Case Notes

August 6, 2014

Part I:

The brain is filled with billions of cells called neurons that communicate with one another by sending electrical signals called action potentials. The action potential travels down the axon, the output end, of one neuron and reaches the dendrites, the input end, of the next neuron at a connection called the synapse.

During a seizure, the brain experiences sudden abnormal electrical activity. A seizure can happen in only one part of the brain, called a focal or partial seizure, or in both sides of the brain, called a generalized seizure. It is possible to experience loss of consciousness due to the overwhelming electrical activity in the brain.

Epilepsy is a neurological disorder that causes reoccurring, unpredictable seizures. Generally, two unprovoked seizures are required for diagnosis. An electroencephalogram (EEG) will show abnormal electrical activity in the brain that is indicative of epilepsy. CT scans and MRIs are also often done to find the cause and location of the problem.

To perform an EEG test, electrodes connected to a recording machine are placed on the scalp. The recording machine measures the electrical activity of the brain, often showing abnormal patterns in patients with epilepsy. The EEG may show the area in the brain where a seizure starts. An MRI scan uses magnets and radio waves to generate pictures of the body. An MRI scan of the brain can show abnormalities in size or shape, or other abnormalities like a tumor.

There are many possible causes of seizures other than epilepsy. One type of non epileptic seizure is a psychogenic seizure, like a panic attack, caused by subconscious thoughts or emotions interfering with normal brain activity. Organic seizures have a physical cause,  like abnormal levels of sodium or glucose in the blood, or a heart problem.

It seems that Jerrod is experiencing absence seizures. Absence seizures are characterized by staring and subtle body movement, and cause loss of awareness. It was noted that Jerrod stares blankly during his seizures, some muscles twitched, and he moved his head slightly back and forth. Also, he was nonresponsive and had no memory of the seizures.

The main goal during one of Jerrod’s seizures is to prevent him from being injured. There should be nothing around him that could hurt him if he were to hit it. He should not be held down or moved, as this could be dangerous as well.

Treatments for epilepsy vary from person to person, but can include medications, lifestyle changes, and sometimes surgery. During surgery, a vagus nerve stimulator (VNS), similar to a pacemaker, may be placed to reduce the number of seizures.

Sources:
http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003931.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm
http://www.mayoclinic.org/diseases-conditions/epilepsy/basics/definition/con-20033721
http://www.epilepsysociety.org.uk/non-epileptic-seizures#.U-E-6FYxMhc


Part II:

Rasmussen Syndrome is a neurological disease, most often found in children under the age of 10, that usually effects only one hemisphere of the brain. It causes frequent and severe seizures that cause damage to the brain, which could include loss of motor skills and speech, hemiparesis, inflammation of the brain, and mental deterioration. This disease can cause irreversible damage, but for some children, surgery can decrease seizures and improve cognitive abilities.

An EEG will show abnormal patterns that indicate seizures and epilepsy, and can also tell us where in the brain these abnormalities are coming from. Ultimately, an MRI helps diagnose the disorder by showing a loss of brain substance (atrophy).

In Jerrod’s case, the left temporal lobe, part of the left frontal lobe, and possibly parts of the parietal and occipital lobes will be removed in the hemispherectomy. The corpus collosum, which allows the two hemispheres of the brain to communicate, will be severed.

Removal of the left temporal lobe may affect Jerrod’s memory, emotions, or communication. Removal of part of the left frontal lobe may affect his decision making, problem solving, and planning skills. Removal of the parietal lobe may affect his processing of sensory information, and removal of the occipital lobe may affect his vision. He will also be partially paralyzed on the side opposite of the removed hemisphere.

Jerrod’s deep brain structures would remain intact, including the thalamus, amygdala, and hippocampus. Though the left temporal lobe is removed, Jerrod will likely retain some control over his emotions because his amygdala is left intact, and some control over memory because his hippocampus is left intact. He will still have full control over the side of his body of the removed hemisphere.

After the surgery, Jerrod’s family should make sure he receives proper physical, occupational, and speech therapy. They should also talk with his school to discuss what options for support he would have there.

Jerrod’s level of functioning would likely get better over time, as he would not be having the seizures that cause damage to his brain nor would he be taking as many medications as before the surgery. Since he is young, the remaining hemisphere of his brain will adapt and will be able to take over the function of the lost side. However, he would experience some weakness or paralysis on the side opposite of the removed hemisphere.

One question I had was about the rate of success of this surgery. I found that recently, 86% of children who had a hemispherectomy were either seizure-free or have non-disabling seizures that do not require medication. However, for patient’s with Rasmussen Syndrome, only 65% are seizure-free after the surgery.

I would recommend that the family goes ahead with this surgery for Jerrod. He is still young, so he is likely to recover successfully. The surgery would prevent further damage to his brain as he will be having seizures less frequently and they will be less severe. The effects of not receiving the surgery will be more harmful than the consequences of receiving it.

