A Correlational Study of Psychogenic Non-Epileptic Seizures Following a Left Temporal Lobe

A Correlational Study of Psychogenic Non-Epileptic Seizures Following a Left Temporal Lobe Stroke: A Case Study of Midwestern United States

CHAPTER 1: INTRODUCTION

1.1 Background of the Problem

In the recent past, the American government has been investing much money in improving the status of healthcare in all states and enacting the necessary laws to support affordable healthcare. Such decisions have been informed by an increase in the mortality rates from different quarters of society. The standards of healthcare adjustments have been addressed through recruitment, training, care delivery, management, education, counseling and research and development. In particular, the United States’ government has made it a particular concern to address epileptic seizures and other abnormal nerve cells activities.

The development of healthcare in the United States has always been an important part of socio-economic development. In the 20^th century, the health sector encountered rapid growth due to the changes in global events that demanded effective healthcare. Such events led to the increase in both public and private healthcare facilities in the country. The advent of affordable Healthcare Act is one example of recent changes in legislation that was intended to provide equitable access to healthcare service to the poor (Department of Neurology, 2015). Addressing the issues of terminal diseases and rare conditions were some of the main reasons for introducing such changes. Similar interceptions have been witnessed in other areas dealing with paraplegic and non-epileptic conditions in different regions.

For example, the National Association for Epilepsy Center was founded by prominent physicians in the nation with an aspiration of setting the national agenda for improving the quality of epileptic care (Shorvon, Andermann and Guerrini, 2011). The centers are non-profit making organizations with over 200 members of specialized epileptic centers in the US. The US department of health has also empowered other facilities like the Pediatric Epilepsy Center, which is one of the biggest and most comprehensive specialized centers to care for epileptic children and individuals suffering from other seizure disorders. The staff members of such facilities are trained and fully dedicated to provide the best care to all epileptic children in a compassionate environment. According to Department of Neurology (2015), the clinical care services provided include stroke, aging and dementia, pediatric epilepsy, adult epilepsy and general neurology. In addition, the center also provides additional care to epileptic adolescents and their families as an additional care service.

However, the government and other non-governmental organizations rely on the availability of information about the epileptic and non-epileptic seizures, strokes and other neurological attacks. Such information helps them in establishing the relevant facilities and providing the right medical attention in their efforts to address the problem (Shorvon, 2010). Evidence-based nursing shows that understanding the cause of each problem in randomized trials has helped in directing the right care to the patient and hence save life. Current research seeks to assess the correlation between Psychogenic Non-Epileptic Seizures and Left Temporal Lobe Stroke in Midwestern United States.

1.2 Statement of the Problem

Psychogenic non-epileptic seizures and temporal lobe strokes are major concerns of all Americans regardless of their social economic status, geographic location or race. It may be related to lack of knowledge about the disease combined with the fatalistic attitudes, as well as cultural and behavioral practices. Midwestern part of the United States is relatively comprised of middle economy states with comparatively lower budgetary allocations on healthcare. It leads to a lower participation in handling rare conditions like epilepsy and high costs of medical insurance and high level of personal health awareness. Access to reliable and affordable data relating various epileptic fits and seizures is a major problem. However, considerable efforts have been made focusing on development of relationship between non-psychogenic epileptic seizures and left temporal lobe attacks. It results in the need of understanding the government intervention in reducing mortality rates in the region caused by the fits and seizures.

1.3 Objective of the Study

Current study attempts to establish the understanding of the correlation between psychogenic non-epileptic seizures after a left temporal lobe stroke. The results of the study will be used to enhance the researchers understand the process and recommend the best way to solve one problem or both.

The specific objective is to determine the relationship between psychogenic non-epileptic attacks resulting from a left temporal lobe stroke.

1.4 Research Questions

The research question for current study should be:

Is left temporal lobe stroke a direct cause of psychogenic non-epileptic seizures?

1.5 Rationale of the Study

The importance of current study is accrued from the need to solve the problem of lack of information regarding the increasing numbers of death rates resulting from left temporal lobe strokes and psychogenic non-epileptic seizures (Shorvon, Andermann and Guerrini, 2011). The study seeks to investigate whether the two conditions are related and which of them leads to the other in order to recommend appropriate treatment. Most of the studies undertaken previously investigate the correlation between the two conditions, while other researches shallowly discuss the impacts of ineffective diagnosis as the root cause of the increased death during treatment and care. The results obtained in present study may assist the doctors to investigate how the left temporal lobe stroke and psychogenic non-epileptic seizure incidences can be reduced in order to save more patients from succumbing to such demise.

The study may have a positive impact in knowledge of the medical practitioners on changing the mode of treatment of the victims by giving hope to them and their families. Shorvon (2010) noted that at times death can be caused by opportunistic problems that affect a patient suffering from epileptic attacks. Such problems include shock, limb fracture and psychiatric trauma. At times, the patient only needs a small medical or therapeutic intervention from a qualified medical practitioner. According to National Association of Epileptic Centers (2015), if the precondition symptoms are detected at an early stage, the impact of stroke, epilepsy and other forms of seizures can be controlled and it can reduce the resulting deaths. The study seeks to identify whether left temporal lobe strokes can lead to psychogenic non-epileptic seizures. The study may also assist in providing necessary information that lacks in literature. In addition, the researcher will also fulfill the academic requirements of attaining a Master’s degree.

