What is Parkinson’s Disease?

August 6, 2014

Before we get started with my “lesson” (blog post), I want to restate that I chose this because my best friend’s dad (who is basically my second dad) was recently diagnosed with Parkinson’s and I felt a real personal connection with studying it. I love to write and feel that I can present information better in a blog post, which is why I chose what I did.

*I tried to make it as bearable to read as possible*

Parkinson’s is a neurodegenerative disease. Parkinson’s disease is often seen in patients of over sixty-five years old, but can occur at any age. This being said, somewhere between five and ten percent of reported cases of Parkinson’s is “early onset” presenting itself in people under the age of 50. It has affected around half a million people in the United States, with around sixty thousand more being diagnosed each year. It has been found that fifty percent more men have Parkinson’s then women, although the disease has no prejudice against gender. The diagnosing is on the basis of the symptoms and a physical examination, as there are no current laboratory means of detecting Parkinson’s.
There are many defining characteristics of this disease, the most commonly know is the tremors. The symptoms include, but are not limited to: stiffness of limbs, bradykinesia (slowness of movement), difficulties with walking and balance, orthostatic hypotension (lightheadedness that may lead to fainting), sexual dysfunction, and excessive salivation as the patient swallows much less frequently. There are also metal symptoms that include depression, anxiety, cognitive impairment, and hallucinations.
As this is a neuroscience course, there has to be a neurological explanation for this right? Yes. Parkinson’s is known to be caused by the degeneration of nerves within the brain. One type of nerve affected by this is one that produce the neurotransmitter, dopamine. Dopamine, as we have learned, relays information from one part of the brain to another. Some specific structures that have been mentioned many times as I have researched this disease are the substantia nigra and the corpus striatum. The connection between these two structures is crucial for smooth, concise movement. The lack of dopamine causes impaired motor skills.
Another neurotransmitter that is shown to be affected by the degeneration of nerves is norepinephrine. This neurotransmitter is the major chemical messenger for the brain to the sympathetic nervous system (parts of the nervous system not encased in bone, which is basically everything other than brain and spinal cord.) This system controls many functions such as blood pressure and heart rate. This bit of information explains the fatigue and orthostatic hypotension.
On the more genetic side, there have been genes linked to Parkinson’s. If you care to know what these are, here you go: SNCA, PARK2, PARK7, PINK1, and LRRK2. So we know that Parkinson’s has a fondness for parks and the color pink… not trying to focus on stereotypical gender roles, but isn’t the pink thing strange considering the fact that fifty percent more men have Parkinson’s. WE ARE ON TO YOU MEN. But…. Seriously, make a mental note of SNCA as we will see him (or her) in just a moment.
Many people with Parkinson’s have shown to have Lewy Bodies in their brain. When doing a microscopic examination of the brain, these clumps of the protein alpha-synuclein show up. (Here’s where that SNCA comes in) SNCA is actually another name for the gene responsible for that protein I just mentioned, alpha-synuclein, and was actually THE first gene to be associated with Parkinson’s.
There are therapies and surgeries that people with Parkinson’s may undergo, however these don’t “cure” the patients, merely ease the symptoms. The disease will worsen as time progresses, but the gradual worsening vs dramatic worsening really depends on the individual. There could be someone after twenty(ish) years who are hardly disabled at all; at the same time, there are others who are completely disabled between five and ten years after diagnosis.

SOURCES:

http://www.patient.co.uk/health/parkinsons-disease

http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/movement_disorders/conditions/parkinsons_disease.html

http://nihseniorhealth.gov/parkinsonsdisease/whatcausesparkinsonsdisease/01.html

Bear, Mark. “The Structure of the Nervous System.” Neuroscience: Exploring the Brain. 172. Print.


Case Notes

August 5, 2014

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

 

 


Case Notes

August 5, 2014

1. We have electrical activity in the brain in order to send messages to other parts of the body.  Neurons are used to help transfer that information from the brain to other parts of the body such as the heart or lungs.

