CASE STUDY: EPILEPSY AND SPLIT BRAIN

Part I: Jerrod and Jump

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

Electrical activity is used in the brain in order to fire electrical impulses to communicate with each other. Neurons use electrical signaling to receive and send information. When a neuron is stimulated, an action potential is fired, which enables the message signals to travel rapidly down the axon terminal.

  • What happens in the brain during a seizure?

A seizure first occurs when there is a disruption in the pattern of the electrical communication system in the brain. This causes neurons to fire off action potentials simultaneously at an extremely accelerated pace. The brain cannot properly compute these ‘mixed messages’, thus a seizure takes place.

  • What is epilepsy? How is it diagnosed?

Epilepsy is a brain disorder in which a person has recurring seizures. Doctors use brain scans, such as an EEG, in order to diagnose epilepsy.

The procedures for conducted an EEG is to attach small electrodes onto the scalp of the patient, which record the electrical activity in the brain, as the actual EEG machine records that information as a series of squiggles, traces. The procedure for an MRI scan is first to remove all metallic objects, then lie in a motorized bed that moves inside of the scanner, in this case you would enter head. A computer is used to operate the MRI scanner by a radiographer in a different room. While in the MRI scanner, you must keep still throughout the entire duration of the scan to receive the most accurate results.

  • What are some possible causes of seizures other than epilepsy?

A cause of Organic non-epileptic seizures (NES) includes a physical cause such as diabetes. Causes of Psychogenic NES include response to frightening or stressful situation (major accidents, psychological stress, abuse, etc). Other plausible causes include drug use, brain injury, withdrawal, stroke, and poison.

  • Based on the information in the case, what type of seizures does Jerrod appear to be having?

Based on the information in this case, I believe Jerrod exhibits the symptoms of having an Absence Seizure since he during his seizures he ” stared blankly, moving his head slightly back and forth, and for a minute or two could not respond to his parents. When the seizures ended, Jerrod had no memory of them”. Absence Seizures cause lapses in awareness, such as staring as well as not remember the occurrence of the seizure. Moreover, I would specifically diagnose Jerrod with Complex Absence Seizures since he makes an involuntary movement, shaking his head back and forth, during the seizure. Furthermore, Absence Seizures are most common in children.

  • What should you do during a seizure to help Jerrod?

During an Absence Seizure, you should make sure that his body is not in harm’s way. This could be done by placing him on a couch and blocking it off so that he does not fall off.

  • What are some treatments for epilepsy? 

Treatments for epilepsy include medication, surgery (to remove a portion of the brain or implant devices such as a vagus nerve stimulation- VNS), and a ketogenic diet, which is a high fat, low carbohydrates died used frequently for children who did not respond to medical therapy.

Part II: A Difficult Decision

  • What is Rasmussen Syndrome (what are its history, symptoms, prognosis, etc.)?

Rasmussen Syndrome is associated with progressive neurological issues and seizures in children. Rasmussen’s Syndrome can become present from 14 months old to 14 years old. Symptoms include seizures, mild weakness in the arm or leg, deteriorating thinking/memory (hemiparesis) or language problems (aphasia). The prognosis of the disease is quite limited since seizure medications do not have much of an effect, anti-inflammatory steroids need more studies to prove their effectiveness. Immunologic therapies (globulin, gamma, rixtuximab, or plasmapheresis). In most cases, the surgical procedure called functional hemispherectomy is used for children in which one cerebral hemisphere is removed from the brain.

  • How did the doctors use EEG and MRI to help diagnose the disorder?

Doctors use EEGs to help diagnose Rasmussen Syndrome by tracking the electrical activities. The EEG then shows which area of the brain demonstrates seizing activity, which can be used to show that there, are partial seizures, which in turn prove that the child has Rasmussen Syndrome. An MRI can be used by doctors to help diagnose the disorder so observe the abnormalities it the brain due to the seizures. Where there is more damage on a certain side of the brain, the doctor could infer, with further testing, that the patient presents symptoms of Rasmussen Syndrome.

  • What structures or abilities of the brain are concentrated in the areas of the left hemisphere that would be removed in the hemispherectomy?

Abilities of the brain that are in the left hemisphere of the brain that would be removed in the hemispherectomy would be analytic thought, logic, language, reasoning, and science and mathematics skills.

  • Other than reducing his seizures, how else might Jerrod’s thinking or behavior be affected by losing these parts of his brain?

Other than reducing Jerrod’s seizures, his behaviors and thinking patterns would be slower compared to other children his age since the left hemisphere of the brain, which is associated with logic, reasoning, and language would be removed during the hemispherectomy.

  • What types of abilities would he still retain, because the brain structures would remain intact?

The abilities Jerrod would retain would be his senses: sight, taste, smell, touch, and hearing; art awareness and creativity; musical awareness; and imagination.

  • What might the family do to help Jerrod recover after such a surgery?

After Jerrod’s surgery, his family should support through his recovery by aiding him with his necessities as well as sending him to the doctor’s to check on his status as well as attend therapy, possibly for speech if it is impaired.

If Jerrod had the surgery, would his level of functioning get better, worse, or stay the same over time?

If Jerrod had the surgery, the abilities, such as language and reasoning, found in the left hemisphere of the brain would decrease since that portion of the brain would be removed. However, it is possible that after therapy, his level of functioning could improve.

  • What other kinds of questions would you have about the surgery? Can you find the answers?

Question: How soon do other neurological issues and weaknesses in the patient occur?

Answer: Weaknesses on one side of the body and intellectual dysfunction often begin 1 to 3 years after the start of the seizures.

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

  • What decision do you recommend to the family? Why or why not go ahead with surgery?

I would recommend the family to go through with the surgery since it is the best treatment option for Rasmussen Syndrome. If there were no treatment, then Jerrod’s left hemisphere of the brain would just become more inflamed and deteriorate, causing more seizures and more irreversible damage in the brain. The surgery could help improve his situation, whereas there is no room for improvement without treatment.

Official Original Post: https://blogs.brown.edu/neuroscience2016sec1/2016/08/04/case-study-epilepsy-and-split-brain/

 

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