Date
of Scan: 24 March 2010
Ref.: 128564
MRI Report – Head – 27738
Indication: Symptoms related to epilepsy
Technique: T1 sagittal, dual echo axials, T1 volume
acquisition to the temporal lobes, coronal FLAIR, axial FLAIR scans were
undertaken
Findings: The ventricles are of normal
shape, size and disposition for a patient of this age. The slight asymmetry of the lateral ventricles
is within the limits for normal variable.
The grey and white matter distribution remains normal. Normal flow void is noted within the
intracranial circulation. Coronal images
through the temporal lobes fail to show any convincing evidence of mesial
temporal sclerosis or of any focal pathology here. The craniocervical junction is normal.
Many
thanks and kind regards.
Yours sincerely,
Dictated but not signed to avoid
delay
*
* *
…the disease
called Sacred: it appears to me to be nowise more divine nor more sacred than
other diseases, but has a natural cause from the originates like other
affections. Men regard its nature and cause as divine from ignorance and
wonder, because it is not at all like to other diseases. And this notion of its
divinity is kept up by their inability to comprehend it. – Hippocrates, The
Sacred Disease – 400 BC
Epilepsy is a term that
covers a range of neurological disorders which disrupt the electrical activity
of the brain and bring on spontaneous seizures.
A seizure occurs when the neurons in the brain begin to fire large
bursts of electricity and ends when the inhibitory mechanisms of the brain
regain control.
A convulsive attack is caused by a
generalised secondary seizure, these can be classified as atonic, tonic, clonic, tonic-clonic and myoclonic. Tonic-clonic, often referred to as ‘grand
mal’, affects the whole of the brain, causing sudden loss of consciousness
followed by the rapid contraction and relaxation of the muscles, which causes
the spasms associated with epilepsy.
I'm going to begin
by asking you to stretch out your arm at full length and tighten the muscles as
hard as you possibly can. Do you see your arm begin to shake? Now imagine every
muscle in your body contracting at the exact same time as hard as it possibly
can. Now that my friend is what a convulsive seizure is like. – Kelley Quinn: 07/01/08
Convulsive seizures usually last for no more than
a few minutes. The individual is likely
not to remember the seizure, having been unconscious, and their consciousness
may not return fully for some time. The after
effects include disorientation, aching muscles (particularly in the jaw which
locks shut during the attack), severe nausea and headaches, and long or
short-term memory loss.
I come around after a seizure I hurt, my mouth
is bleeding, sometimes I break bones…I feel very depressed…I think that’s the
worst part of it all. –
jerrytom: 20/12/2006 – 9:07pm
40% of epileptic cases
are due to a physical abnormality in the brain, such as a tumour or a scar
resulting from an accident. 60% of
sufferers have idiopathic epilepsy, with no apparent damage or abnormalities in
their brain, the seizures are spontaneous and the condition is thought to be
genetic. A seizure can be brought on,
even in a successfully medicated patient, by a single forgotten pill or unusual
circumstances such as excessive stress, be it emotional or physical.
Fyodor Dostoyevsky
experienced his first convulsive seizure upon receiving news of his father’s
murder.
Many epileptics
experience ‘auras’ before the onset of a convulsive seizure, these vary
greatly; they can be very distressing for some, and euphoric for others. For those who experience them they are
recommended as a warning period during which the individual can put themselves
in a secure position or warn others around them.
There was a
moment or two in his epileptic condition almost before the fit itself…when
suddenly amid the sadness, spiritual darkness and depression, his brain seemed
to catch fire at brief moments....His sensation of being alive and his
awareness increased tenfold at those moments which flashed by like
lightning. His mind and heart were flooded by a dazzling light. All
his agitation, doubts and worries, seemed composed in a twinkling, culminating
in a great calm, full of understanding...but these moments, these glimmerings
were still but a premonition of that final second (never more than a second)
with which the seizure itself began. That second was, of course,
unbearable.' – Dostoyevsky The Idiot, 1968
At any one time 1% of
the population has epilepsy, and 4% of the population will experience epilepsy
during their lifetime. There is a
further percentage of the population, much larger and unrecorded, who
occasionally experience the same abnormal electrical activity in the brain without
ever having a convulsive seizure. These
people experience ‘mini seizures’, principally these are auras which never
develop in to a generalised secondary.