Sources:
http://www.aans.org/en/Media/General%20Press%20Releases/2000/September/Hemispherectomy%20shown%20on%20ABC%20show%20%20Dr%20Ben%20Carson%20says%20most%20young%20people%20who%20have%20half%20their%20brains%20surgically%20removed%20do%20great.aspx?sc_database=web
http://www.ninds.nih.gov/disorders/rasmussen/rasmussen.htm
http://www.epilepsy.com/learn/types-epilepsy-syndromes/rasmussens-syndrome
http://my.clevelandclinic.org/neurological_institute/epilepsy/treatments-services/hemispherectomy.aspx
http://www.hopkinsmedicine.org/press/2003/October/031014.htm


Case Notes

August 5, 2014

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.

http://www.epilepsysociety.org.uk/non-epileptic-seizures#.U970TEiBRJg
http://www.epilepsy.com/learn/epilepsy-101/what-epilepsy
http://www.webmd.com/epilepsy/guide/epilespy-diagnosis-tests
http://www.medicinenet.com/seizure/page14.htm


 

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.
https://www.epilepsy.org.uk/info/syndromes/rasmussen-syndrome
http://hemifoundation.homestead.com/rasmussen.html
http://en.wikipedia.org/wiki/Hemispherectomy#Results
http://www.brainhealthandpuzzles.com/brain_parts_function.html
http://brain.oxfordjournals.org/content/126/3/556.full


Case Notes

August 5, 2014

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


Case Notes

August 5, 2014
  • The electrical activity occurring in the brain comes in the form of action potentials. After reaching a threshold, an electrical signal propagates from the axon hillock and down the length of the axon. This signal then reaches the dendrites of the adjacent neuron, causing neurotransmitters to be released. Neurons use this system as form of communication, most commonly referred to as a synapse.
  • During a seizure, the brain experiences abnormal electrical activity. Depending on whether the electricity travels or remains restricted to one area, becomes a deciding factor in what form of epilepsy a patient might have.
  • Epilepsy from the Greek, meaning “to possess, seize, or hold”. Electrical processing abnormalities in the brain beget seizures in epilepsy patients. Also, physical or behavioral changes may occur after the abnormal electrical event because the over-synchronization produces waves. It is diagnosed using patient interviews, and brain scans.
  • EEG (electroencephalography): Detects abnormal electrical patterns, electrodes are typically fastened to a flexible cap (similar to a swimming cap) that is placed on the participant’s head. From the scalp, the electrodes measure the electrical activity that is naturally occurring within the brain. This type of brain scan is passive, no current is delivered. The signal being measured is the difference in charges between the electrodes.
  • MRI (magnetic resonance imaging): Imaging technique used to thoroughly study anatomy of the brain. These scanners require the use of strong magnetic fields and radio waves.
  • Other causes of non-epileptic seizures are because brain injuries, tumors, and drugs. However, it could also be a cause of psychogenic seizures, a direct impact of subconscious thoughts and activities.
  • Jerrod could possibly have absence seizures, characterized mild twitches.
  • In case of a seizure, Jerrod should be not be restricted or held down in any manner, one should speak calmly and clear the room/area of objects that may injure him. If a seizure lasts more than 5 minutes, then 911 should be called immediately.
  • Epilepsy can be treated with anti-seizure medication, surgery or other devices may be considered.

Sources:

http://www.epilepsy.com/

http://www.mayoclinic.org/diseases-conditions/epilepsy/basics/definition/con-20033721

 

  • Characterized by frequent and severe seizures, loss of motor skills and speech, hemiparesis (paralysis on one side of the body), and encephalitis (inflammation of the brain), Rasmussen Syndrome affects one cerebral hemisphere in children under the age of 10. Research indicates that the cause is still unknown, however there are assumptions that it may be similar to autoimmune disease.
  • In order to detect abnormal electrical activity and EEG will be administered. But a MRI scan has the ability to display the progression of tissue damage in the restricted area of the brain experiencing activity. But these forms of brain scanning are used to diagnose the early stages of Rasmussen and to continually observe tissue damage.
  • During the hemispherectomy, the left frontal and temporal lobes may be removed. In these lobes, are where functions such as motor skills, language, and cognitive abilities are located. Also, the ability to express emotions, associated with the temporal lobe, may also be impacted as well.
  • After losing these parts of his brain, Jerrod may have difficulty with movement abilities on the right side of his body. It is also possible for Jerrod to experience impairment in cognitive and language skills as well.
  • Jerrod goes through surgery, he will retain complete control in terms of movement, on the right side of his body. Research reports that Jerrod may also be able to increase his IQ.
  • After a hemispherectomy, patients tend to receive therapy regarding speech, motor, and occupation. However, another form, outpatient therapy is given to ensure that speech and motor skills can be regained and help the patient function like normal children.
  • If it is decided that Jerrod will have the surgery, there is still a high chance for to improve his intelligence and better yet, lessen the brain damage brought on by the seizures. However, Jerrod may have difficulty with controlling the right side of his body.
  • My question was regarding the success rate of undergoing a hemispherectomy. Nearly 75 to 80% of patients have control of their seizures.
  • I would recommend that Jerrod’s parents go through with the surgery. It will lessen the burden of daily seizures and inhibit further brain damage. Despite the possible risks and consequences, Jerrod still has a chance to boost his IQ and live a normal life.