2. During a seizure, the neurons get out of control because there is too much electrical activity going on in the brain at one time.  The brain is not sure how to react, so it just goes out of control.

3. Epilepsy is a neurological disorder in which a patient has reoccurring seizures.  In order to diagnose epilepsy, a series of tests must be performed in order to be one hundred percent sure that epilepsy is the problem at hand.  Some of the primary tests include and EEG, MRI and CT scan of the brain.  This gives a closer look into the brain and what might be causing it to lose control.

4. The two main procedures for diagnosing epilepsy are and MRI and and EEG.  An EEG measures electrical activity of the brain.  There are specific patterns for abnormalities in the brain such as head trauma or seizures.  The doctor will compare the electrical waves measured from the patient and then compare it to other specific patterns.  An EEG is a painless and noninvasive procedure.  Electrodes are placed on the scalp and attached to an electrical box which will measure the brain activity after being transmitted to a computer.  An MRI is also another noninvasive procedure used for diagnosing epilepsy.  It produces a very high resolution photo of the brain and shows even more detail than a CT scan would.

5. Non epileptic seizures are caused by a few things including metabolic and physical reasons or psychogenic reasons.

6.  Based on the information already given, it seems that Jerrod could be having epileptic seizures.

7. While Jerrod is having a seizure, there are a few things to do in order to make sure everyone, especially Jerrod, is safe.  Make sure there is no furniture in the way or anything else he could possibly hurt himself on.  In addition it is important, if it is possible, to help him gently on to the floor so he does not fall, and most importantly do not try to hold Jerrod down during a seizure, as this could cause much more damage.

8. There are many safe and effective treatments for epilepsy including medication, VNS therapy, and various types of neurosurgery.

_____________________________________________________________________________________________________________

1. Rasmussen Syndrome is a neurological condition starting in children anywhere from 14 months to 14 years old.  Rasmussen is associated most often with seizures, most often partial seizures.  While this disease is rarely fatal, the effects can be very devastating.  Weakness on one side of the body, mental handicap and other symptoms most likely occur in a patient with Rasmussen Syndrome.  Anti epileptic drugs as a treatment most often does not work in patients with Rasmussen.  A brain procedure called a functional hemispherectomy can sometimes be successful.

2. Doctors can use either an MRI or EEG to diagnose Rasmussen Syndrome by viewing brain images and attempting to find brain abnormalities associated with Rasmussen’s.

3.  The left hemisphere of the brain is mainly responsible for language and communication.

4. Jerrod may have issues completing various actions, but he may as well lose short term memory ability and have difficulty with emotions after having the surgery.

5. Jerrod would retain much of his brain and functions.  He would have some muscle memory, coordination and his senses would mostly be left in tact.

6. If Jerrod was to have the surgery, his level of functioning would most definitely increase over time.

7. Are there any alternatives before going ahead with surgery?  Jerrod could try taking medication, but the surgery does have the highest percentage of working in his case.

8. I would recommend that Jerrod go ahead with the surgery.  His level of functioning would increase over time and he would have a decreased amount of seizures.  If this is left untreated, more devastating and fatal effects from Jerrod’s condition could end up occurring. If Jerrod and his family are still unsure about the surgery, they could get a second opinion and rethink the decision.

Sources:

http://www.brainfacts.org/diseases-disorders/epilepsy/articles/2012/seizures-and-epilepsy/

http://www.epilepsy.com/learn/diagnosis/diagnosis-101-basics

http://www.epilepsysociety.org.uk/non-epileptic-seizures#.U-A_wl7argI

http://www.webmd.com/epilepsy/tc/helping-a-person-during-an-epileptic-seizure-topic-overview

http://epilepsy.med.nyu.edu/epilepsy/types-epilepsy/rasmussen-syndrome#sthash.J5OXAJ2N.gbBm46ph.dpbs


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 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


Neuroscience and the Law

August 4, 2014

Currently, neuroscience technology is being developed at a faster rate than ever before. While it seems that these recent developments are designed to diagnose neurological problems or to help people overcome neurological challenges, many people do not realize the alternate use of neuroscience technology in a court of law.

