Case Study Analysis

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Keiser University *

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Psychology

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Dec 6, 2023

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Uploaded by AgentPowerSparrow30

1 Case Study Analysis Adlih Rodriguez Keiser University Pembroke Pines Campus Behavioral Neuroscience (PSY3309GP4-104032023 Professor Dominguez April 16, 2023

2 Case Study Analysis Part I Why is there electrical activity in the brain? Describe how it is used by neurons. The brain uses rapid electrical impulses, described as electrical activity, to allow the brain to communicate within itself. This process emphasizes our behaviors, thoughts, and even our perceptions of the world. The neurons in the brain use these electrical impulses to not only receive, but also send information throughout the body. When a neuron is stimulation by the brain’s electrical impulses, and action potential is launches, thus enabling the signals to travel to the axon terminal with rapid force (Abdellah, 2016). What happens in the brain during a seizure? When the brain experiences a seizure, there is an abruptly powerful eruption of electrical activity that interrupts how the brain normally works. This electrical activity can occur in a miniscule part of the brain, normally lasting for a few seconds, or it can also be widespread throughout the whole brain, causing it to be ongoing for several minutes. During a seizure, the way neurons normally fire change. What this can lead to is multiple neurons electrically pulsing at the same time. Due to this extreme electrical activity, the messages neurons send can be jumbled, causing other symptoms like uncontrollable movements, changes in behavior and emotion to accompany seizures ( What happens in your brain during a seizure?, 2020). What is epilepsy? How is it diagnosed? In the world, Epilepsy is the fourth most common neurological disorder. Epilepsy is a brain disorder which causes the brain to have recurrent, motiveless seizure. If a person presents

3 with two unprovoked seizures, or one unprovoked seizer with the risk of more, a physician may diagnose a person with epilepsy. To do so, a doctor will evaluate their medical symptoms, condition, and history. There might be a multitude of tests which will be done to diagnose epilepsy. These tests include a neurological exam, which tests a person’s abilities, behaviors, and mental functioning. There might also be blood tests to check for any infection, or genetic conditions that can be causing the seizures ( What is epilepsy?, n.d). What are the procedures for doing an EEG test and MRI scan? What type of information does each of these tests provide? The procedure for an EEG is as follows: The person receiving the EEG will be asked to lie on a bed, approximately between 16 and 25 electrodes will be attached to their scalp, with either a paste or a cap, then they will be asked to close their eyes, relax, and be as still as possible. The testing will then commence, and the patient must be as still as possible. When the initial recording is done, the physician may provide multiple stimuli to see how the brain wave activity changes during each presentation of stimuli. This examination can last anywhere from 45 minutes to two hours. An EEG is about 100 pages of electrical brain activity, which will show basic waveforms of the brain, and any sudden but brief bursts of energy in the brain, whether in response to stimuli or lights. EEG are used to diagnose and evaluate multiple different brain disorders ( Electroencephalogram (EEG), nd.). The procedure for an MRI is as follows: The patient will be asked to remove any clothing, jewelry, glasses, hearing aids, or anything that might affect the procedure. Then the patient will lie on a scan table that slides them into a large circle opening of the scanning machine. The MRI tech will give the patient earplugs or headphones to help remove the noise from the MRI scanner, while still allowing them to communicate with the patient in the form of

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4 speakers. During this examination the patient must remain very still being that the MRI creates pulses of magnetic radio waves, creating a loud clicking noise. An MRI is a noninvasive medical test which uses magnets and radio waves to create images of the body. MRIs are used to differentiate soft tissues among themselves, as well as abnormal and normal soft tissue ( Magnetic Resonance Imaging (MRI), 2021). What are some possible causes of seizures other than epilepsy? Non-Epileptic Seizures (NES) are seizures not caused by epilepsy. NES are normally a form of psychological or neurological seizures. Attention issues, anxiety, mood, dissociative, or personality disorders, psychosis, PTSD, physical, emotional, or sexual abuse, family conflict, substance abuse, TBI (Traumatic Brain Injuries), or behavioral disruptions can all be associated and possible causes of NES (Akers, 2021). Based on the information in the case, what type of seizures does Jerrod appear to be having? Jerrod stares blankly, moving his head slightly back and forth, and could not respond to his parents. The information provided might show that Jerrod is suffering from Absence Seizures. Absence seizers trigger gaps in consciousness, causing the patient to stare for moments at a time and not recall the manifestation of the seizure. Complex Absence Seizures cause involuntary movements as well as the “staring spells” (Abdellah, 2016). What should you do during a seizure to help Jerrod? When Jerrod experiences a seizure, the first thing that should be done is keep him in a safe place, being that he might become confused and disoriented. Then, any dangerous objects he might have in his hands should be taken away. If Jerrod is near any body of water, or in any

