Contents

Abstract

Chapter#1

Introduction

Mini Mental Status Examination (MMSE)

Clock Drawing Test (CDT)

Bender Gestalt Test (BGT)

Epilepsy

Chapter#2

Methods

Subjects

Instrument

Material

Procedure

Chapter#3

Administration of the test

Identifying Data

Case History
Behavioral observation

Test taking behavior

Interpretation

Chapter#4

Discussion and Conclusion

Chapter#5

Limitations and Suggestions

Chapter#6

Rehabilitation Plan

References
 Abstract

The present comparative case study concerns the administration of the Mini mental status
examination (MMSE), clock drawing test (CDT) and Bender Visual Motor Gestalt Test
(BGT).The current study was carried out with two female subjects, a neurological patient of
eEpilepsy and a healthy subject. Both were 20 years old. After administration of the test
quantitative and qualitative interpretation were carried out. The neurological subject got a score
10 on MMSE which is below the cut off score of 23 which indicate the severe cognitive
impairment. He scored 7 on BGT which is above the cut off score i.e. 5 and made many errors on
Clock Drawing Test which indicates the presence of severe cognitive impairment. Normal
subject made accurate clock and showed correct time, the healthy subject scored 30 on MMSE
which is the highest possible score on MMSE and indicates no cognitive impairment and on
BGT he scored 1 which is also below the cutoff score and indicates him as being normal.
 Chapter 1

INTRODUCTION OF THE TEST

Clock Drawing Test was published in1986. The first study association the CDT with the

screening of elderly prints with cognitive disorders, particularly the screening and follow up of

acute dementia and delirium. Since then, various studies have been carried out with the aim of

establishing criteria to apply and interpret CDT and evaluate its current role as screening

instrument for patients with cognitive impairment. Its contributions have also been investigated

in the assessment and follow up of delirium, focal cerebral lesions, Huntington’s diseases,

schizophrenia, unilateral neglect, multiple sclerosis among others.

Instruction for the test

Step 1: Give patient a sheet of paper with a large (relative to the size of handwritten numbers)
pre-drawing circle on it, indicate the top of the page.

Step 2: instruct patient to draw numbers in the circle to make the circle look like the face of a
clock and then draw the hands of the clock to read “10 after 11”.

Scoring system for Clock Drawing test (CDT)

The procedure of the CDT beings with the instruction to the participant to draw a clock
reading a specific time after the task is completed, the test administrator draws a clock with the
hands set at the same specific time. Then the patient is asked to copy the image. Errors in clock
drawing are classified according to the following categories: omissions preservations, rotations,
misplacements, distortions, substitution and addition ,memory concentrations, initiations, energy
, mental clarity and indecision all are measure that are scored during this activity.

Shulman et al. (1993) six point scoring method

Scoring the clock based on the following six-point scoring system

score Error(s) Examples

1 “perfect” No errors in the task

2 Minor visuo_spatial errors a) a). Mildly impaired spacing of times.

b) b).Draws times outside the circle

c) c).Turns page while writing so that some numbers

appears outside down

d) d).Draw in lines (spokes) to orient spacing

3 Inaccurate representation of 10
a) a).Minute hand point to 10
after 11 when visuo-spatial
b) b).Writes “10 after 11”
organization is perfect or shows
only minor deviations c) c).Unable to make any denotation of time

4 Moderate visuo-spatial
a) a).Moderately poor spacing
disorganization of times such that
b) b).Omits numbers
accurate denotation of 10 after 11

c) c).Preservation: repeats circle or continue on past 12 or

13 14 15, etc.

d) d).Right left reversal: numbers drawn counter clock wise

e) e).Dysgraphia : unable to write numbers accurately

5 Severe level of disorganization See examples for scoring of 4

as described in scoring of 4

6 No reasonable representation of
a) a).No attempt at all
a clock
b) b).No semblance of a clock at all
 c) c).Writes a word or name

Interpretation: higher scores reflect a greater number of errors and more impairment .A score of

>3 represents a cognitive deficits, while a score of 1 or 2 is considered normal.