Sources:

http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/types/rasmussen_syndrome.html

https://www.epilepsy.org.uk/info/syndromes/rasmussen-syndrome


Case Notes

August 4, 2014
  • The reason there is electrical activity in the brain is because of communication. The neurons in our brain communicate with each other in order for us to be able to function as we do. To communicate the neurons send messages, via electrical activity, down a “highway” known as an axon to a different neuron.
  • During a seizure, there is a burst of, or interruption in, the regular electrical currents within the brain.
  • Epilepsy is described as a condition in which a person may have recurring, unprovoked seizures. It can be diagnosed by blood tests, EEGs, MRIs, CT scans, and spinal taps to measure the pressure surrounding the brain and spinal cord and to test the CSF.
  • During an EEG, the patient will have electrodes attached to his/her head that will measure the electrical activity within the brain. An MRI will create detailed images of the brain by using magnets and radiofrequencies.
  • There are many other causes of seizures other than epilepsy, such as: head trauma, infection, high fever, brain tumors, medications, and genetic factors.
  • I believe that Jarrod is having what is known as Absence Seizures based on the following information.
  • Absence seizures (also called petit mal seizures). These seizures are characterized by a brief, altered state of consciousness and staring episodes. Typically, the person’s posture is maintained during the seizure. The mouth or face may twitch or the eyes may blink rapidly. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the person may not recall what just occurred and may go on with his or her activities, acting as though nothing happened.” (hopkinsmedicine.org)
  • Due to the type of seizures that he is having, only light restriction on some of his activities is necessary. Be sure to document all of the medicine he take and when he does so, as well as the information about his seizures.
  • The main treatment for seizures is just basic medication. This being said, there may be an option of surgery or a Vagus Nerve Stimulation (the control of seizures by sending small currents of electricity to the brain through a large nerve in the neck) however this is for children twelve and older.

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

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CASE NOTES PART TWO

  • Rasmussen’s disease is characterized as an autoimmune process that effects one hemisphere of the brain with deterioration and inflammation.
  • Jarrod’s EEG showed that the abnormal electrical activity in the brain was located in only one specific part of the brain, not caused by a tumor, but had only caused slight damage on the second MRI.
  • In the hemispherectomy, the temporal lobe, frontal lobe, parietal lobe, and the occipital lobe would be removed from Jarrod’s brain. The temporal lobe organizes sensory input and memory; the frontal lobe controls decision making, problem solving, and empathy; parietal lobe controls language processing; occipital lobe is over visual perception and color recognition.
  • Other than reducing his seizures, the removal of these sections may cause Jarrod difficulties with sensations of the right side of his body, and maybe some issues with memory and language comprehension.
  • All in all, his senses should remain intact as well as his motor control.
  • After having the surgery, Jarrod would undergo rigorous physical and speech therapy in order to help regain his motor control and speech as much as possible.
  • If Jerrod had the surgery, his ability to function would rise as he would be rid of the weakening seizures and brain damage, to allow his IQ to increase and live as much like a normal child as possible.
  • My main question is on the success rate of this surgery, and I have found that more than 75% of patients experience complete, or nearly complete, control over his/her seizures.
  • I recommend going through with the surgery. Although it may seem scary, and there are risks involved, he would have a much better chance at a normal life after the surgery. If he didn’t have the procedure done, his seizures would continue to worsen and would result in severe brain damage. With the surgery he would have a good chance at having a normal(ish) life.

 

 

hopkinsmedicine.org

symptomtreatment.org

epilepsy.med.nyu.edu

 


Case Notes

August 4, 2014

PART I:


1. The nervous system is made up of cells called neurons. Neurons communicate with each other by generating electrical impulses known as action potentials. The action potential runs down the length of the cell body and ends at the axon terminal. Here, the electrical activity induces the release of chemicals known as neurotransmitters. These neurotransmitters are released into the intercellular space right outside the axon terminal, known as the synaptic cleft, where they bind to receptor proteins on the dendrites of another neuron. This is called a synapse and is the point of communication between neurons.

2. Seizures occur when there is abnormal electrical activity within the brain. This can be caused by an imbalance of excitory and inhibitory neurons in the brain. As a result, individuals can lose voluntary control of certain muscle groups or lose consciousness.

3. Epilepsy is a chronic disease that involves recurring, unprovoked seizures. Diagnosing epilepsy is difficult, as it can be caused by a number of different things (e.g. brain tumors, Alzheimer’s, strokes). Specialists usually recommend that the patient and/or their family gather as much information about the seizures as possible. This includes circumstances surrounding the seizure, behavior or sensations during the seizure itself and condition following the seizure. Doctors may also look into a patient’s medical history to see if there are any risk factors for epilepsy (e.g. family history, head injury, meningitis).