5 dangerous activity, he should be removed. If there is any action plan for this seizure in place, it must be followed (Sirven & Shafer, n.d). What are some treatments for epilepsy? Epilepsy might be treated with medication. There are anti-seizure medications that can allow a person suffering from epilepsy to be seizure-free. Surgery is another treatment for epilepsy. If the area of the brain that is being attacked by the epilepsy is small, well-defined, and not interfering with vital functions of the body, it might be removed through surgery. Four therapies have been found to treat epilepsy including: Vagus Nerve Stimulation, which is when a doctor implants a vagus nerve stimulator under the skin of the chest, and it sends electrical energy through the vegus nerve into the brain. The ketogenic diet, which is high in fat and low in carbohydrates can also be used to treat seizers, since the body will break down fats for energy instead of carbohydrates. Deep brain stimulation can be done by surgically implanting electrodes into a specific part of the brain and with connection to a generator placed on the check, is send regular electrical impulses to the brain. Lastly is the responsive neurostimulation, which is pacemaker-like devices which can analyze brain activity to detect seizures when the begin and deliver either electrical impulses or drugs to that part of the brain which stops the seizures before it impairs the person (Wong-Kisiel, 2021). Part II What is Rasmussen Syndrome? Rasmussen syndrome is also known as Rasmussen Encephalitis, which is a rare disorder located in the central nervous system. It is known to cause chronic inflammation of one of the

6 cerebral hemispheres. When a patient has Rasmussen’s encephalitis, they normal experience episodes of uncontrolled electrical activity in the brain that causes epilepsy, as well as progressive destruction of the brain. This syndrome causes, with time, weakness of one side of the body, language developmental problems, and intellectual disorders (Mathern, 2023). What structures or abilities of the brain are concentrated in the areas of the left hemisphere that would be removed in the hemispherectomy? It is said that the left side of the brain controls logic, science, sense of time, and language. If a left hemispherectomy is done there might be potential damages to the language function of the brain. If a left side hemispherectomy is done when older, the possibility of not being able to talk is high. However, if done at a younger age, the brain is still “plastic” enough to develop the missing language skills on the right side of the brain (Grey, 2019). Other than reducing his seizures, how else might Jerrod’s thinking or behavior be affected by losing these parts of his brain? If Jerrod were to lose the left hemisphere of his brain, he could potentially loose his language abilities, which include fully talking and listening. He might also lose his logical sense, and sense of time. If his left temporal lobe is removed, his memory can be affected. If a portion of his left frontal lobe is removed, his cognitive and motor abilities would be compromised. If a portion of his parietal lobe is removed, he could lose some of the responsible part of the brain for sensory processing. Lastly, if a portion of his occipital lobe is removed, he might lose his vision, or his way of viewing items, and even words (Mandybur, 2021). What types of abilities would he still retain, because the brain structures would remain intact?

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7 Since Jerrod’s hemispherectomy is for the left side of his brain, he would maintain intact his right side of the brain, which controls the left side of the body. The right side of the brain focuses on intuition, how words are spoken, creative thoughts involving but not limited to music, estimation, memory, and even his warm climate survival (Figueroa, 2017). What might the family do to help Jerrod recover after such a surgery? Once a hemispherectomy is done, the patient will first be in the ICU for about two days, and then in the hospital for another four days. His family would help him get back to hospital in about 14 days to have the stiches removed. The recovery time for hemispherectomies is about six to eight weeks, in which this time Jerrod can experience headache, forgetfulness, tiredness, nausea, and even puffy eyes. They must also remind Jerrod to take his seizure medication at the request of his doctor, which might be for the next two years. They should also remind Jerrod to take any medication prescribes by the doctor for pain and infections ( D'Arrigo, 2021). If Jerrod had the surgery, would his level of functioning get better, worse, or stay the same over time? If Jerrod had the left side hemispherectomy, his language skills would worsen. His logical and sense of time might also worsen. His memory, cognitive and motor abilities would worsen. Lastly his sensory and vision might also worsen. His seizures, dependent on how much of the seizure inducing parts of the brain were successfully removed could get better. Therapies can aid in his recovery of lost skills (Abdellah, 2016). What other kinds of questions would you have about the surgery? Can you find the answers? Question: What is the success rate of a hemispherectomy?

