Mild Brain Atrophy

Miss Guatami Pattnaik's date of birth is 16/09/2005.

Miss Guatami 's condition today:-
1) She is able to walk but when she begins to walk fast (rather very fast) she falters slightly. Sort of unsteady steps.
2) She is able to understand where the edges of cot/bed/chair/sofa/staircase/dining table are. She stops herself at the edges. Accordingly slides or climbs down from the edges. Can also descend from staircase in sitting or sliding position. She climbs up staircase with our help or independently in sitting position.
3) Is able to drink water from glass, picking it up & holding it with both her hands. After the desired quantity she throws down the glass or some times she roles it down slowly.
4)Not able to communicate or ask for food or water (when she is thirsty or hungry), she is passing urine & stools in her garments/clothes but is not able to tell us.
5) Makes some form of primary communication to us for carrying her – in form of dry crying(with out tears). She comes close to us & raises both her hands as an indication.
6) At crowded shopping malls or departmental stores when we call her Guddi she recognises us & comes to us. In this process, we have been gradually increasing the calling distance between her & us in phase wise manner. All under our strict supervision.
7) She has begun playing with dogs, cows, animals. Naughtily pulling their ears or tail but is not afraid/frightened of them.
8) She keeps making noises (aa, aeee, pi, pa, etc., mono syllables) but no meaningful ones. Sometimes she responds in almost similar mono syllables that we make – of late this has increased & is more direct.
9) Jerky movements of the neck – fits (Salami Seizures) have stopped from around August 2007.
10) We are excerising her on a physio ball – (huge big blown plastic-rubberish ball – 3feet in diameter).
11) She immensely loves to go down a slide (we need to take care of the last end part) & wants to climb it from the reverse.
12) Once we put her on a swing she can swing almost independently (more or less) without any support,.

Medication:-
In consultation with Professor Doctor(Neurologist) R N Sahoo – Cuttack, Orissa we are medicating her with Valparin (Sodium Valproate Oral solution I.P.) syrup. Each 5 ml contains Sodium Valproate I.P. 200Mg.
Medicine manufacturers Sanofi Aventis.

Help & Solutions:-
I as a Father am willing to digest all reality. Doctor what will be her final condition will she be able to read, write, talk, etc., I have no regrets of what has been. I am accepting her status/condition as she is. I would want to do as much as possible so that she can at least lead as normal a life as possible. Therefore I ask you to guide me in this endeavour/effort.


Attaching below a discharge of certificate from NIMHANS.






NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES
(DEEMED UNIVERSITY)  BANGALORE -29, INDIA.

DICHARGE SUMMARY

CONSULTANTS: Prof P Satish Chandra/Dr Uday B Muthane/Dr A Nalini/Dr G Kulkarni

Age 1yrs Neuro No
Patients' Name: Miss GUATAMI PATTNAIK Sex:Female N/438172
Address: The blessing, plot no 1341/61,justice D.O.A:25.9.06
chakk, mahandi vihar – 753 004 D.O.D:26.9.06
Cuttack

Diagnosis: Idiopathic west syndrome Result: Unchanged

History & Examination:
1 year old child brought with c/o jerky movements of neck, regression of milestones for 6 months, born to non consanguineous parentage, full term cesarean, no birth asphyxia, normal milestones till 5 months.
Started getting recurrent jerky flexion of head more after getting in mornings, not precipitated by sound, light, touch, initially 20-30 per day, after  receiving ACTH 0.5 ML/DAY FOR 2 months, gets 4.5/day.
Gradually regaining milestones, can sit without support, stand with support, recognizes mother, no h/o GTCS. Can coo, social smile attained. No family history.

ON EXAMINATION no skin lesions HC 46 cm
no neurocutaneous markers
Systems normal, alert, tracks visual, auditory stimuli
EOM full
Cranial nerves normal
Moves all limbs, left hand preference seen
Neonatal reflexes absent
Flexor plantar DTR present

INVESTIGATION EEG: MODIFIED HYPSARRYTHMIA
MRI films not available done outside

Course in hospital and condition on discharge

1 year child with myoclonic jerk and regression of milestones, currently improving with ACTH came for second opinion
advised routine biochemistry, ammonia, serum Hexsaminidase
USG Abdomen
Opthalmology opinion for any cherry red spot, etc.,

Advice on discharge
Syr Valparin 2.5 ml bd
T Predmet 5mg ½ od
Syr. Neuracetam ½ tsp bd
T Clonazepam 0.5mg ½ od for 3 days
½ bd for 3 days
(1-0-1) to continue


Signature of Resident



Dr R Subasree