurotransmitter across the synapse). During in a seizure, the brain becomes “hyperactive”, meaning that the action potentials fired by the axons of the nerve cells are disproportionately higher in magnitude than what would be considered a normal level of activity. These sudden bursts of electrical activity results in a loss of control of all voluntary behaviours or movements. Epilepsy is classified a neurological disorder in which the individual experiences recurrent episodes of these kind of unpredicted seizures, or convulsions. Epilepsy can develop at any time during your life, at any age. Despite this, the disorder is most commonly seen in young children and in older people.

Epilepsy is a very difficult disorder to diagnose quickly, since signs of the disorder greatly overlap with the symptoms of many other neurological disorders, making it difficult for doctors to distinguish between them. The nature of the seizures, frequency, sensation before the seizure, whether or not the individual experienced any warning signs etc. are all vital pieces of information to the doctor in making a diagnosis. In most cases however, it is likely that further tests (such as an EEG or an MRI) will be necessary. An EEG uses electrodes placed on the scalp to record your brain’s electrical activity, and is able to detect abnormality in neural activity, or “epilepsy waves”. Since abnormality of the brain’s activity can be a sign of a number of other disorders, Epilepsy is categorised by the electrical “waves” spreading over both sides of the brain. Alternatively, an MRI scan produces an image of the brain’s structure, rather than directly measuring the brain’s signals. The procedure lasts anywhere between 15- 90 minutes, and requires the individual to lay on a motorised bed within an open-ended cylinder, while the magnetic field produces a detailed image of your brain. Use of the magnetic field means it is vital to remove all metal objects from your body, including watches/jewellery.

Non- Epileptic seizures have a range of different causes, from low blood sugar, to psychological distress (causing the function of the heart to become irregular).Based on the given information, I believe Jerrod appears to be affected by Epileptic seizures, since they are so unpredicted, and the normality of his lifestyle would rule out seizures induced by psychological distress. His young age would also indicate the likelihood of Epilepsy.

 Unfortunately the only way of helping Jerrod during a seizure would be to reduce the  risk of possible injury by putting something soft and supportive under the head, and making sure he is in a clear space. It is also important to wait for the seizure to pass before attending to the child. The type of treatment given for Epilepsy is typically tailored to the frequency and severity of the experienced seizures, as well as by the age of the individual. However, anticonvulsant drugs is the most common form of treatment for this disorder. Classic examples of medication used include Valium and Zarontin. Such medication can successfully control seizures in about 70% of patients. In more severe cases,  brain surgery may be required. Some diets and vitamin supplements  (in large doses) have been found to help those suffering from Epilepsy.


Part 2:

 Rasmussen syndrome is a rare, inflammatory neurological disorder most common between 14 months, to 14 years of age, and is associated with the rapid deterioration of one hemisphere of the brain (causing irreversible damage). The associated symptoms of Rasmussen syndrome include frequent, severe seizures (caused by the irregular function of the brain cells), which can in turn lead to the weakness of the side of the body affected by the seizures. There is no consistent prognosis for this disorder, with a great deal of variation from child to child. Unfortunately, most children affected by the disorder are left with partial paralysis, and suffer from problems with their speech. However, it has been known in some cases that only mild impairments have been experienced. Using an EEG, doctors were able to identify the seizure activity of Jerrod’s brain, noted by the particular pattern of “spikes” obtained from the results. From this the doctors were able to determine that only part of Jerrod’s brain was affected by the seizures (which is characteristic of Rasmussen syndrome). By using an MRI scan,  it  was possible to locate the precise area of the brain affected by the seizures, as well enabled doctors to identify the extent of the damage to the left hemisphere of Jerrod’s brain. Combined, this allowed for an accurate diagnosis.

During a hemispherectomy, structures of the left hemisphere that would be removed from Jerrod’s brain include the left temporal lobe, part of his left frontal lobe, as well as some areas in his parietal and occipital lobes if necessary. This radical surgery could possibly affect Jerrod’s short term memory, speech and hearing, as well as his judgement and decision making. If his parietal and occipital lobes are disturbed during the surgery, he could possibly experience some visual problems. Jerrod’s adaptive skills may be one significant area of change to his behaviour, which could potentially impact his social interactions with friends. However, since the thalamus, hippocampus and amygdala will remain intact, it is likely that Jerrod would not experience paralysis, while retaining sensations and spatial sense. In addition, his long term memory is likely to remain intact. Following this radical surgery, roughly 85% of patients report significant improvement to their seizures, and in about 60% of cases, their seizures will be completely eliminated.

To enable the best outcome of this surgery, Jerrod’s family could help him by taking him to rehabilitation/ speech therapy, to limit the effects of the hemispherectomy on his speech (following his discharge from hospital). If Jerrod had this surgery, I believe that his functioning would get better, and would not be so debilitated by his seizures (thus affecting his overall quality of life, not just the frequency of his seizures). One question to bare in mind about this surgery is the likelihood that the child will remain dependent on their medication, which has been  investigated by a study at John Hopkins Children’s Center. Their study showed that almost all children no longer required their medication, and were able to lead a close to normal life.

Based on these outcomes, I think that proceeding with Jerrod’s surgery would be the best option for both Jerrod, and his family, by eliminating the distress of their day to day lives. Without surgery, it is inevitable that his condition will deteriorate, and is extremely likely that his brain would be damaged further by his seizures.

 

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