MINI MENTALSTATUS EXAMINATION

A mental status examination (MMSE) is an assessment of a patient’s level of cognitive

(knowledge related ) ability , appearance , emotional mood, speech and thought patterns at the

time of evolution. It is one part of a full neurologic (nervous system ) examination and includes

the examiner’s observation about the patient ‘s attitude and cooperativeness as well as the

patients answers t o specific questions. The most commonly used test of cognitive functioning is

Folstrien Mini-Mental Examination (MMSE) developed in 1975.

The MMSE consist of seven simple tasks for questions, grouped into seven domains:

1. Orientation to time.

2. Orientation to place.

3. Registration to three words.

4. Attention and calculation.

5. Recall of the three words.

6. Language.

7. Visual construction.

Scoring of MMSE

Administration by a trained interviewer takes approximately 10 minutes. The test yields a total

score of 30 and provides a picture of the subject’s present cognitive performance based on direct

observation of completion of test items or tasks.

Category Possible Description

points

Orientation of time 5 From the broadest to most narrow. Orientation to time

has been correlated with feature decline.

Orientation of place 5 From broadest to most narrow. This is sometimes

narrowed down to street, and sometimes to floor.

Registration 3 Repeating named prompts.

Attention and 5 Serial sevens, or spelling, “words” backwards it has been

calculation suggested that serial sevens may be more appropriate in a

population where English is not the first language.

Recall 3 Registration recall

Language 2 Naming a pencil and a watch

Repetition 1 Speaking back a phrase.

Complex 6 Varies. Can involve drawing figure shown

commands

Deriving the total score

Add the number of correct responses. The maximum is 30.

23-30 = normal /19-23 =borderline /<19=impaired up to Grade 8 level.

BENDER GASTALT TEST.

BGT is an individually administered paper and pencil test used to make a diagnosis of brain
damage. There are 9 geometric figures drawn in black. These figures are presented to the
examinee one at a time, then the examinee is asked to copy it on a blank sheet of paper.
Examinees are allowed to use eraser. The average time to complete the test is about 5-10
minutes. One method requires that the examinee view each card for five seconds after which the
card is removed. The examinee draws the figure from memory. This form of administration is
most commonly used.

Administration

Examinee is shown stimulus cards with designs and asked to copy each of the designs on a sheet
of paper. Cards are administered according to the original sequence. Then the examinee is asked
to redraw designs from the memory.

Scoring of BGT

The time of examinee took, examinee’s approach to draw each design is carefully noted and
analysis is made according to the lack’s scoring system based on the scores obtained by the
examinee.
Introduction

Epilepsy is a common medical and social disorder or group of disorders with unique
characteristics. Epilepsy is usually defined as a tendency to recurrent seizures. The word
“epilepsy” is derived from Latin and Greek words for “seizure” or “to upon”. This implies that
epilepsy is an ancient disorder; indeed, in all civilizations it can be traced as far back as medical
records exist. In fact, epilepsy is a disorder that can occur in all mammalian species, probably
more frequently as brains have become more complex. Epilepsy is also remarkably uniformly
distributed around the world. There are no racial, geographical or social class boundaries. It
occurs in both sexes, at all ages, especially in childhood, adolescence and increasingly in ageing
populations.
The periodic clinical features of seizures are often dramatic and alarming, and frequently
elicit fear and misunderstanding. This in turn has led to profound social consequences for
sufferers, which has greatly added to the burden of this disease. In ancient times, epileptic attacks
were thought to be the result of invasion and possession of the body by supernatural forces,
usually malign or evil influences, requiring exorcism, incantations or other religious or social
approaches. Today, seizures are viewed as electromagnetic discharges in the brain in predisposed
individuals, attributable in part to putative genetic factors, underlying neurological disorders, and
largely unknown neurochemical mechanisms. A wide range of different seizure types and
epilepsy syndromes have been identified. Patients are now treated with pharmacotherapy,
occasionally with neurosurgical techniques, as well as with psychological and social support.

