Case Notes

Part I

1.    There is electrical activity in the brain in the form of action potentials, which the neurons use to communicate with other neurons.
2.    A seizure is experienced when there is altered electrical activity in the brain, usually tending to be an overload. A loss of consciousness occurs if the seizure involves the whole brain, but some consciousness is present if only one brain region experiences seizures.
3.    Epilepsy is a chronic neurological disorder where the patient experiences recurring seizures. Epilepsy can also bring forth different types of seizures as well as other neurological symptoms. This disorder is diagnosed by understanding family history, ruling out symptoms, as well as through the conduction of different tests such as the EEG, PET Scan, Epilepsy and the Spinal Tap to figure out which types of seizures are being experienced, as each responds to different tests.
4.     An EEG is performed by attaching electrodes to the scalp, which record the electrical activity of the brain. Abnormal patterns of brain waves found in this test will prove that you have epilepsy, while also helping the doctors figure out what type of seizures are being experienced. An MRI, on the other hand, will use very powerful magnets as well as radio waves to obtain a detailed visual of the brain, which will help detect any abnormalities in the brain that might be causing seizures.
5.    Some possible causes of seizures other than epilepsy can be the result of low blood sugar, or hypoglycemia, or a physical problem in the heart. Psychogenic non-epileptic seizures are caused when thoughts and feelings interfere with brain activity, such as panic attacks, dissociative seizures, and factitious seizures.
6.    Jerrod appears to be having atypical absence seizures, as he is unconscious and unresponsive during the seizure, and his head nods slightly back and forth.
7.    If Jerrod is having a seizure where he loses consciousness, the best way to help is to roll the person on their side, which helps prevent choking or vomiting fluids. You should also make sure that the person’s airways stay open; you can do that by tilting their head back. Another important thing to do is to make sure there are no sharp or solid objects in the person’s vicinity that they might injure themselves with during the seizure.
8.    The most common treatment for epilepsy is drug therapy, where drugs are prescribed based on the factors of side effects, frequency and intensity of seizures, age, and medical history.


Part II
1.    Rasmussen Syndrome is similar to an autoimmune process where one hemisphere in the brain starts to inflame and then deteriorate. Damage to the brain is irreversible. This syndrome starts displaying itself in kids between the age of 14 months and 14 years.  One of the first symptoms of this syndrome is seizures, which can then become chronic and progress to hemiplegia, or weakness on one side of the body. Further progression of the disease can lead to behavioral or learning difficulties. There is no known cause for this syndrome, but a theory is that at times, a viral infection can trigger antibodies to respond in the brain, causing the inflammation.
2.    The MRI is used to detect areas of atrophy, or shrinkage of brian matter, in affected side of the brain due to inflammation. The EEG gives us information of the seizures occurring on the affected side of the brain, for example, what type they are, how often they occur, etc. The MRI is more effective in showing the progression of the Rasmussen Syndrome.
3.    In this case, the affected parts of the brain that are going to be removed by the hemispherectomy are going to be the left temporal lobe, part of his left frontal lobe, and possibly parts of the parental and occipital lobe. The corpus collosum will be severed to prevent communication between the two hemispheres of the cerebrum.
4.    Losing these parts of the brain will affect his daily lifestyle. The side of the brain he loses will affect the opposite side of the body greatly. He might encounter problems with his vision, but there is no significant long-term effects on memory or personality. Change in cognitive function is also not drastic, and studies have shown that the brain can adapt fairly well to the surgery and move on to carry out parts of the other hemisphere’s responsibilities.
5.    Jerrod will still retain some motor functions because the thalamus will still be functioning, his memory since the hippocampus will stay intact, and some emotions due to the functionality of the amygdala.
6.    The family should encourage Jerrod and help him through this time by providing the proper support at school to aid possible learning difficulties that could arise after the surgery.
7.    The surgery would be an immediate cure for the Rasmussen Syndrome and control over seizures. However, Jerrod would be left with the incurable weakness of hemiplegia on one side of the body. Jerrod’s age contributes to its neuroplasticity, allowing him to adapt to the surgery over time.
8.    I was wondering about the success rate of hemispherectomies, which was approximately 75%, but lower in kids with Rasmussen Syndrome. As shown by a study called “Clinical Outcomes of Hemispherectomy for Epilepsy in Childhood and Adolescence”, no significant cognitive deterioration was present, such as loss of language. There was also behavioral improvement in 92% of children who had pre-operative behavioral problems.
9.    I would recommend that Jerrod and his family go through with this surgery, because if he didn’t, the situation will only get worse. At least at this point there is still a significant portion of the brain to salvage, and a good chance that the other hemisphere of the brain will adapt to the situation due to the brain’s neuroplasticity. There is no way of telling when there would be a non-surgical cure for Rasmussen Syndrome, and if it is not soon, there is no point in waiting until the syndrome is too advanced to treat.

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