In the past, polygraphs were frequently used in court, detecting changes in blood pressure, pulse, skin conductivity, and respiratory rate. Erratic changes in these measurements were thought to indicate lying. However, people can learn to keep calm to “trick” the test, rendering the polygraph inaccurate. More recently, CT scans and MRIs have been used as evidence in courts. CT scans and MRIs can show abnormalities in the brain. For example, the CT scan of the brain of John Hinckley Jr, the man to attempted to assassinate President Reagan, showed “slight brain shrinkage and abnormally large ventricles”. The defense lawyers stated that this was indicative of a mental defect, though the prosecution claimed the scans were normal. In addition, a structural MRI looks at the static structure of the brain, and has been used to diagnose disorders like schizophrenia, for example.

The most recent piece of neuroscience technology to make its way into the court is the fMRI, functional magnetic resonance imaging. The fMRI looks at areas of blood flow in the brain to detect areas of activity during cognitive control, attention, and moral decision making tests. This has been used in place of a polygraph, as it is thought that frontal lobe activity can indicate lying, in addition to activity in the areas of the brain that are involved in impulse control and decision making. Also, the fMRI has shown that the brains of psychopaths show distinct defects in the paralimbic system that controls memory and emotion. fMRI scans have been shown in court so that the defense could plead insanity. One example of this is the case of Brian Dugan, a man who had raped and murdered women and young girls. His fMRI scan was presented in court, and the defense could use it to claim that “Dugan is a psychopath and could not control his killer impulses”.

Though the fMRI seems like an accurate, reliable piece of neuroscience technology, it has far more points against it than for it. The fMRI detects activity based on blood flow, but it has nothing to do with the activity of neurons. If it cannot show or measure the firing of brain cells, how do we know that blood flow is an accurate predictor of neuronal activity? The fMRI is rarely used in diagnosis, so it cannot be used to prove that someone is schizophrenic or a psychopath, for example. A recent fMRI scan does not necessarily indicate anything about a person’s mental status at the time he or she committed the crime, so, again, in court, it cannot be used to prove that the person was experiencing a mental health episode. Most importantly, it is very difficult to interpret the results of an fMRI for one single case. When studying fMRIS, neuroscientists look at average differences between different groups of people; showing a single fMRI during a court case would be very misleading. The fMRI is in no way reliable or accurate enough, at this time, to be used in legal settings.

Some lawyers may claim that neuroscience technology should undoubtedly be used in court. It can show patterns of brain activity or brain processes that can identify a person’s altered mental state. They believe that it is scientific proof, and should be treated as any other piece of evidence. However, for this exact reason, neuroscience technology should not be used as evidence in court. It may be used to make the defense look impressive, easily misleading a jury. In addition, if members of the jury do not have an understanding of this technology, for example how one single fMRI scan is almost irrelevant, they can also be misled. Perhaps, in the future, as more neuroscience technology becomes available, and existing neuroscience technology becomes more accurate and reliable, it can be reintroduced into courts. For now, however, neuroscience technology should be left out of the courts.


Alzheimer’s Disease Research Final Project

August 4, 2014

Hello everyone!

For my final project I researched Alzheimer’s disease, which is the most common form of dementia and has always been a topic of interest to me. Despite this commonality, there is still no cure for this disease. I was interested to find out more about how the disease manifests itself, to discover the common symptoms of the disease and become familiar with the abnormalities that cause this severe memory loss. I hope you enjoy what I’ve put together!