4. MRI (magnetic resonance imaging) scans provide detailed pictures of the brain’s surface. These are useful in identifying areas of abnormal brain structure and/or development. It can show abnormalities in the size of brain regions, the presence of a tumor, or a lesion on the surface on the brain. This is very important in determining the immediate cause of a seizure and what kind of action would be required to rectify the problem. For example, MRI scans can show whether or not invasive surgery would be effective in preventing future seizures.

The MRI itself involves the use of a magnetic field contained in an MRI machine. Patients lie in an MRI machine for around half an hour. During this time, they are asked to minimize movement so as to provide as clear an image as possible. This allows the magnetic field to penetrate and produce images based on the structure of the brain.

EEG (electroencephalography) is used to provide information on brain activity. This is done by attaching many electrodes to the patient’s scalp, and recording electrical activity in the brain. The electrical activity of the brain can show evidence of epilepsy risk factors like tumors or brain trauma. There are also EEG patterns that are specific indicators of epilepsy called ‘epileptiform abnormalities’.

The recording of the EEG can last between 20-30 minutes. An EEG technician usually exfoliates the scalp a bit to remove residue or substances that might interfere with the recording. The technician then attaches the electrodes to the patient’s head using an adhesive paste that can be washed off later. During the recording itself, the patient is asked to relax, fall asleep or shown mild stimuli.

5. Non-epileptic seizures have causes other than epilepsy. They mainly differ in that they are not caused by malfunctions in the brain’s electrical activity. They could be caused by metabolic disorders (like diabetes), extreme stress or emotional problems.

6. I believe Jerrod appears to be having partial epileptic seizures.

7. When witnessing a seizure one should remain calm and try to make sure the patient is not in environment in which they could get injured. One should gently try and make the patient lie or sit down to prevent injury, but avoid forcing the patient to do anything. Furthermore, one must pay close attention to the patient’s breathing and the length of the seizure. If the seizure lasts longer than 5 minutes, one should call an ambulance.

8. There are a variety of treatments for epilepsy, but they depend on the root cause of the condition. Some epilepsies can be cured using surgical techniques, others may require medication. In some cases, patients are implant with a vagus nerve stimulation (VNS) device that works as a sort of pacemaker to regulate electrical impulses in the brain.

Sources:
“About Epilepsy.” Epilepsy Society. National Society for Epilepsy. Web. 04 Aug. 2014.
Epilepsy Therapy Project. Ed. Patricia O. Schafer. Epilepsy Foundation. Web. 04 Aug. 2014.

PART II:


1. Rasmussen’s syndrome is a disease that is usually manifested in early childhood. The exact cause is still unknown, but scientists suspect it may be triggered by a particular virus. In Rasmussen’s syndrome, one hemisphere of the brain becomes inflamed and deteriorates. The damage that is done to the brain is irreparable. One of the first signs of the syndrome are frequent partial seizures; the seizures can sometimes be continuous. Rasmussen’s commonly affects the frontal lobe, which is where the motor cortex is located. This is why the seizures tend to involve twitching and rhythmic jerking. The syndrome is progressive and can cause weakness on one side of the body in the long run, called hemiparesis. It can also result in developmental and intellectual difficulties and behavioral problems.

Rasmussen’s syndrome is usually diagnosed by evidence of deterioration in one hemisphere provided by MRI scans. Medicines tend to be ineffective in treating the disease as a whole, though they may offer a means to better manage the epilepsy in the long run. If left untreated, the inflammatory process appears to decrease after a few years and eventually stop. However, the damaged neurons still malfunction and the epilepsy itself may still exist. The most effective ‘cure’ for Rasmussen’s syndrome is a hemispherectomy, but the surgery will most likely result in permanent hemiparesis or even hemiplegia

2. Jerrod’s EEG showed the doctors that the seizures were partial. This is because the abnormal electrical activity was localized to one part of the brain (in this case, the left hemisphere). The MRI scan later helped the doctors to diagnose Jerrod’s condition as Rasmussen’s because the left hemisphere was damaged whereas the right hemisphere was not.

3. The left temporal lobe is associated memory, emotion and hearing. It is particularly functional in speech and the understanding of language. The frontal lobe deals with cognitive functions such as planning and decision making, and also contains the part of the motor cortex that controls the right side of the body. Both the parietal and occipital lobes deal with receiving and interpreting sensory information.

4. Typically, a functional hemispherectomy results in some degree of hemiparesis, with patient’s typically losing the function of the hand on the opposite side of the hemisphere that is removed. In addition, patients tend to lose vision in the eye on that side as well. There is also the possibility of disabilities in speech, language and memory.

5. Jerrod should not experience weakness on the left side of his body, and his sensory input from that side of the body should also not be impaired. Scientists have found that, due to the plasticity of the brain (especially at a young age) the ability to speak and understand language, intellectual development and coordinated movement like walking may not be affected by functional hemispherectomies. In fact, because of the lack of seizures and medication, many children’s intellectual abilities increase following a hemispherectomy.