Symptoms

Because epilepsy is caused by abnormal activity in brain cells, seizures can affect any
process your brain coordinates. Seizure signs and symptoms may include,

 Temporary confusion
 A staring spell
 Uncontrollable jerking movements of the arms and legs
 Loss of consciousness or awareness
 Psychic symptoms
 Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will
tend to have the same type of seizure each time, so the symptoms will be similar from episode to
episode.
Doctors generally classify seizures as either focal or generalized, based on how the
abnormal brain activity begins.

Focal seizures

When seizures appear to result from abnormal activity in just one area of your brain, they're
called focal (partial) seizures. These seizures fall into two categories.

 Focal seizures without loss of consciousness (simple partial seizures).

These seizures don't cause a loss of consciousness. They may alter emotions or change
the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a
body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness
and flashing lights.

 Focal dyscognitive seizures (complex partial seizures).

These seizures involve a change or loss of consciousness or awareness. During a complex

partial seizure, you may stare into space and not respond normally to your environment or
perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.
Symptoms of focal seizures may be confused with other neurological disorders, such as
migraine, narcolepsy or mental illness. A thorough examination and testing are needed to
distinguish epilepsy from other disorders.

Generalized seizures

Seizures that appear to involve all areas of the brain are called generalized seizures. Six
types of generalized seizures exist.
  Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in
children and are characterized by staring into space or subtle body movements such as eye
blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of
awareness.

 Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually
affect muscles in your back, arms and legs and may cause you to fall to the ground.

 Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle
control, which may cause you to suddenly collapse or fall down.

 Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle
movements. These seizures usually affect the neck, face and arms.

 Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of
your arms and legs.

 Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are
the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness,
body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

Causes

Epilepsy has no identifiable cause in about half of those with the condition. In the other,
the condition may be traced to various factors.

 Genetic influence. Some types of epilepsy, which are categorized by the type of seizure
you
experience or the part of the brain that is affected, run in families. In these cases, it's likely
that there's a genetic influence.
Researchers have linked some types of epilepsy to specific genes, though it's estimated that
up to 500 genes could be tied to the condition. For most people, genes are only part of the
cause of epilepsy. Certain genes may make a person more sensitive to environmental
conditions that trigger seizures.
  Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause
epilepsy.

 Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or
strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age
35.

 Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis,
can cause epilepsy.

 Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by
several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies.
This brain damage can result in epilepsy or cerebral palsy.

 Developmental disorders. Epilepsy can sometimes be associated with developmental

disorders, such as autism and neurofibromatosis.

Risk factors

Certain factors may increase your risk of epilepsy.

 Age. The onset of epilepsy is most common during early childhood and after age 60, but
the condition can occur at any age.

 Family history. If you have a family history of epilepsy, you may be at an increased risk of
developing a seizure disorder.

 Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce
your risk by wearing a seat belt while riding in a car and by wearing a helmet while
bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of
head injury.

 Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can
lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce
 your risk of these diseases, including limiting your intake of alcohol and avoiding
cigarettes, eating a healthy diet, and exercising regularly.

 Brain infections. Infections such as meningitis, which causes inflammation in your brain
or spinal cord, can increase your risk.

 Seizures in childhood. High fevers in childhood can sometimes be associated with

seizures. Children who have seizures due to high fevers generally won't develop epilepsy,
although the risk is higher if they have a long seizure, other nervous system conditions or a
family history of epilepsy.

Prognosis

Prognosis One in three people with a single unprovoked seizure will have a second
seizure over the next five years (39). Treatment should be considered only to prevent
recurrence, not to prevent epilepsy. Untreated, after a second seizure, 75% will have another
seizure within the next one or two years (40). Whether “seizures beget seizures” is unclear.
Numerous predictors for recurrence, control, remission and intractability have been developed
at the onset and during treatment. Most important are diagnosis by syndrome and response to
the first appropriately prescribed and taken AED. Persistence of seizures after two AEDs
requires pre-surgical evaluation, as chances of remission are less than 5% with a third AED
and 50–80% following successful surgies
 Chapter 2

METHODOLOGY

Subject of a patient of epilepsy and normal functioning subject. Both subjects were females of
age 16. Th e present comparative case study was conducted to analyze the differences in the
neurological functioning

Material

The materials provided during the assessment session of the present comparative case
study included pencil, eraser, ruler, sharpener, and papers.

