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CASE STUDIES

Epilepsy Case Study

Thirty three years old, A resident of Faridabad had become the first patient in India who had Brain Pacemaker for uncontrolled Epilepsy. She was a second child born via normal delivery with normal milestones.

At the age of 18 months she started having fits specially on her left side. It used to last for 15-20 minutes with no loss of consciousness. After fit she used to feel weakness on left side.

She was treated in local hospital in Faridabad and remained controlled with medications for 12 years. Fits started again when she failed in 12th standard. Her fits were same starting from left side and then goes to other part of body. Fits continued for 15-20 minutes and used to occur one to two times a day. Again she was put on medications but fits continued. Despite all kinds of medication fits used to occur once in 2-3 weeks time.

Gradually the frequency of fits increased to 2-3 fits every alternate day. Many times she was admitted in I.C.U in local hospital for control of fits but again after some time they used to recur. Till December 2011 she was confined to her house as she can have fits outside house. Her father has to remain along with her to take care of any kind of emergency. She was referred for Epilepsy surgery it was refused as she was not a proper candidate for surgery.

She came to us in the month of January at Artemis hospital. Having exhausted all the option for medications we decided to introduce a pacemaker in very specific area of her brain called Anterior Thalamus which is a gate way through which all epileptic discharges goes to brain and then to l the limbs. This deep brain stimulation surgery (Pacemaker) is a approved therapy in Europe and has received CE Mark approval for Epilepsy.

She was operated on 15th January 2012. By stereotactic technique very thin wires (Electrodes) were introduced in her deep nuclei on both side after making two small holes in her skull just behind hairlines and later-on they are connected to a Pacemaker implanted underneath the color bone on left side through connecting leads . Surgery lasted for 9-10 hours.

After surgery programming of the pacemaker was started and continued for 10 days. After that she was discharged. Her stitches were removed on 10th day and she was followed in O.P.D. Presently she is seizure free for last one and a half month.

Her post-operative E.E.G has become normal which was abnormal earlier and her PET CT Scan head showed improvement in blood flow in the affected area.

OCD Case Studies

R A was a BPO employee who had persistent doubts on whether he had turned off the taps or whether he had locked his door. He feels very tense of he did not check and clarify his doubt, however even after checking he once again would start doubting. He progressively increased number of times he checked things and soon noted that he started missing his office bus, his condition progressively worsened and he would return home from office to check on his doubts of having left the door or taps open. He soon resigned his job and confined himself to home and was later-on brought for assessment.

S K was a science graduate who started thinking his hands were contaminated by disease causing germs. He started washing his hands 7 times to get rid of them but the thought would return after a brief period of relief. Two years later he started washing his hands with detergent soap and developed rashes on his hands and continued to wash even with hands covered with rashes. He sought help of a skin specialist who sent him for assessment.

Tara was a housewife who was deeply religious, she soon noted that when she went to the temple she had an urge to utter an obscenity which she did silently, later she had these urges on seeing any religious photographs or books. When alone, she would speak the obscenity aloud. She then started keeping all religious articles away from her sight and stopped watching TV. She kept aloof and confined herself to a room, however it was only after she an overdose of available tablets and pills at home that she was brought for assessment. hoarding etc.

Results:

The three highlighted cases presented for psychiatric assessment 2-5 years after having distressing symptoms during which period they were functioning very poorly at home. They were treated with a group of medication commonly known as SSRIs (specific serotonin reuptake inhibitors) and a type of psychotherapy known as CBT (Cognitive Behaviour Therapy). Usually these interventions alone would suffice for most suffers of OCD. medication. However for a small number these measures will not be enough.