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


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).

12

 

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.

 

 


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


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.