1. Introduction to Alzheimer’s Disease

 

Alzheimer’s Disease is a neurodegenerative disease and the most common form of dementia. There is no cure for this disease, despite its discovery in 1906, but extensive research has led to many advanced in Alzheimer’s treatment and care (Alzheimer’s Association, 2014). Alzheimer’s disease progresses with time and eventually strips patients of cognitive functions. This disorder is so prominent that it “accounts for 60% to 70 % of cases of progressive cognitive impairment in elderly patients and the total prevalence of AD in the US is estimated at 2.3 million patients”(Cummings, 2002). These statistics reveal the need to continue researching this disease and work towards developing a cure.

The most difficult aspect in dealing with AD is that dementia is rarely recognized in their early stages. According to the American Academy of Neurology, mini-mental state examination is useful in detecting dementia in its early forms and should be used at check ups in populations with an increased risk of developing this disease (Folstein, 1975). Several associations have also been working to raise awareness regarding the disease in order to inform patients and their families of suspicious symptoms. “Abnormalities in learning new information, difficulty handling complex tasks, impaired reasoning ability, and changes in language or behavioral alterations” are all signs that a patient may be suffering from Alzheimer’s (Cummings, 2002). AD’s most common symptom is an “amnesic type of memory defect”. Patients suffering from this disease eventually lose the ability to recognize their own family members, or lose the ability to perform daily tasks (Cummings, 2002). AD continues to be the most researched neurodegenerative disease and the most puzzling to researchers, which are yet to determine a cure.

Through this web series, we will be finding out more about the clinical characteristics of this disease. We will discover more about the abnormalities in the brain that lead to the development of Alzheimer’s disease by looking at its molecular genetics and pathogenesis. Finally, we will also be learning about known treatments for AD and why these treatments have proved effective.

2. Clinical Characteristics of Alzheimer’s Disease

 

 

There are still no definitive laboratory tests designed in order to diagnose Alzheimer’s disease, however certain characteristics are definitely linked to the disease, which aid in determining whether a patient is suffering from AD (Harciarek and Krzysztof, 2005). The typical characteristics of AD are the loss of memory, difficulty in attaining new information or recalling vocabulary, progressive language disorder “beginning with anomia and progressing to aphasia, and disturbances of visuospatial skills” (Cummings, 2002). Alzheimer’s patients have difficulty remembering both current events and past memories due to their inability to encode and store memory. The loss of verbal information is definitely one of the defining aspects of the disease, which progressively worsens and eventually leads to the patient’s inability to communicate (Harciarek and Krzysztof, 2005).

The most commonly used tool for determining problems with verbal deficits is the Auditory-Verbal Learning Test, which is used to detect early occurrences of memory defects and speech impairments. Delayed recall of word lists or persistent evidence of short-term memory loss are all indications that the person may be exhibiting early signs of AD (Harciarek and Krzysztof, 2005). However, there is evidence to suggest that patients with AD will have perfect recollection of old memories, which often cause family members to believe that the patient could not be suffering from a memory problem.

Patients with Alzheimer’s disease are also known to suffer from personality disorder and sudden shifts in emotions. There are a variety of behavioral symptoms that can be seen even in the early stages. These include neuroticism, which essentially means that the patient suffers from intense stress, and sudden mood swings (Gilbert and Herbst, 2014).

Neuropsychiatric symptoms are also very common in Alzheimer’s disease. Patients tend to exhibit diminished interest for past hobbies or people, and reduced concern for previously important aspects of their lives (Cummings, 2002). AD patients also become increasingly agitated in situations with high stress and often display depressive symptoms. In fact, about 50% of AD patients also experience depressive symptoms, and as many as 25% also experience delusions (Cummings, 2002).

Finally, motor system abnormalities are common symptoms of the disease. These symptoms are absent in the early years of AD, so they cannot be used in order to diagnose the disorder. However, in the final years of the disorder, patients suffer from focal abnormalities, gait changes or even seizures. Motor system abnormalities are so severe that most patients die 7 to 10 years after the symptoms begin to manifest (Cummings, 2002).

All of these symptoms are caused by abnormalities in the brain. We will continue by investigating the molecular genetics of Alzheimer’s disease in order to determine the reasons for this disease.