A very strong feeling of day
dreaming that freezes you, you disconnect from the world around you. You can speak but you don’t know what you are
saying, you can hear but you are in a bubble…and when you come back, well, you
feel very relaxed, tired, your brain seems to have gone to sleep – Crisfca: 22/06/2009 – 3:59am
Mini seizures have a
large number of side effects, different for each individual. Simple partial seizures are defined by their physical
symptoms, causing an increase in pulse, flushing, paleness of the skin, while
also disturbing the senses, often creating hallucinatory lights, sounds, smells,
tastes or the sudden sensation of vertigo.
The simple partial seizure is largely responsible for sensory
disturbances and rarely affects consciousness as the complex partial seizure
does, though the two categories do cross over on the aspect of psychic
disturbance.
During a complex
partial seizure the consciousness is usually impaired as it always involves
psychic symptoms incurred by the disturbance of high cerebral functions. Complex partial seizures are responsible for
sudden bouts of detachment, disorientation and depersonalization and therefore
often mistaken for panic attacks.
I have been having these thoughts
every once in a while that ordinary things, objects, words, concepts, seem
somewhat silly or different than they normally would feel. In a way, I feel like I’m processing the
world differently, almost a bit, yet not entirely, detached from it for just a
few seconds or so – Mikey4: 06/09/2008 – 3:09pm
The cerebral
disturbances brought about by a complex partial seizure can cause sensations of
ecstasy, a confused perception of time, visual and auditory illusions, and
extreme states of déjà vu or jamais vu.
It starts with a sudden rush of
anxiety but at the same time feels kind of euphoric…everything seems distant
and hazy, sounds seem muffled but still audible…everything that happens within
those ten or so seconds seems to have happened before…
For a diagnosed epileptic
a mini seizure can act as a reminder to take their medication. It can also evolve into a full-scale
generalised seizure (acting as an aforementioned aura). For others it can indicate dormant epilepsy
which, though presently inactive, may spike later in life. Many who experience these mini seizures do
not consult a doctor or ever have them diagnosed. They often appear during times of hormonal
influx or emotional stress.
…I don’t feel like I’m predicting
what’s happening, but when it does, I seem to tell myself ‘I knew that was
coming’ – Sbamber 29/03/2011 – 6:35am
The complex partial
seizure can begin in the frontal lobe or, more commonly, in the temporal lobe. The temporal lobe controls hearing, speech, social
and sexual behaviour, emotions and memory.
They come always as the feeling
that something I am seeing, thinking or otherwise experiencing was part of a
dream I had the previous night, even when it is quite clear that this can’t
have happened. – Phenom: 29/03/2012 – 6:15am
Déjà vu (‘already
seen’) describes the phenomenon of being in a previously unseen environment or
situation and feeling that one has experienced it before. Correspondingly, ‘jamais vu’ (‘never seen’) describes
a state of spontaneous unfamiliarity with the familiar. These are phenomena common to everyone, but
which are frequently experienced in the extreme during partial seizures.
The images were in my mind’s eye,
not hallucinations. – Trix on Thu, 22/10/2009 – 6:12am
Déjà vu and jamais vu
are possibly the most peculiar of all psychic epileptic symptoms as they alter
the subject’s mental perception very suddenly and comprehensively.
In the case of déjà vu,
the subject is frequently not merely presented with the impression of
familiarity, but with a suggestion of further knowledge which, most
extraordinarily, temporarily forms false memories.
A lot like a dream, but not a day
dream. A lot like a nightmare but too
fleeting to leave an impression of fear.
The most distressing aspect is simply that it allows for no
satisfaction, it moves too fast, once you feel that you have grasped one
element of it, one situation or scene or window on the spinning movie reel, it
is pushed aside and you are shown another.
You instantly lose any memory of what the last thought was, it is
obliterated, against your will. This
experience lies somewhere between the disappointment of losing the details of a
dream upon waking, and amnesia. In the
space between the electrically charged brain and the exposed scalp lies a place
where the question of what is ‘real’ becomes immaterial, where these fabricated
memories are temporarily just as significant as the tangible. –
Patient, Ref 128564: 24/03/2010
*
* *
Date: 8th April 2010
Ref.: 128564
Diagnosis: Complex Partial/
Secondary Generalized Seizures (Tonic-Clonic)
Suggested
Medication: 300mg Carbamazepine / twice daily
Prescription:
100mg b.d. for 1 week
200mg b.d. for 2
weeks
300mg b.d. for 3
weeks
I
will review in 6 weeks.
Many
thanks.
Dr
M P E Heathfield
*
* *
On the
spot where the epileptic first falls a black cock is buried alive, along with a
lock of the patient's hair and some parings of his nails. I have seen at least
three epileptic idiots for whom this is said to have been done... –
Scottish folklore
No comments:
Post a Comment