The Nocturnal Brain by Dr. Guy Leschziner

Author:Dr. Guy Leschziner
Language: eng
Format: epub, azw3
Publisher: St. Martin's Publishing Group

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During our initial appointment, I tell Janice that I want to look for evidence of epilepsy. She has already spent the night in the sleep lab, having seen my respiratory colleague. The sleep study only shows generally poor sleep. Sod’s law, she has not had any events overnight, perhaps because this was not done in the week before her period. I organise an MRI of the brain, to look for any abnormalities that might give rise to epilepsy, but it is normal. We undertake a routine EEG, recording for about half an hour while Janice is reclined on a couch. This is also essentially normal. I organise another, this time as a sleep-deprived recording, to see if we can monitor her brainwaves as she drifts off to sleep. This time we see some slightly abnormal activity over the left temporal lobe, not specific to epilepsy, but at least suggesting that there is some abnormality of brain function in this region. I book in a repeat admission to record a whole night, to see if we can capture one of her events but, as luck would have it, again we are unsuccessful.

I am enormously frustrated by my inability to prove my diagnosis of epilepsy, and Janice is too. Ultimately, she does not care what is causing her events, she just wants them treated. In desperation, I request a PET scan. This type of study involves the injection of glucose labelled with a radioactive marker. The brain is scanned for radioactivity, to look at patterns of utilisation of the injected glucose. Sometimes, areas disrupted by frequent seizures exhibit abnormal function by taking up less glucose than they should. When I see her again in clinic following her scan, the results are definitive. On the right side, the insula glows purple and pink, showing normal uptake of the radioactive glucose. But on the left, it is obviously blue and green, the cooler colours showing much less activity than would be expected. To Janice’s and my relief, the diagnosis of insular epilepsy is confirmed. We can start treatment.

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