3. Molecular Genetics and Pathogenesis of Alzheimer’s Disease

 

A pathological diagnosis of Alzheimer’s disease requires the presence of neuritic plaques and neurofibrillary tangles that are abnormal in a healthy individual. Neuritic plaques (or senile plaques) are extracellular deposits of beta amyloid in the gray matter of the brain, which are often associated with degenerative neural structures (Cummings, 2002). Neurofibrillary tangles contain helical filaments of abnormal tau protein that extend into the dendrites. It is the primary marker in Alzheimer’s disease (Cummings, 2002).

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Mutations in the brain are also causes of Alzheimer’s disease, and they are valuable in studying the disorder. Mutations in the amyloid precursor protein (APP gene) and the presenilin 2 gene are responsible for the development of the disease. The amyloid protein is deposited in the neuritic plaques. The accumulation of amyloid initiates events contributing to cell death, tangle formation and inflammation (Cummings, 2002). These contribute to the degeneration of the neuronal axon and the loss of synapses, which in turn contribute to neurotransmitter deficits. These are all the main causes of Alzheimer’s disease, and researchers look for these irregularities in order to diagnose the disease.

Researchers such as Gregory and Hodges discovered that the progressive amnestic disorder in Alzheimer’s disease happens because of the breakdown of attentional, perceptual, and visuospatial abilities. “This is due to the breakdown in the structure of semantic memory. These statements are supported by several experiments testing the absence of general knowledge and deficiencies in sensory input and output (Gilbert and Herbst, 2014).

4. Known Treatments for Alzheimer’s Disease

 

 

Although there is no cure for Alzheimer’s disease, there have been many treatments that have proven to be effective either in preventing AD or changing the course of the disease when caught in its early stages. These treatments are administered only with the consent of the patient and their family, and mut reflect their values and needs. There are many therapeutic strategies available, as well as disease-modifying treatments.

One of these treatments is known as cholinesterase inhibitors, “which are the only approved medications approved by the US Food and Drug Administration as treatment for AD” (Cummings, 2002). This treatment is considered standard therapy for patients. There are four inhibitors available: tacrine, donepezil, rivastigmine and galantamine. These inhibitors have been proven to produce improvements in cognition, reduction in behavioral disturbances, and stabilization of daily activities (Cummings, 2002). However, although this treatment is widely used and appreciated, some patients do not respond to it. This is because Alzheimer’s disease is known to differ greatly in every individual.

Another treatment is the reduction of amyloid production, which as we learned in the previous section is one of the main reasons for the development of Alzheimer’s disease. Excess production of amyloid leads to the degeneration of the neuronal axon, so reducing amyloid production or removing it “addresses the basic pathophysiology of AD” (Cummings, 2002).

There are other treatments such as hormonal and psychotropic. Hormonal treatments help with the prevention of Alzheimer’s disease, while psychotropic treatments help with the management of behavioral disturbances. Treatments using selective serotonin are used to manage the depressive symptoms of AD (Cummings, 2002). Again, not all patients respond to these treatments, but they have been effective.

The effectiveness of these treatments is determined through placebo-controlled trials in order to determine whether the medication has positive effects in the patients. The most important aspect of curing Alzheimer’s disease is getting tested sporadically in order to be able to detect the disorder at an early age. Dramatic progress has been made in developing treatments for this disease, however none of the therapies are even close to 100% effective. In addition, the advances have had no impact on the prevalence of AD thus far, which continues to be a major global issue (Cummings, 2002). Researchers worldwide are continuously researching Alzheimer’s disease and trying to determine a clinical or therapeutic cure for it.

Citations:

“Alzheimer’s & Brain Research Milestones | Research Center | Alzheimer’s Association.” Alzheimer’s Association. N.p., n.d. Web. 28 July 2014.

Cummings, J. L.. “Alzheimer Disease.” JAMA: The Journal of the American Medical Association 287.18 (2002): 2335-2338. Print.