1.6 Scope of the Study

The research will focus on establishing whether left temporal lobe stroke is a direct cause of psychogenic non-epileptic seizures. The study will cover control measures, such as the impacts of other epileptic attacks and their effect on different age groups. The research location shall be limited to available clinical records in Midwestern United States particularly in Omaha, Nebraska.

1.7 Research Hypothesis

Essentially, hypothesis entails predicting about the possible answers to the research questions and the component parts. Such predictions are critical parts of a research project. They help the researcher in developing the literature review and also serve as a basis for the research methodology in order to collect sufficient data to support or reject the hypothesis. It also allows the researcher to focus on data analysis and the subsequent chapters of the research.

Hypothesis 1:

H₀: There is no relationship between left temporal lobe stroke and psychogenic non- epileptic seizure among patients in Omaha, Nebraska.

H₁: There is a relationship between left temporal lobe stroke and psychogenic non- epileptic seizure among patients in Omaha, Nebraska.

1.8 Definition of Terms

Stroke – it is a serious medical emergency that takes place when there is a problem of blood supplying to the human brain.

Left temporal lobe – temporal lobe is one of the four components of the cerebral cortex located below the lateral fissure on the cerebral hemisphere in a mammalian brain. The left temporal lobe is responsible for primary auditory cortex, which helps in processing the semantics for both vision and speech in human beings (National Health Interview Survey, 2010).

Epilepsy – is a type of neurological disorder that is characterized by convulsive and vigorous shaking in unconscious state.

Epileptic seizure – it is a sudden electrical surge in human brain that may affect a person for a short time. All activities that the brain and the body do during conscious state can still occur during seizure (Shorvon, Andermann and Guerrini, 2011).

Psychogenic diseases – they are types of physical illnesses that originate from mental or emotional distress. Such diseases form a bigger part of psychosomatic illnesses, which include hysteria (Shorvon, Andermann and Guerrini, 2011).

Demographic – it is a characteristic of a population based on various factors, such as age, the level of education and income. It is used in current study to show the characteristics of population based on the subgroups to which they belong (Creswell et al, 2012).

CHAPTER 2: LITERATURE REVIEW

Introduction

Epilepsy and epileptic seizures have been recognized as some of the rarest conditions that have not received the media attention that it deserves. There has been very little awareness of the disease and little government intervention compared to the attention accorded to other diseases. People who suffer from such condition and their family members receive little information on the kind of assistance required to help the person or the kind of effective medication or therapeutic treatment. Current chapter highlights some of the major differences between epilepsy and other forms of conditions that can lead to epilepsy. In addition, the researcher relies on the existing literature to study the relationship between psychogenic epileptic seizures after a patient suffers a left temporal lobe stroke.

The chapter also highlights the various causes of epilepsy, in different parts of the United States, its prevalence levels, mortality rates and modes of treatment. Each method is vividly described, highlighting strengths and weaknesses of epileptic condition at different stages. The author also focuses on the various factors that have led to the increase in prevalence rate and various forms of government intervention in fighting the menace.

In addition, the researcher evaluates the importance of having increased public awareness on epilepsy and on the effectiveness of treatment. The effectiveness of epileptic treatment and control depend on proper implementation of the screening process (National Association of Epileptic Centers, 2015). Without effective diagnosis, research, care and treatment can be delayed, thus, making the illness impossible to heal. Lastly, the effectiveness of the program in reducing mortality rate should be harm free. The author seeks to understand whether the program can be effective without causing further complications to the patients.

Psychogenic Non -Epileptic Seizures

According to The International Bureau of Epilepsy (IBE), epilepsy is defined as a brain disorder that is characterized by enduring predilection to general epileptic seizures and cognitive, biological and psychological effects (Perry, Ashton & Young, 2012). Indeed, biologists agree that patients suffering from such condition exhibit neurobehavioral disorders that reflect suicidal behaviors. Psychotic disorders are more severe mental disorders that lead to abnormal thinking and perceptions, making patients lose their relation to reality. Such kind of medical condition is characterized by delusions, hallucinations and other forms of disorganized negative behaviors, such as reduced speech, diminished range of emotions and inability to initiate and maintain a valid goal-oriented activity. People suffering from severe epileptic seizure may collapse and become unconscious, cry loud, move or twitch uncontrollably, drool and at time loose the control of their bladder. Within a short time, the attack ends and the person regains consciousness, though feels completely dazed and exhausted. It is the most common image and perception held by most people when anything about epilepsy is mentioned. However, there are other types of the same condition but with different symptoms.