6. After the surgery, Jerrod will need to undergo occupational, physical and speech therapy to prevent long term disability from the surgery. His family will need to facilitate that, as well as try and help Jerrod to develop intellectually as much as possible throughout his childhood. There is the possibility of changes in Jerrod’s temperament and behavior, which they would need to anticipate and accommodate.

7. Seeing as Jerrod showed no signs of hemiplegia prior to the surgery, it is likely that his motor skills on the right side of his body will get worse afterwards. However, his cognitive abilities have the potential to develop much more due to the absence of seizure medication. Overall, Jerrod’s quality of life should increase as the epilepsy would be cured, and Jerrod could function as a normal child.

8.  Will the functional hemispherectomy work for sure?
Usually, functional hemispherectomies are successful in curing epilepsy. However, there are cases when the inflammation can return. Only anatomical hemispherectomies (where the entire hemisphere is removed) have been shown to be 100% successful.

9. I would recommend that Jerrod’s family go ahead with the surgery. The potential benefits far outweigh the risks, and there are many examples of children recovering from hemispherectomies and living healthy, fulfilling lives. This is especially true seeing as there is no other cure for Rasmussen’s syndrome: the loss of function associated with hemispherectomies are also associated with progressive Rasmussen’s. Hence, Jerrod’s family have nothing to lose by going ahead with the surgery.

Sources:

Appleton, Richard, Rachel Kneen, and Stewart Mcleod. “Rasmussen Syndrome.” Epilepsy Action. British Epilepsy Association, n.d. Web. 05 Aug. 2014.
Choi, Charles. “Strange but True: When Half a Brain Is Better than a Whole One.” Scientific American. Scientific American, Inc., 24 May 2007. Web.
“Epilepsy and Functional Hemispherectomy.” WebMD. WebMD, LLC., n.d. Web. 05 Aug. 2014.
Suzuki, Kelli. “Hemispherectomy.” Childrens Hemiplegia Stroke Association. CHASA, n.d. Web. 05 Aug. 2014.


Case Notes

August 4, 2014

Why is there electrical activity in the brain? Describe how it is used by neurons. We have electrical activity in the brain in order to send messages to and from neurons. Neurons can be either “off,” or “on.”  Each message passes through neurons to get where it needs to be and the electrical activity help it get there.

What happens in the brain during a seizure? A seizure is when there is a continuous period of hyperactivity in the brain. Which basically means when there is abnormal electrical activity.

What is epilepsy? How is it diagnosed? Epilepsy is a brain disorder that has recurring strokes and losses of consciousness. It can me diagnosed by an EEG or MRI scan.

What are the procedures for doing an EEG test and MRI scan? What type of information does each of these tests provide? (See here for EEG info and MRI info, make sure you follow the sublinks in the navigation bar on the left for more info) An EEG is a small helmet on your head that detects and records brain activity. It shows electrical impulses and so showing a disturbance will help diagnose epilepsy. An MRI takes an image of your brain. The MRI can help to find an abnormality in your brain to diagnose epilepsy.

What are some possible causes of seizures other than epilepsy? Shaking of the body can cause a seizure. This doesn’t happen every time but it is a possibility.

Based on the information in the case, what type of seizures does Jerrod appear to be having? Jerrod appears to have epilepsy.

What should you do during a seizure to help Jerrod? You should stay calm, and protect him from injury. If he is on stairs or somewhere where he could fall you need to help him.

What are some treatments for epilepsy? There are certain diets one can go on, certain vitamins you can take, and a surgery is possible.

  • What is Rasmussen Syndrome (what are its history, symptoms, prognosis, etc.)? Rasmussen syndrome is a disease where the patient (usually under 15) experiences frequent seizures and loss of speech and motor skills. But damage has only ever been seen in one side of the brain.
  • How did the doctors use EEG and MRI to help diagnose the disorder? The EEG will show that the abnormal electrical activity is not happening all over the brain, but rather in a smaller section. The MRI will show that there is only damage in one hemisphere. In Jerrod’s it is his left.
  • What structures or abilities of the brain are concentrated in the areas of the left hemisphere that would be removed in the hemispherectomy? The loss of Jerrod’s temporal lobe will mean he will lose the ability to retain long term memories and react/ analyze visual stimuli. But this is only in one half of his temporal lobe. If Jerrod loses part of his frontal lobe, he will lose some of his ability to reason, problem solve, and experience emotion. The parietal lobe is for reacting to sensory information (pain, touch, etc.). The occipital is for visual functions. Lastly, the corpus collosum is the small bundle of fibers that connects the two hemispheres and lets them communicate.
  • Other than reducing his seizures, how else might Jerrod’s thinking or behavior be affected by losing these parts of his brain? Jerrod would lose a lot of memory, he may not be able to move parts of his body on the right side, and he could forget how to do simple tasks.
  • What types of abilities would he still retain, because the brain structures would remain intact? He would still be able to move the right part of his body, create motivation, sending out memories, and wake up in the morning!
  • What might the family do to help Jerrod recover after such a surgery? The family will need to reteach a lot of things to Jerrod, including basic, daily functions.
  • If Jerrod had the surgery, would his level of functioning get better, worse, or stay the same over time? Over time it will get better because there are doctors who work with post-brain surgery patients to help improve their lives.
  • What other kinds of questions would you have about the surgery? Can you find the answers? 1. What does the surgery cost? 2. How long does it take? 3. What are the major risks during the surgery?
  • What decision do you recommend to the family? Why or why not go ahead with surgery? I do recommend the surgery. This disease is incredibly rare and the surgery seems to be the only way of stopping the damage to your brain.

