Case Notes

Part 1

Electrical activity in the brain is caused by neurons, which shoot electrical impulses down its axons. These axons use action potentials, which are essentially pulses of electrical activity, in order to communicate among themselves.

During a seizure, the neurons increase in electrical activity and this prohibits the brain from processing the normal signals fired by the neurons. Thus seizures can be defined as periods of sustained hyperactivity in the brain. The nerve cells fire massive bursts of electricity, during which the patient is not in control of their own body. After several seconds/minutes, the brain regains control. If the activity is limited to one portion of the brain, the patient may remain conscious during the seizures, however if the entire brain is involved, the patient suffers from complete loss of consciousness.

Epilepsy is a brain disorder which is characterized by epileptic seizures. What happens during the seizure is the most important piece of information in diagnosing epilepsy, since there are many disorders that can cause alterations in behavior. Doctors gather a variety of information regarding the seizures and begin to rule out other syndromes. Epileptic seizures are episodes of abnormally excessive neuronal brain activity that manifests in the form of jerking and momentary lapse of consciousness.

During an EEG test, the patient lies down on an examining table. Electrodes are placed on the skull and a series of lights go off which cause changes in brain-wave patterns. This technique is used in order to detect abnormal behavior in electrical signals in the neurons. During an MRI scan, the patient on the examining table must lay perfectly still in a cylindrical hole for a substantial amount of time (usually around half an hour). MRIs provide pictures of the brain which can prove to be incredibly helpful and informative. These will provide information as to whether or not there is a problem receiving signals in the neurons.

Many conditions can cause seizures. Epilepsy is a nervous system problem that causes seizures, however they can be a symptom of another health problem. They can happen as a result of increasing fever, low blood sugar level such as in a patient with diabetes, damage to the brain from a brain injury, withdrawal, brain tumor, infection, parasitic infections and many more.

Based on the information available to us, I believe that Jerrod is suffering from epilepsy. He loses control of his voluntary behavior for a brief time, and he suffers from short lapses of consciousness and involuntary convulsions or movements which he does not later recall. He could also be suffering from complex absence seizures, during which the patient stares into space and experiences involuntary movements. It is still to early to tell definitively which of these conditions is more likely.

Unfortunately, there is not much that can be done while Jerrod is having a seizure. The people around him should make sure that he does not fall and hit his head. They should not try to hold him or shake him, but let the seizure pass and then take him to the hospital immediately.

There are different types of epilepsy, and the disorder manifests itself different depending on the patient, so there are several treatments available. Antiepileptic medicine helps prevent seizures. In addition to an assortment of medication, however, patients may also try a Ketogenic diet, which is adequate in protein. Other options that are available are vagus nerve stimulation therapies, anterior temporal lobectomy and hemispherectomies.


Part 2

Rasmussen syndrome is a very rare case of brain malfunction which usually develops during childhood. Not very much is known about this syndrome, however it is known that the brain cells in one hemisphere of he brain becomes very inflamed. It is possible that a virus may trigger an antibody response in the brain which causes this inflammation and malfunction. The symptoms associated with this disease are frequent seizures. The most affected parts of the brain are the frontal and temporal lobes. This makes sense seeing as one of the motor control centers in the brain is in the frontal lobe.

The doctors used the EEG in order to detect a particular pattern of spikes in electrical activity representing his seizures. Using the EEG exam, the doctors found that Jerrod’s seizures were partial, meaning they only included a part of the brain. The MRI scan showed that the area in the left side of Jerrod’s brain was beginning to show some slight abnormalities which indicated that his brain was beginning to be damaged by the seizures.

The left part of the hemisphere is associated with logical behavior, such as problem solving and language. A hemispherectomy may affect this part of the brain, which might cause difficulties in Jarrod’s speech and use of grammar. Structures that may also be removed are the left temporal lobe, left frontal lobe, and is parietal and occipital lobes, which could result in a loss of short term memory. So, in addition to reducing his seizures, losing parts of his brain will affect other parts of his daily activity.

Since the right brain (which will not be affected) can carry out many of the tasks that the left brain does when necessary, Jerrod will still be able to recognize people and emotions, and will most likely not be paralyzed. Also, there will be no effect on his long-term memory.

There are many options that Jerrod’s family can try to get him through the surgery, such as physical therapy and similar treatments that would help him to regain cognitive abilities lost during the operation. Since Jerrod is young, there is a very high probability that he is going to regain a lot of his previous cognitive function. One question that comes to mind is how long Jerrod is going to be in need to hospitalization and constant care, which would interfere with his schooling and the regular life of a pre-teen. The post-surgery requirements differ from patient to patient, however they are extensive seeing as this is a very radical procedure.

My personal recommendation to Jerrod and his family is to go through with the surgery, because he is very young and the seizures will progressively worsen if they are not adequately dealt with. Since he is so young, his cognitive abilities will return almost fully after extensive therapy and treatment. The upsides of the surgery clearly outweigh the downsides. If Jerrod continues having these seizures and does not respond to other medication, he could experience mental retardation. Of course, this decision is ultimately in the hands of Jerrod’s parents.



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