Case Notes

Part 1

Electrical activity in the brain exists because that is the mode of communication amongst neurons (nerve cell). Any movement you make is a result of the relaying of a message by neurons in your brain along a specific pathway or circuit. In order for messages to be passed from neuron to neuron, a certain amount of electricity, or voltage, must be reached inside the cell to relay the message or signal by the release of chemicals (called neurotransmitters) to the next cell in the pathway.

During a seizure, bursts of abnormal electrical signals are received by neurons in a particular part of the brain, which interrupts normal brain function. Because the brain controls all voluntary and involuntary responses, the miscommunication amongst neurons in the brain causes abnormal behavior.

A person is considered to have epilepsy if they have two or more unprovoked seizures, meaning that the seizures aren’t caused by something such as abnormal blood sugar levels, concussion, or drug withdrawal. Epilepsy is diagnosed by EEGs, which measure the electrical activity of the brain, blood testing, a PET scan that locates the part of the brain causing the seizure, and a spinal tap to examine the fluid surrounding the spinal cord, which is a major part of the nervous system.

To perform an EEG (electroencephalography), electrodes are placed on the scalp. The electrodes are connected by wires to an electrical box that is connected to the actual EEG machine. The electrical box detects the electrical signals that are being sent within the brain and the EEG machine records the electrical activity with traces (the squiggles), which correspond to different brain regions. An MRI takes brain structure images, whose level of provided information correspond to the strength of the magnetic field of the machine, by sending pulses of radio waves at your brain ( you don’t feel anything).

Possible causes of seizures other than epilepsy can be provoked or unprovoked. Provoked causes include and are not limited to alcohol and drug use, brain trauma, brain disease, medications, cortical dysplasia. Unprovoked causes include but are not limited to congenital conditions, fever, infection, metabolic or chemical imbalances, and Alzheimer’s disease.

Based on the information in the case, it seems like Jerrod is having absence seizures, which are characterized by short episodes of loss of consciousness , maybe some twitching, and no memory of the occurrence, all of which describe Jerrod’s behavior.

If Jerrod has a seizure, you should immediately protect him from injuring himself by moving nearby furniture, possibly guiding him to the ground so he doesn’t fall, and position his head so that fluid can flow from his mouth. Do not restrain him in any way because that can injure you and/or Jerrod.

Depending on the age, seizure type, and side effects, medication can be prescribed to lower the frequency of seizures. Vagus Nerve stimulation can also be done, which sends energy to the brain via a the vegus nerve, which is large and located in the neck. If the seizures are always caused by a specific part of the brain, surgery can be done to remove it if it does not affect normal functionality of the individual.

Sources:

http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/epilepsy_and_seizures_85,P00779/

http://www.webmd.com/epilepsy/guide/epilespy-diagnosis-tests

http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/seizures/causes/

 

Part II

Rasmussen’s syndrome is a neurological disease that should be very carefully diagnosed, as some other disorders have the same effects as this one. It generally affects one hemisphere of the brain and often causes seizures. The syndrome starts to affect the individual between one and fourteen years of age. Weakness and other neurological issues begin to appear one to three years after frequent seizures start to take place. After surgery, which is the usually the most effective treatment, some children recover in 2-3 months.

The EEG showed the brain area that the seizures were caused by, each line representing an area of the brain and the spikes indicating seizure activity. The MRI showed structural abnormalities in the left hemisphere of the brain, which controls the movement of the right side of the body.

If Jared’s left temporal lobe is removed, he will have a lack abilities in memory recall and possibly communication. If parts of the other three brain lobes are taken out, he may have compromised abilities in problem solving, vision, and processing of sensory information. Jerrod’s decisions may not be very well thought out and he might have issues responding appropriately to his environment. Jerrod would retain proper endocrine function, metabolism, the ability to process fear, and the ability to form memories.

During Jerrod’s recovery, it is imperative that his family makes sure he gets plenty of rest, be accommodating of his physical weakness, and keep up with all the occupational and physical therapy appointments along with the neurological assessment appointments.

Jerrod’s level of functioning would most likely get worse regarding motor and cognitive function. However, the seizures would decrease in frequency.

One question I would have is what the complication rate is in the performing of this surgery. I found that it is 0%, but if respective techniques are used only, it can be up to 22%.

I would definitely recommend going ahead with the surgery. It is the best option because the negative effects of the surgery are much less in collateral damage than if the disease continues to progress and cause severe and irreversible brain damage that could be detrimental to the functionality of Jerrod. Also, the procedure is safe and Jerrod would have a much better quality of life if the seizures were less frequent and less severe.

Sources:

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

http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/rasmussen_syndrome/patient_information.html

http://www.aboutkidshealth.ca/en/resourcecentres/epilepsy/understandingepilepsydiagnosis/epilepsysyndromes/pages/rasmussen-syndrome.aspx

One response to “Case Notes”

  1. Brianna Margaret Cathey says:

    I compared my answer with Whitney Wilson’s conclusion on the decision about the surgery and we agree completely. Although the surgery may compromise some of his functionality, it is a much better alternative than severe and permanent brain damage.

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