 

 

 

 


Case Study

August 4, 2014

Part I

The brain is made of billions of individual cells called neurons. And they communicate through electrical signals known as action potentials. When a neuron experiences a change in electrical voltage that exceeds a certain threshold value, it shoots an electrical signal that propagates down the length of the cell body. At the gap between one neuron and the next, the electrical signal will cause chemicals known as neurotransmitters to be released. These chemicals activate an action potential in the adjacent neuron. And so on. Thus, electrical signals travel throughout the brain.

During a seizure, clusters of neurons send out the wrong signal. A group of neurons will collectively fire action potentials at once, but without any purpose. There are many types of seizures, but the most common feature of a seizure is a wave of uncontrolled electrical signals spreading throughout the brain. Seizures cause people to have strange emotions, behaviors, or muscle movements. They may also lose consciousness, and there is a possibility of the neurons being damaged.

Epilepsy is a condition where people have repeated seizures. It is usually diagnosed after a person experiences two or more seizures. For it to be diagnosed, you have to meet with a neurologist and go through some basic tests. You will review your medical history, describe your seizures, and go through some neurological examination. Usually, this examination is an EEG (electroencephalogram) test or a MRI (magnetic resonance imaging) test.

To take an EEG test, an EEG technologist will lightly glue several electrodes to your head. You will be led to a dark, quiet room, and asked to do things like move your eyes, look at lights, breathe, fall asleep, etc. The EEG test shows either normal or abnormal patterns of brain electrical activity. The results look like a bunch of horizontal, squiggly lines. These are electrical readings from different electrode locations. Certain patterns, known as “epileptiform abnormalities”, may indicate epilepsy. The EEG can also determine where in the brain the seizures are taking place, or whether the seizure is spread over the entire brain.

To take an MRI test, you may be given an intravenous injection. You will have to lie still underneath a large, noisy magnet that causes certain protons in your blood to spin differently. A sensor picks this up and uses it to create a detailed 3-d image of the fluid brain. MRI images can show changes in the brain structure, and some of these changes are associated with epilepsy. The MRI might show a brain tumor, an abnormal blood vessel, malformations of the development of the cortex (front of the brain), sclerosis (hardening of the brain tissue), or previous injuries (such as trauma, inflammation). This also provides information as to the potential effectiveness of surgery, since some things like sclerosis are easier to operate on than other things like malformations of cortical development.

There are a few possible causes of seizures other than epilepsy. Non-epileptic seizures are not caused by increased or abnormal electrical activity in the brain. Psychogenic seizures, or “pseudoseizures”, are caused by subconscious emotions or stress, and they are mostly psychological. EEG is the best way to tell whether a seizure is epileptic or psychogenic. Sometimes, other factors like brain injuries, tumors, and drugs can cause seizures that don’t qualify as epileptic seizures.

Jerrod may be having complex absence seizures. During complex absence seizures, a person will stare into space for up to 20 seconds, while making other movements like blinking or hand twitching. The best way to deduce what types of seizures he’s having is to wait for the EEG and MRI test results, which are usually more revealing than outward symptoms. If Jerrod has a seizure, it is important to stay calm and reassure people who are nearby. Speak calmly to Jerrod, clear the area of hazardous materials, but do not hold him down to stop him from moving. Time the seizure with a stopwatch, and act friendly as he regains consciousness. Call 911 if the seizure lasts longer than 5 minutes.

Epilepsy is generally treated with a variety of anti-seizure medications. Medicines can control seizures in about 7 out of 10 patients. Most people need to try more than one medicine. Some medicines act on neurons, and others affect neurotransmitters. If medicine does not have its intended effect, surgery, dietary therapy, and implantable devices are other potential treatment options.

Part II

Rasmussen’s Syndrome is a rare, chronic condition usually found in a single hemisphere of the brain. It is named after Theodore Rasmussen, a Canadian neurosurgeon. Some symptoms are: frequent and severe seizures, loss of motor skills and speech, paralysis on one side of the body, inflammation of the brain, and mental deterioration. The seizures often result in scarring and damaging of the brain tissue. The disease is caused when immune system cells enter the brain and cause inflammation. The reason for this inflammation is not known. The prognosis for Rasmussen’s patients varies, as no medical treatment has been shown to fully halt the progress of the disease. Most Rasmussen’s patients experience some paralysis and neurological deficits (especially cognitive and speech-related).

