PRELIMINARY REPORT FROM 23 HOUR EEG- DR. MARCACELLI
NOVEMBER 16-17, 2011
1) He reviewed and compared all of Ryan’s past MRI’s and EEG’s. This EEG showed an abnormal pattern.
2) He said this EEG shows a mild slowing of brain rhythm of 8 bumps per second. For Ryan’s age (3), it should be about 12 bumps per second during sleep. It means his brain can’t process as fast as it should. The bumps should increase as the child ages. 8 bumps per second is ‘normal’ for a 2 year old. He said Ryan might just be on the low end of normal but will monitor through further studies. He mentioned this could be another delay, like the developmental delays, that come with the Chromosome 18.
3) He did not know if Ryan’s Chromosome 18 abnormalities are causing the seizures or the seizures are independent from Chromosome 18 issues.
4) The EEG’s and MRI’s confirmed left temporal sclerosis occurring on the left side of the brain in the temporal lobe. The cells in this part of the brain are very specialized and affect memory and learning. This area has been affected by recent fevers and seizures. There is no scarring on the right side of the brain.
5) Ryan’s vomiting is probably related to his seizure activity.
6) He said we wants to prevent seizures from going to the right side of the brain and the scarring on the left side of the brain to get bigger, so they are going to increase the dose of Lamactil to prevent future seizures. (Currently Ryan takes 15MG 2x daily – they’d like the full dose to be 30MG 2x daily) The dose will slowly be increased over time (increasing every 10 days – starting to increase at night first – 4 tablets/20MG for 10 days, then increasing to 4tablets/20MG in the morning for ten days, etc.). He said Keppra and Lamactil is a good combination of drugs to prevent seizures. Lamactil does affect the liver, white blood cell count, and a rash may develop, so report any rashes to Dr. Joseph. Lab work will continue to monitor the liver and white blood cell count. The next liver level will be taken in a month.
7) No tumors are seen now and will be monitored through follow up MRI’s.
8) The right hippocampus will have to take over for the left side deficits and scarring. With children under the age of 6, the brain has plasticity and with continual learning, the right side can compensate for the left side.
9) Prolonged seizures and febrile seizures could have caused the scarring – hippocampal sclerosis.
10) The left side of the brain has to do with learning and memory. The right side of the brain is concerned with visual spatial orientation.
11) The goal now is to prevent future seizures, fevers, viruses or any other things that may provoke a seizure.
12) When Ryan stares to the left, this is not necessarily always a precursor to seizure activity.
13) On the EEG, it showed discharges and spikes (due to scarring).
14) Lamactil doesn’t affect how you think. It prevents the spread of discharges.
15) Keppra doesn’t affect other parts of the body.
16) Call Dr. Joseph if there are any changes in Ryan’s motor skills or any other skills. Also call her if Ryan has any further seizures or develops a rash.
17) On the labs done today, it showed elevated liver enzymes so will repeat labs and monitor in a month.