Procedure

The present study was conducted to analyze the difference in the neurological functioning
of the two subjects. Among whom one was the patient epilepsy while the other was a normal
functioning subject. After taking the permission, rapport was built with both the subjects as their
history was recorded. Then tests including MMSE, CDT, and BGT were applied on them. After
administration of the tests the interpretation was done both qualitative and quantitative for
comparative study of both the subjects.
 Chapter#3
Administration of test
Duration of sessions
Two sessions were conducted with client from 20th March 2018 to
21th March 2018
Referral
Client’s mother was the referral.

Identifying Data

Subject Client
Name A.B.C A.B.C
Age 20 years 20 years
Gender female female
Religion Islam Islam
Qualification class 8 matric
Socio-economic status lower class lower class
Father alive/dead Died Alive
Father’s education un-educated B.A
Father’s occupation jobless clerk
Mother alive/dead Alive Alive
Mother’s education un-educated un-educated
Mother’s occupation house wife house wife
No. of siblings 3 siblings 4 siblings
Birth order third born child second born child
Marital status un married un married
Neurological illness epilepsy Nil
Neurological test MMSE, CDT, BGT MMSE, CDT, BGT

Referred by Dr. X.Y.Z Dr. X.Y.Z

Symptoms,

 Temporary confusion
 A staring spell
 Uncontrollable jerking movements of the arms and legs
 Loss of consciousness or awareness
 Bleeding from nose

Family history

The patient belongs to a family of lower socioeconomic status, living in Islamabad .Her father

was died and her brothers were living separate. She was living with her mother alone. She was

the third born in last child of the family. And also was educated at primary level. Her mother

was working in others houses their no other sources so that’s why had a low socioeconomic

status. There was no evidence of any neurological history to be mention in her past .

The healthy subject belonged to a family of upper middle socio economic class. The subject lives

in Islamabad . Subject’s father was a government employee. She was the second born child of

family. She enjoyed healthy relationship with her family. There was no history of any

neurological and psychological illness in her family.

Personal History
Client was 20 years old female. Client’s education was only up to class 8th . Client’s birth
was normal, and she was a healthy child. Client had 3 siblings and she was a last-born child of
her family. Client’s relationship with her family was good. Client’s family was not well educated
her father was jobless and now he was not alive and her two brother were married and lived
separate. When she was 16 years old she suffered from an attack of complex partial seizure and
fits. In early two years of her illness she had few seizures attacks but after two years of her
illness she suffered from seizure attack twice and thrice in a day. Her MRI and CT-Scan reports
suggest that she suffered from epilepsy. She gets hospitalized for about two to three times.
Doctors diagnosed that she suffered from Tonic Clonic Epilepsy. She also had anxiety and fear
to come in the front of any unknown persons. She had only one friend. She also had inferiorty
feelings that nobody likes her.
Behavioral Observation
Client was lying on a bed and frighten . Her hands and legs were trembling and not had
eye contact with doctor she was too much shy and spoke in a very low tone. The client was so
depressed and confused and she was worried about her problem. She had a fear that every person
wants to kill her to give harm to her that’s why she had a fear from every unknown person. She
did answered properly and had difficulty to understand.

Test Taking Behavior:

During the assessment sessions the patient was thoroughly observed for 150 minutes. The patient
was not interesting in test. She had difficulty in reading and understanding question. She did not
maintain the eye contact properly. She used to stare the wall of the room whenever she had
difficulty in giving the answer. She had problems of attention. She used compensatory
mechanisms on many subtests such as counting on fingers, repetition and the frequent use of
paper pencil. She was easily distracted due to the environmental stimuli. She completed the test
in 55 minutes.
Family History of patient

The patient was belong to a middle socio-economic status, living in Islamabad. he was

doing government job and financial condition of the family was satisfactory. He was second

born child in family. His father was retired government employee and had middle socio

economic background. There was no evidence of any neurological his past. Selection of Normal

Client
 For the comparison with a neurological patient, a normal client was taken with the

same demonstration variables for the comparative study. Otherwise we cannot properly

understand a condition of a tumor. So we compared it with its broadly acceptable standards. In

the context both clients were belonging to the same class and had same age. Their family

background and age was similar . Social and economic life was somewhat identical too.