Cummings, Jeffrey L.. “Alzheimer Disease.” The Journal of the American Medical Association. N.p., 8 May 2002. Web. 28 July 2014. <http://jama.jamanetwork.com.revproxy.brown.edu/article.aspx?articleid=194892>.

Dash, Paul, and Nicole Pittman. Alzheimer’s disease. New York, N.Y.: Demos, 2005. Print.

Folstein MF, Folstein SE, McHugh PR. Mini-mental state.  J Psychiatr Res.1975;12:189-198.

Gilbert, T., and M. Herbst. “Alzheimer’s disease: charting the crossroads between neurology and psychology.” Journal of Neurology, Neurosurgery & Psychiatry 85.2 (2014): 133-134. Print.

Harciarek, Michal, and Krzysztof Jodzio. “Neuropsychological Differences Between Frontotemporal Dementia and Alzheimer’s Disease: A Review.” Neuropsychology Review 15.3 (2005): 131-145. Print.

 

 


Neuroscience in the Law

August 4, 2014

In court, one of the biggest obstacles to justice is this: you can’t tell whether someone is lying. If somebody says they didn’t kill the victim, do you believe them? If somebody pleads insanity, do you really know that they are insane? This is why some courts have turned to brain technology to try to answer some of these questions.

Numerous types of brain technology have been used. In 1982, the CT (X-ray) scan of John Hinckley Jr. showed abnormally sized portions of the brain, which may have indicated a mental defect. In the 1990’s, neuroscientist Ruben Gur developed algorithms, with limited (around 80%) accuracy, that could use positron emission tomography and structural MRI to test for schizophrenia or brain damage.

The main type of brain technology currently being debated by the courts is known as fMRI, or functional magnetic resonance imaging. First, you place the person’s head inside an MRI scanner, which contains a large donut-shaped magnet. When the person does a particular action, such as talking, the parts of the brain associated with talking will experience increased electrical activity. When this happens, more oxygenated blood will be sent to that part of the brain. Because of the MRI’s magnetic field, the protons in the blood are spinning. However, protons in oxygenated blood spin more slowly than protons in non-oxygenated blood. Thus, when oxygenated blood is sent to active parts of the brain, the scanner can detect the change in the protons’ spin. The scanner is continuously measuring the spin in all areas of the brain, and it uses this information to generate a continuous picture. When parts of the brain have slower spinning protons, this shows up in the image as a bright, fluorescent area. Therefore, the fMRI allows you to tell which parts of the brain are being used when a person does a particular activity or receives a particular stimulus.

Down the road, if scientists are able to link patterns of brain activity with certain states of mind, neuroscience will be an invaluable tool to look into the thoughts of court witnesses. One scientist trying to accomplish this is Kent Kiehl, a neuroscientist who collects brain data on psychopaths. He has noticed distinguishing traits in the brain of a psychopath: certain distinct defects in the paralimbic system of the brain. He has amassed a lot of data and noticed average differences in the brains of certain special populations. This data definitely has an application, because, if you fMRI scan a witness and see that his brain has certain traits (e.g abnormal thinness in the areas involving empathy), you know that he has a higher statistical probability of being a psychopath. People complain that the fMRI is still primitive, and thus unreliable in these types of situations. But then again, almost every piece of data has a measure of unreliability to it. The standards of reliability/admissibility in a courtroom are lower than the standards in a scientific lab.

Another application of the fMRI is in lie detection. According to Stanford researchers: under controlled experimental conditions, and with certain complex algorithms, fMRI data can be used to tell whether individuals think they are lying or telling the truth. Lying activates brain regions involved in suppressing information and resolving conflicts. By averaging a set of fMRI data on a particular individual, the fMRI can also tell whether the person tends to lie more often or tell the truth more often. Accusations against the integrity and character of a witness are important to consider, and they are admissible in the courtroom.