In diagnosing Rasmussen’s syndrome, EEG tests will show electrical epileptic waves and slower brain activity in the affected hemisphere. MRI tests will show shrinkage of the affected hemisphere, as well as inflammation or scarring. With Jerrod, both of these tests did indicate Rasmussen’s was a possibility. In his EEG, only certain areas of the brain showed seizure activity (this is the reason why his seizures are labeled as “partial” seizures). In his MRI, there were signs of scarring and shrinkage in the left hemisphere. The MRI showed that repeated seizures have started to damage his brain tissue.

A hemispherectomy would affect Jerrod’s left temporal lobe, part of his left frontal lobe, some of the parietal and occipital lobes, and the corpus collosum. These areas of the brain are involved in a variety of different tasks, and many of tasks revolve around cognition, communication, speech, etc. The left temporal lobe is involved with speech and vision processing, speech comprehension, and verbal memory. The frontal lobe is involved with cognition, decision making, consequences, and long-term emotional memories. The parietal lobe is involved with language processing, sensory information, and spatial recognition. The occipital lobe is involved with processing space, color, and motion. All four of these lobes are interconnected, and they are all part of the cerebral cortex. The corpus collosum connects the left and right hemispheres, and is involved with the coordination of activities that use both sides of the body.

Jerrod’s visual, motor, and cognitive function may be negatively impaired. He may have difficulty forming words with his mouth or processing speech. However, there are many arguments in favor of doing a hemispherectomy. First and foremost, Jerrod is likely to stop having seizures. 65% of Rasmussen’s patients are seizure free after surgery. But also, if Jerrod underwent a hemispherectomy, he would still retain certain abilities in undamaged parts of the brain. A hemispherectomy would not touch his thalamus, amygdala, hippocampus, brain stem, or basal ganglia. These are known as deep brain structures. The thalamus relays signals to the cortex and regulates consciousness. The amygdala processes memory, emotions, and decision-making. The hippocampus is located beneath the cerebral cortex and processes memory. The brain stem controls basic involuntary actions, like heart rate, breathing, and sleeping. The basal ganglia play a role in various functions including motor movements and procedural learning.

The whole family can help by creating a very supportive environment to minimize Jerrod’s stress as he recovers from surgery. It is likely that he might have a post-operational fever, but most of these fevers are harmless. It is also helpful to be around Jerrod while he goes through physical therapy, occupational therapy, and speech therapy.

Jerrod’s level of functioning might be negatively impacted in the short term, but it will likely make recoveries in the long term. Many hemispherectomy patients have difficulties with speech immediately after the surgery. It takes a certain measure of time (months or years) and rehab for patients to become accustomed to speaking again, but their brains do adapt by increasing the size of the speech centers in the undamaged hemisphere. In addition, all hemispherectomy patients have partial paralysis on one side of the body, but a great majority of them have adapted and regained the coordination necessary to do complicated activities like dancing. After rehab, Jerrod will likely be able to walk with a slight limp or a small ankle brace. He might lose some sensations in his right hand, however. Also, Jerrod most likely won’t experience an intellectual disability afterwards. In fact, neurosurgeons have shown that a patient’s IQ generally goes up after a hemispherectomy.

I personally would recommend going through with the surgery. There are many risks, and you as a family must be prepared for a long road back to recovery, but the benefits do outweigh the costs. As you have discovered, medicinal treatments are not likely to help with Rasmussen’s syndrome. More conservative surgical options are not likely to help either. And these seizures cannot be allowed to continue, as we don’t want Jerrod’s motor and intellectual abilities to gradually deteriorate. If Jerrod keeps having more and more intense seizures, not only will his left hemisphere be permanently damaged, but it might affect his right hemisphere too. He is still young, and his condition will only get worse with time, so now is the best time to act swiftly and end the seizures. As former patients have shown, it is possible to regain a considerable amount of one’s speech abilities with the proper post-operational therapies. Especially since Jerrod is still young, his brain has more plasticity than an older person’s brain, so he will find ways to adapt to his new lifestyle.

Sources:

Grubin, D. 2001. The Secret Life of the Brain. [Television series]. New York and Washington, DC: Public Broadcasting Service.

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

http://www.epilepsy.com/

http://www.ninds.nih.gov/disorders/rasmussen/rasmussen.htm

http://www.hopkinsmedicine.org/press/2002/November/021108.htm, http://www.hopkinsmedicine.org/press/2003/October/031014.htm

http://www.aans.org/en/Media/General%20Press%20Releases/2000/September/Hemispherectomy%20shown%20on%20ABC%20show%20%20Dr%20Ben%20Carson%20says%20most%20young%20people%20who%20have%20half%20their%20brains%20surgically%20removed%20do%20great.aspx?sc_database=web

http://brain.oxfordjournals.org/content/126/3/556.long#sec-12

http://my.clevelandclinic.org/neurological_institute/epilepsy/treatments-services/hemispherectomy.aspx

Wikipedia.org: “Thalamus,” “Amygdala,” “Basal ganglia,” “Brain stem,” “Hippocampus,” “Parietal lobe,” “Temporal lobe,” “Frontal lobe,” “Occipital lobe.”