8 Answer: About two-thirds of children who have hemispherectomies are completely seizure-free, and another 15-20% have a very substantial reduction in the seizures they experienced prior to the surgery ( Cleveland Clinic medical professional, 2020). What decision do you recommend the family? Why or why not go ahead with surgery? Based on the conversations with the Doctors, the medicines they are currently providing Jerrod are not working and his brain is becoming damaged by the seizures. If there are no more medicines left to try, the surgery would be the only way for the sections of the brain that are seizing the be removed, and the damage to be halted. This surgery, based on research, has a high probability of success, and if nothing is done his left hemisphere of the brain is going to continue to incur damage; damaging everything that the left hemispherectomy is going to remove anyhow.

9 References Abdellah, S. (2016, August 24). Neuroscience in action: Understanding our brains and nervous systems . Neuroscience in Action Understanding our brains and Nervous systems. Retrieved April 17, 2023, from https://blogs.brown.edu/sarahabdellahneuroscience/2016/08/24/case- study-epilepsy-and-split-brain/ Cleveland Clinic medical professional. (2020, December 14). Hemispherectomy: What is it, Definition & Recovery . Cleveland Clinic. Retrieved April 17, 2023, from https://my.clevelandclinic.org/health/treatments/17092-hemispherectomy D'Arrigo, T. (2021, July 26). Functional hemispherectomy for epilepsy: What happens, recovery . WebMD. Retrieved April 17, 2023, from https://www.webmd.com/epilepsy/guide/functional-hemispherectomy Electroencephalogram (EEG) . Electroencephalogram (EEG) | Johns Hopkins Medicine. (2021, August 8). Retrieved April 17, 2023, from https://www.hopkinsmedicine.org/health/treatment-tests-and- therapies/electroencephalogram-eeg Figueroa, E. (2017, July 8). What's the difference between the right brain and left brain? YouTube. Retrieved April 17, 2023, from https://www.youtube.com/watch? v=Xe817Aj-mgM

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10 Grey, H. (2019, November 26). Here's what happens when you remove half your brain . Healthline. Retrieved April 17, 2023, from https://www.healthline.com/health-news/heres- what-happens-when-you-remove-half-your-brain#Younger-brains-are-more-plastic Magnetic Resonance Imaging (MRI) . Magnetic Resonance Imaging (MRI) | Johns Hopkins Medicine. (2021, December 6). Retrieved April 17, 2023, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/magnetic- resonance-imaging-mri Mandybur, G. (2021, January). Epilepsy surgery, temporal lobectomy, vagus nerve stimulation: Cincinnati Ohio Mayfield brain & spine . Temporal lobectomy, Vagus Nerve Stimulation | Cincinnati Ohio Mayfield Brain & Spine. Retrieved April 17, 2023, from https://mayfieldclinic.com/pe-epilepsysurg.htm Mathern, G. W. (2023, February 8). Rasmussen encephalitis - symptoms, causes, treatment: Nord . National Organization for Rare Disorders. Retrieved April 17, 2023, from https://rarediseases.org/rare-diseases/rasmussen-encephalitis/ Sirven, J., & Shafer, P. O. (n.d.). First aid absence seizures . Epilepsy Foundation. Retrieved April 17, 2023, from https://www.epilepsy.com/recognition/adapting-plans/first-aid- absence-seizures Sparks Akers, A. (2021, June 30). Nonepileptic seizures: Symptoms, causes, treatment, and tips . Medical News Today. Retrieved April 17, 2023, from https://www.medicalnewstoday.com/articles/non-epileptic-seizures#causes

11 What happens in your brain during a seizure? Epilepsy blog. (2020, June 5). Retrieved April 17, 2023, from https://www.epsyhealth.com/seizure-epilepsy-blog/what-happens-to-the-brain- during-a-seizure What is epilepsy? Epilepsy Foundation. (n.d.). Retrieved April 17, 2023, from https://www.epilepsy.com/what-is-epilepsy Wong-Kisiel, L. (2021, October 7). Epilepsy . Mayo Clinic. Retrieved April 17, 2023, from https://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/drc- 20350098

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