Case Notes

Part I: 

Electrical activity is necessary in the brain because it is how neurons communicate with each other. Once a threshold is reached inside a specific neuron, a signal is sent down its axon to another neuron and neurotransmitter is released. This event is called a synapse.

During a seizure, the brain experiences increased electrical activity in neurons. Neurons fire in large bursts that the brain can not control, thus sometimes resulting in loss of consciousness and voluntary movement. However, if the seizure only involves a part of the brain, it is possible to remain conscious.

Epilepsy is a neurological disorder that entails reoccurring seizures. It is usually present in children under the age of 10. Epilepsy is diagnosed by a series of brain scans, such as EEG and MRI. EEG measures normal or abnormal electrical activity in the brain through a cap placed on the subject’s head. An MRI uses magnetic fields and radio waves to show a detailed picture of the brain, further helping with diagnosis. Only after these test have been done can it be confirmed that a person has epilepsy.

Non-epileptic seizures can be caused by many things, such as low blood sugar and diabetes, problems in the heart, panic attacks, brain injuries, and drug use.

Jared is a healthy kid. He is active and does not have diabetes or any additional medical conditions that could be causing his seizures.  Based on the information given, I think that Jerrod is having complex absence seizures. This would explain the twitching of his arm and “staring into space.” Absence seizures don’t last very long, which is also a factor of the seizures Jerrod is having.

To help Jerrod during a seizure, make sure there is nothing around that could hurt him if he loses control of his movements and clear the area. Do not try to hold him down, just make sure he will be safe until the seizure is over. Afterwards, document the events leading up to, during, and after the seizure with detail.

Epilepsy can be treated with medicine, surgery, or, in some cases, vagus nerve stimulation, which is a device that is implanted into the patient to control electrical impulses. The type of treatment often depends on the patient and is chosen to best treat the type of seizures they are having.

Sources: 

http://www.epilepsy.com/start-here/introduction-epilepsy

http://www.nlm.nih.gov/medlineplus/epilepsy.html

http://www.sturge-weber.org/medical-matters/seizures-and-neurological-issues.html

http://www.epilepsy.com/learn/types-seizures/absence-seizures

Part II:

Rasmussen Syndrome is a progressive neurological disease that almost always affects only one cerebral hemisphere and generally occurs in children under the age of 10. The cause of Rasmussen Syndrome is unknown, but research indicates that it may be similar to that of an autoimmune disease. The disease includes symptoms such as progressive seizures, paralysis of one side of the body, and often loss of speech ability and learning.

MRI is used in diagnosis of rasmussen syndrome to give evidence of tissue loss in one hemisphere of the brain. This shows that the brain is deteriorating in that hemisphere. EEG is used early on in the diagnosis and can identify epileptic patterns in the brain. However, MRI is the most useful technology in catching rasmussen syndrome as it progresses, because it shows actual scans of the damage on the brain.

The left frontal lobe and the left temporal lobe are the main areas of the brain concentrated in the left hemisphere that could be affected. The left frontal lobe deals with language abilities , motor abilities, and other cognitive functions. The left temporal lobe is associated most with language and emotions.

By losing these parts parts of his brain, Jerrod will lose some motor control on the right side of his body (if his left hemisphere is tampered with) and sensation is his hand and fingers on that side of his body will most likely be decreased. He may also have decreased language and memory abilities.

If Jerrod went through with the surgery, he would still have complete control over the right side of his body, in terms of motor control and senses. According to the AANS, he even has a good chance of increasing his IQ after the surgery, due to the new lack of seizures and brain damage.

After a hemisphererectomy, most patients receive physical, occupational, and speech therapy. If not needed, Jerrod will still have to have outpatient therapy. This will help make sure he can regain as much of his motor control and speech as possible and function like a normal child to the best of his ability.

If Jerrod had the surgery, his control over the right side of his body would most likely worsen, but his brain would be much better off. He would be free from the seizures and any more potential brain damage that could occur. He could begin to increase his intelligence.

One question I had about the surgery was the success rate and how many people have been operated on thus far. I found that usually less than 100 hemispherectomies are performed per year and seizures are eliminated in 70-85% of patients.

I would recomend that Jerrod’s family go ahead with the surgery. Though there are still risks and consequences to the surgery, it is still better than definite prolonged brain damage. Without the surgery, Jerrod would only continue to get worse. At least, by having a hemispherectomy, Jared has a great chance to eliminate his seizures from causing any further brain damage and he can live like a normal child for the most part.

Sources:

http://www.surgeryencyclopedia.com/Fi-La/Hemispherectomy.html

http://www.braininjuryinstitute.org/Brain-Injury-Types/Frontal-Lobe-Damage.html

http://www.epilepsy.com/learn/types-epilepsy-syndromes/rasmussens-syndrome

http://brain.oxfordjournals.org/content/128/3/454.full

 

 

One response to “Case Notes”

  1. Swathi Srinivasan says:

    I completely agree with your opinion as to why Jerrod and his family should go through with the surgery. It will help prevent further brain damage and he still has a chance to live a normal life.

Leave a Reply

Your email address will not be published. Required fields are marked *