Case Notes

August 4, 2014

Case Study I

Why is there electrical activity in the brain? Describe how it is used by neurons.

The neurons within the brain send signals to each other in the form of electricity. This electricity is passed on from brain to body and vice-versa.

What happens in the brain during a seizure?
In a seizure, the electricity gets to a level that is so high that the brain cannot control the impulses anymore. People lose control of all of their movements.

What is epilepsy? How is it diagnosed?
Epilepsy is the tendency to get many seizures due to environmental changes or just internal factors. Somebody can be diagnosed with epilepsy if they have two or more seizures within a 24 hour period.

What are the procedures for doing an EEG test and MRI scan? What type of information does each of these tests provide? (See here for EEG info and MRI info, make sure you follow the sublinks in the navigation bar on the left for more info)
An EEG machine measures the electrical activity within the brain. It measures and records these on a computer in the form of up and down lines called traces. This can tell one if they have normal or abnormal brain electricity levels. An MRI shows the brain’s structure and form. It can show doctors if there is a problem within the brain causing epilepsy due to an abnormality in the shape of the brain.

What are some possible causes of seizures other than epilepsy?
Seizures can be caused by pregnancy-related high blood pressure. Non epileptic seizures can be caused by mental health issues or emotional stress and conflict.

Based on the information in the case, what type of seizures does Jerrod appear to be having?
It seems to me that Jerrod is having epileptic seizures. They happened within a 24 hour period, and he has no conflict in his life, nor is he pregnant I presume!

What should you do during a seizure to help Jerrod?
During a seizure you should make sure that Jerrod is not going to bite down on anything within his mouth. You should hold his head so that it is not jerked and cannot hurt him even more.
What are some treatments for epilepsy?
Someone diagnosed with epilepsy can be put on a “Ketogenic Diet”, or take many vitamins. There is also a surgery called Vagus Nerve Stimulation, but it comes with many risks. There are also many prescribed drugs for children and adults with epilepsy.

 

 

 

 

 

 

Case Study II:

What is Rasmussen Syndrome (what are its history, symptoms, prognosis, etc.)?
Rasmussen Syndrome is a system of brain malfunctions that affects children from 3 to 11 years old. Not much is known about Rasmussen Syndrome, but it could possibly be a virus triggering an antibody response in the brain. This could cause the brain to malfunction. Symptoms of the disease are frequently occurring seizures. The most common areas of the brain affected are the Frontal and Temporal lobes.

How did the doctors use EEG and MRI to help diagnose the disorder?
The doctors saw that, on the EEG there was a frequency that was abnormal in Jerrod’s brain. The MRI showed that the left side of Jerrod’s brain was abnormally shaped.

What structures or abilities of the brain are concentrated in the areas of the left hemisphere that would be removed in the hemispherectomy?
In the hemispherectomy, Jerrod’s left temporal lobe, so his memory, emotion, hearing, and language may be affected. A good portion of his left frontal lobe would be removed, so his problem-solving skills would have issues.

Other than reducing his seizures, how else might Jerrod’s thinking or behavior be affected by losing these parts of his brain?
Jerrod might have trouble in school due to his decision-making and problem-solving skills being lessened. The left temporal lobe will also be removed, so Jerrod might find it difficult to pull things from his memory.

What types of abilities would he still retain, because the brain structures would remain intact?
He would still be able to maintain homeostasis. His thalamus would still be intact. He would still be able to retain things from long term memory due to his intact hippocampus.

What might the family do to help Jerrod recover after such a surgery?
The family would want to do things to stimulate the right side of his brain. This is going to be the area that is most functional after the surgery. They might want to read up on the effects of the surgery, like memory loss and problem-solving skills and understand that this is what their son will be going through soon.

If Jerrod had the surgery, would his level of functioning get better, worse, or stay the same over time?
At first, Jerrod’s level of functioning would worsen. However, with recovery and rehabilitation, he will get to a point where he will be able to function normally.

What other kinds of questions would you have about the surgery? Can you find the answers?
I was wondering what the consequences of not having the surgery would be. How much damage would there be to the brain?
What decision do you recommend to the family? Why or why not go ahead with surgery?
I recommend that they go through with the surgery. I could not find anything that said what the consequences of not having the surgery would be, but I presume the continuation of brain malfunctioning would be worse than the problems that a child would be faced with after having the surgery.

 

 

 

 

 
http://www.epilepsy.com/learn/about-epilepsy-basics

http://www.webmd.com/epilepsy/tc/seizures-topic-overview

http://www.webmd.com/epilepsy/guide/epilepsy-treatment-care

https://www.epilepsy.org.uk/info/syndromes/rasmussen-syndrome


Case Notes

August 4, 2014

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.

 

 

Sources Used:

http://psychology.about.com/od/aindex/g/actionpot.htm

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

http://www.medicinenet.com/seizure/article.htm

http://en.wikipedia.org/wiki/EEG-fMRI

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

https://www.epilepsy.org.uk/info/syndromes/rasmussen-syndrome