Ethics

Ethics

Introduction

The case study discussed HB is a 2.5 year old male (ht 36 inches, wt 37 lbs, NKDA, Latex Allergy) admitted to the hospital suffering from juvenile spasms with intractable epilepsy. He has had multiple hospitalizations for assessment and treatment of seizure activity since about the age of 11 months. Mom is a 22 year old single parent who is currently unemployed. Recent seizure activity presents with heightened frequency and increased duration of myoclonic, tonic, and atonic seizures. Juvenile spasms confirmed per recent video EEG. HB is currently on Depakote Sprinkles 250 mg PO BID, Zonisamide 125 mg PO morning, Zonisamide 50 mg PO evening, and Diastat Pediatric 7.5 mg Rectally PRN (NTE dosing recommendations).

Assessment

The assessment was then presented to the physician. Juvenile myoclonic epilepsy (JME) is a syndrome of idiopathic generalized epilepsy (IGE) with an age-related onset of seizures; it is characterized by myoclonic jerks, tonic-clonic seizures and less frequently by typical absences. Prevalence is 5-10% among adult and adolescent patients with epilepsies, and both sexes are equally affected. As with other IGE syndromes, JME is defined by electrophysiological features indicating involvement of both cerebral hemispheres from the beginning of seizures. There are `no neuroradiological signs' in patients with JME (Commission on Classification, 1985) and visual inspection of high-resolution MRI is normal in patients with IGE. However, using semi-automated MR segmentation and quantitation, we identified widespread cerebral structural changes with larger than normal cortical grey matter volumes in patients with various IGE syndromes, supporting the existence of structural changes in these patients . The spatial resolution of this study was constrained by the use of volumes of interest that comprised one-tenth of the anteroposterior extent of each cerebral hemisphere.

Pathophysiological considerations

In epilepsy, structural changes detected on MRI quantitation in the cerebral grey matter may reflect changes in neuronal connectivity (Sisodiya ...