However, the fMRI has come under intense controversy for its uses in the courtroom, and for good reason. One chief complaint of scientists testifying against fMRI use is that fMRI technology is still relatively crude and primitive. It’s slow, taking two or three seconds to scan the entire brain once. This also introduces the aspect of luck into fMRI use. Researchers once used the fMRI to find brain activity in a dead salmon. This demonstrates the risk of measuring false positives due to just the neural noise in the brain. This also highlights the crudeness of the fMRI. Voxels (3-d pixels) in the image are large. fMRI is also crude because you’re not actually measuring the electrical activity of neurons. You’re really just measuring oxygenated blood levels in different general areas of the brain. This is thought to be correlated with neural activity, but obviously it cannot be a 100% correlation. In addition, the data you compile of certain witnesses may not even be applicable. If you are screening a defendant for psychopathy, their brain may have changed significantly in the time since they committed the crime. This is especially true for people whose cases are brought up in court decades after they actually committed the crime.

fMRI is rarely used in diagnosis of disease for the same reasons that fMRI should not be used in the courtroom. Most fMRI studies are small and unreplicated, so the body of data is quite limited. And, fMRI studies only compare average differences in brain activity in groups. For instance, they say: on average, psychopaths have lower brain activity in these certain regions than non-psychopaths. However, the groups “people with regular brain activity” and “psychopaths” are not mutually exclusive. It is impossible to scientifically ascertain that one particular person is a psychopath because he has lower brain activity. Also, psychopaths have complicated, varying symptoms. Some psychopaths share neurological responses to people with damaged medial temporal lobes. If an unscrupulous scientist picked up on that in an fMRI, he might label somebody as a psychopath when really, they only had a concussion or some type of brain damage. It’s the same with lying. If a scientist witnessed increased brain activity in lying-related areas, he might conclude that the witness was lying when really, he was just thinking hard about not lying.

In short, additional research is needed before fMRIs can be used to make specific conclusions about people’s brains. Overall, there is such a wide range of symptoms, like neurological responses and abnormal connections, in different groups of people. There are many exceptions, overlaps, and lurking variables in the data. This makes the data very “hazy”. Only more research and more careful studying of the finer details of the brain can pave the way for fMRI to be a viable technology in the courtroom. Since imprecise data has the potential to inaccurately bias juries, the prejudicial detriments of fMRI technology outweigh the probative benefits.


Case Notes

August 4, 2014

 Part 1:
There is constantly some form of electrical activity in the brain as this is how neurons are able to communicate with each other. As electrical impulses are conducted down the axon away from the cell body of the neuron (the soma), the axon generates an action potential (causing the release of a particular neurotransmitter across the synapse). During in a seizure, the brain becomes “hyperactive”, meaning that the action potentials fired by the axons of the nerve cells are disproportionately higher in magnitude than what would be considered a normal level of activity. These sudden bursts of electrical activity results in a loss of control of all voluntary behaviours or movements. Epilepsy is classified a neurological disorder in which the individual experiences recurrent episodes of these kind of unpredicted seizures, or convulsions. Epilepsy can develop at any time during your life, at any age. Despite this, the disorder is most commonly seen in young children and in older people.

Epilepsy is a very difficult disorder to diagnose quickly, since signs of the disorder greatly overlap with the symptoms of many other neurological disorders, making it difficult for doctors to distinguish between them. The nature of the seizures, frequency, sensation before the seizure, whether or not the individual experienced any warning signs etc. are all vital pieces of information to the doctor in making a diagnosis. In most cases however, it is likely that further tests (such as an EEG or an MRI) will be necessary. An EEG uses electrodes placed on the scalp to record your brain’s electrical activity, and is able to detect abnormality in neural activity, or “epilepsy waves”. Since abnormality of the brain’s activity can be a sign of a number of other disorders, Epilepsy is categorised by the electrical “waves” spreading over both sides of the brain. Alternatively, an MRI scan produces an image of the brain’s structure, rather than directly measuring the brain’s signals. The procedure lasts anywhere between 15- 90 minutes, and requires the individual to lay on a motorised bed within an open-ended cylinder, while the magnetic field produces a detailed image of your brain. Use of the magnetic field means it is vital to remove all metal objects from your body, including watches/jewellery.

