Radiologist MRI report and epilepsy

First, the radiologist report:

The paranasal sinuses and mastoid air cells are clear.

Impression:  Subtle T2/FLAIR prolongation of the right hippocampus with questionable decrease in size of the mid  posterior body relative to the left. Findings are concerning for recent seizure or early mesial temporal sclerosis.

Asymmetry of the left cranial vault and postsurgical change status post known repair of the craniosynostosis.

This is exactly what dave told me he saw a week ago but it wasn't real to me until I actually saw it in writing.
What does this mean? It means Calvin has temporal lobe epilepsy (TLE).  It means Calvin has been having seizures for a long time. It means the repeated seizures have caused scaring in his brain.  I'm sure it means so much more that I have yet to learn.  I have been reading quite a bit about epilepsy this week.

I have experienced a wide range of emotions since learning this. First, I thought, ta da, we found the missing piece to the puzzle and FINALLY know what is going on with our boy. It is not just that he is hyperactive, defiant, difficult. It's not just that I'm a bad parent and can't teach the child right and wrong. It is not just that he isn't sleeping well. There is a real physical cause for all of his problems.  It is sort of nice to know that all of my persistence and begging dr's to run tests on him to try and find a physical cause for his problems was not  just a crazy mother looking for an excuse. I have always known there was an underlying physical cause that at least contributed to his struggles.  That was my first reaction.  My second was of sadness. Now that we know the cause of his problems, it is sad to know that he has been experiencing seizures for years and they have been causing serious damage to his brain.  I have to grieve the loss of my child yet again. What would Calvin be like if he did not have these seizures going on in his head preventing him from learning as he should and causing such out of control emotions?  Who is the real Calvin?   And lastly, most of all I feel so blessed. We are lucky to know what Calvin has. We're lucky he's in a great school. We are so lucky we have healthy children. Our problems are so small compared to others. 

Some quotes from one of Dave's Neurosurgery book.

Seizures are defined as an alteration of behavior, movement, or sensation that results from an abnormal and excessive discharge from a group of neurones.

Epilepsy is defined as two or more unprovoked seizures.

Incidence of epilepsy during childhood is 1%.

The impact of repetitive seizures and anti epileptic medications can present noxious stimuli at critical developmental windows....although the vast majority of children with epilepsy eventually enter into remission, they remain at a substantially increased risk of not meeting their educational, vocational, and social goals.

Mesial temporal sclerosis (MTS) is the most common pathology in adults undergoing epilepsy surgery. It is rarely seen in a child less than 10 years of age.

Children with TLE spend a significant portion of their "awake" time with an altered percetion of surrounding stimuli. The effect of this intrusion into the child's normal developmental schema blurs and therefore affects the normal processing of information necessary for the normal functional development for cognition and other neuropsychological abilities. Numerous studies using full-range IQ scoring have shown that intellectual function is depressed in these children and many have debilitating behavioral problems that include temper tantrums, aggression, attention deficit disorders, and hyperactive states... 

Children with imaging abnormalities rarely "outgrow" their seizures.

Important disclaimer for the following quotes -these came from a NeuroSURGICAL book so of course the point of view is slanted toward surgery. We haven't been to the neurologist yet to find out if he would even consider surgery for Calvin.  From my reading it seems that surgery is recommended for people who have seizures which can't be controlled by medication 

Early surgery in children with MTS leads to an overall improved chance of seizure-free state an dimporved outcome with regard to cognitive and neuropsychological measures.

If a patient has had seizures for less than a year and is found to have a lesion, he or she can be treated for the lesion alone with excision with a high likelihood of curing the seizures. If the seizures have been occurring for more than a year, in children with lesions, then they are less likely to be cured with lesional resection alone

Surgery remains superior to continued medical therapy with regard to outcome, morbidity and mortality in children with intractable temporal lobe epilepsy (INTRACTABLE means very difficult to control with medication).


Temporal lobe epilepsy articles:
http://www.hindawi.com/journals/ert/2012/849540/#B8
http://www.epires-journal.com/article/S0920-1211(04)00120-2/abstract


We still haven't been to the neurologist.  Our appt is 3 weeks away. We have so many questions.