According to Shorvon (2010), non- epileptic seizure is a brain condition that clusters the neurons in the brain indicating a condition of abnormality. Normally, the nerve cells produce electrochemical impulses that react with other glands, neurons and muscles to create some form of human thoughts, emotions and actions. In a non-epileptic condition, the normal actions and routine activities of the brain become disturbed leading to abnormal sensations, behaviors and emotions, muscle spasms, convulsion and, in some cases, the patient may lose consciousness. During a seizure, the neurons may fire more than 500 times per second, a rate which is much faster than the normal (Perry, Ashton & Young, 2012).

Epilepsy is neither contagious nor caused by mental retardation or illnesses. There are some people with mental retardations who suffer from seizures but it does not mean that any person who suffers from seizure will develop mental impairment. According to Kruk and Pycock (2011), many people suffering from epileptic seizures possess normal or above average IQ. There are several famous people who were told to have suffered from epileptic seizure and their intellectual capacity was very high. Among such celebrities are Alfred Nobel (Nobel Peace Prize founder), Philosopher Socrates and Napoleon, the famous military general (DeFeudis & Mandel, 2009). However, severe seizures result in brain damage but most of them do not have detrimental effects on the brain. Any change that may occur is usually subtle and unclear whether the brain damage is caused by seizure or other psychological or biological conditions.

Causes of Non-Epilepsy Seizure

Non-epileptic seizure may have various causes. Anything that has the effect of disturbing the normal operation and the pattern of neuron activities can result in seizure. Such disturbances include brain damage, illnesses and abnormal brain development. Non-epileptic seizures are the string attacks and fits that originate from the brain and not from the physiological body activities.

Brain Damage

It is an abnormality that develops from brain wiring and an imbalance between the nervous signaling chemical properties commonly known as neurotransmitters or a combination of similar other factors. According to Shorvon, Andermann and Guerrini (2011), the brain has a self-repair function after damages caused by head injury, stroke or other related problems. In some cases, the brain may inadvertently generate abnormal nerve connections that may result in epilepsy. Other abnormalities in brain wiring may take place during the process of brain development and may subsequently disturb neuronal activities of the brain leading to epilepsy. Research shows that the cell membranes that surround the neurons play a very important role in causing or preventing epilepsy (Perry, Ashton & Young, 2012).

The cell membrane plays a very important role for neurons to generate electrical pulses. For this reason, more researches are being performed to establish how molecules and cell membrane manage to nourish and repair the broken parts. According to Kruk and Pycock (2011), some people with epilepsy develop a high level of excitatory neurotransmitters that abnormally increase the person’s neuronal activities. Other people have abnormally low inhibitory transmitters that reduce neuronal activities of the brain to abnormally low levels. Gamma amino butyric acid (GABA) is one of the most researched inhibitory neurotransmitter that plays a major role in causing epilepsy (Shorvon, 2010). Receiving of such information has led to development of drugs that alter the rate of neurotransmitters production in the brain in response to inhibition. Medical researchers have also found the need to study exhibitory neurotransmitters like glutamate in order to develop the right drug to it (DeFeudis& Mandel, 2009).

Genetic Factors

Genetic abnormalities may also be another factor contributing to epilepsy. Some forms of epileptic disorders are related to a specific gene, while others may be passed through families. It means that various genes influence the presence of epilepsy. According to National Association of Epileptice Centers (2015), 500 genes have been recorded to play a major role in causing the disorder. However, Ross, Horton-Szar and Smith (2012) dispute such suggestion by clarifying that most types of genes only play a partial role in increasing a person’s vulnerability to seizures that are caused by the environment.

Other Disorders

In other cases, epilepsy develops due to inflicted or inherent damages to the brain caused by other forms of disorders. For example, alcoholism, Alzheimer’s disease and brain tumor are among factors that may lead to epilepsy, altering the normal working capacity of the brain. Different related conditions, such as heart conditions or strokes, that deprive the brain of its oxygen lead to epilepsy. 32% of all developed epileptic cases among old people occur due to cerebrovascular diseases that reduce the level of brain’s oxygen supply.

Temporal Lobe Attack

It is a kind of non-psychotic epilepsy syndrome that is common with focal seizures. Such kinds of seizures are often connected with sensation and aura. Temporal lobe epilepsy starts during childhood and Ross, Horton-Szar and Smith (2012) suggested that such condition can cause a certain element of brain culture known as hippocampus, which reduces over time. The importance of hippocampus is essential to a person’s learning and memory. It may take years for temporal lobe seizure to cause damage to the brain but the impacts on people are very serious. However, early detection and treatment of the problem can be more effective in reducing the chances of non-psychotic epilepsy in future (Alexander, 2012).

Temporal lobe epilepsy is one of the commonest forms of localization or partial cause related to epilepsy and accounts for approximately 60% of epileptic prevalence. Other than the left temporal lobe, there is a medial temporal epilepsy. Temporal lobe epilepsy often begins within the internal structures of the brain. Despite being too prevalent, temporal lobe epilepsy is very resistant to medication and therapeutic treatments. For instance, the hippocampal sclerosis is difficult to treat both through surgical procedures or medical options (Ross, Horton-Szar and Smith, 2012).

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