Non- Epileptic seizures have a range of different causes, from low blood sugar, to psychological distress (causing the function of the heart to become irregular).Based on the given information, I believe Jerrod appears to be affected by Epileptic seizures, since they are so unpredicted, and the normality of his lifestyle would rule out seizures induced by psychological distress. His young age would also indicate the likelihood of Epilepsy.

 Unfortunately the only way of helping Jerrod during a seizure would be to reduce the  risk of possible injury by putting something soft and supportive under the head, and making sure he is in a clear space. It is also important to wait for the seizure to pass before attending to the child. The type of treatment given for Epilepsy is typically tailored to the frequency and severity of the experienced seizures, as well as by the age of the individual. However, anticonvulsant drugs is the most common form of treatment for this disorder. Classic examples of medication used include Valium and Zarontin. Such medication can successfully control seizures in about 70% of patients. In more severe cases,  brain surgery may be required. Some diets and vitamin supplements  (in large doses) have been found to help those suffering from Epilepsy.


Part 2:

 Rasmussen syndrome is a rare, inflammatory neurological disorder most common between 14 months, to 14 years of age, and is associated with the rapid deterioration of one hemisphere of the brain (causing irreversible damage). The associated symptoms of Rasmussen syndrome include frequent, severe seizures (caused by the irregular function of the brain cells), which can in turn lead to the weakness of the side of the body affected by the seizures. There is no consistent prognosis for this disorder, with a great deal of variation from child to child. Unfortunately, most children affected by the disorder are left with partial paralysis, and suffer from problems with their speech. However, it has been known in some cases that only mild impairments have been experienced. Using an EEG, doctors were able to identify the seizure activity of Jerrod’s brain, noted by the particular pattern of “spikes” obtained from the results. From this the doctors were able to determine that only part of Jerrod’s brain was affected by the seizures (which is characteristic of Rasmussen syndrome). By using an MRI scan,  it  was possible to locate the precise area of the brain affected by the seizures, as well enabled doctors to identify the extent of the damage to the left hemisphere of Jerrod’s brain. Combined, this allowed for an accurate diagnosis.

During a hemispherectomy, structures of the left hemisphere that would be removed from Jerrod’s brain include the left temporal lobe, part of his left frontal lobe, as well as some areas in his parietal and occipital lobes if necessary. This radical surgery could possibly affect Jerrod’s short term memory, speech and hearing, as well as his judgement and decision making. If his parietal and occipital lobes are disturbed during the surgery, he could possibly experience some visual problems. Jerrod’s adaptive skills may be one significant area of change to his behaviour, which could potentially impact his social interactions with friends. However, since the thalamus, hippocampus and amygdala will remain intact, it is likely that Jerrod would not experience paralysis, while retaining sensations and spatial sense. In addition, his long term memory is likely to remain intact. Following this radical surgery, roughly 85% of patients report significant improvement to their seizures, and in about 60% of cases, their seizures will be completely eliminated.

To enable the best outcome of this surgery, Jerrod’s family could help him by taking him to rehabilitation/ speech therapy, to limit the effects of the hemispherectomy on his speech (following his discharge from hospital). If Jerrod had this surgery, I believe that his functioning would get better, and would not be so debilitated by his seizures (thus affecting his overall quality of life, not just the frequency of his seizures). One question to bare in mind about this surgery is the likelihood that the child will remain dependent on their medication, which has been  investigated by a study at John Hopkins Children’s Center. Their study showed that almost all children no longer required their medication, and were able to lead a close to normal life.

Based on these outcomes, I think that proceeding with Jerrod’s surgery would be the best option for both Jerrod, and his family, by eliminating the distress of their day to day lives. Without surgery, it is inevitable that his condition will deteriorate, and is extremely likely that his brain would be damaged further by his seizures.