Economic status etc was selected so to draw a comparison between the different

stages of their lives to understand what resulted in impairment of tumor client . Also the

difference in their tests indicate how a tumor client is different in his response as compared to the

normal one.

Behavioral observation

During the interview, the client was sitting on a chair in a relaxed and calm manner. He

was very co-operative. He answers of all the questions honestly. He didn’t show any resistance.

He maintained stable eye contact. There was a connection between his words and sentences. His

tone was normal with normal speech. It was easy to built rapport with him. The client expressed

that he does not like to communicate with strangers but he tries his best that they don’t' built any

complaint against him.

Personal History of Normal Client

The healthy subject was also belonged to the family of middle socio-economic class. The

subject lives in Islamabad. she was a student . she was the 3rd born child of the family. she
 enjoyed a healthy relationship with his family. There was no history of any neurological

disorder psychological illness in his family.

The history alone can be very suggestive as to the cause of the patient’s symptoms and

will help create a focused differential diagnosis.

Medical and Psychiatric History of a Normal Client

There is no medical and psychiatric history of a normal client. she doesn’t have any

surgery in his past.

Informal Assessment

During the session the client was thoroughly observed. she was co-operative and

confident. Apparently he seemed to be good in maintaining conversation and well groomed.

Throughout the interview the client was observed keenly and no sign of any pathology was

observed by informal behavioral observation. she was sincere and seemed to be hardworking.

Her relationship with his family is stable which indicate his balance personality and healthy

nature.
Interpretation of the MMSE
Quantitative Interpretation
Neurological patient
The total score of the patient was calculated
total 10 out of 30. This score is below in the
cut-off scores of 23, which indicates severe
cognitive impairment in the subject.
Healthy subject
The total scores of the subject are found to be
29. As this score are above the cut-off scores
23, it may be said that the patient is well
oriented and unimpaired.

Comparison of responses of Neurological patient and healthy subject on MMSE

Category Patient of Epilepsy Healthy subject

Orientation of time 2/5 5/5
Orientation of place 2/5 5/5
Immediate recall 1/3 3/3
Attention, calculation 1/5 5/5
Recall 1/3 2/3
Naming 2/2 2/2
Repetition 0/1 3/3
3 stage command 1/3 1/1
Writing 0/1 1/1
Reading 0/1 1/1
Copying 0/1 1/1
Total scores 10/30 29/30

Qualitative Interpretation

Neurological patient Healthy subject

The patient was not cooperative throughout the The subject was a confident female who took
assessment session. She was little disoriented the test with much curiosity. She was perfectly
to the time, responding correctly only to the well-oriented with respect to time and place.
items indicating the patient’s orientation to She performed well on the test registration and
place as well. This indicates that she was calculation, making no errors, which indicate
disoriented with respect to time, place and that the short-term memory of the subject is
person. intact.
She could not perform well on category of Her recall was intact, and she could not easy
registration of three items, requiring only a repeat the object learned initially in
single trial. registration. This indicates the absence of
The subject could not perform the attention and short-term memory deficits. The
mathematical calculations of serial-sevens. subject’s language repetition skills were also
She failed the test of attention as well. This good. She also performed on the test of stage
indicates that she may be suffering from commands, reading, writing, and copying. This
attention deficits. she failed to recall and repeat indicate that cognitive functioning of the
and recall the objects name initially registered subject is intact. the overall performance of the
within a single trial and was unable to produce subject indicates the absence of cognitive
them at all. This indicates that his short-term impairment.
memory and attention deficits affected her
ability to recall the learned items. the patient’s
language and repetition abilities were intact
however, a single error was made on the
language sub test. She also performed little
poorly on the stage command test that shows
she was little able to follow commands and
instruction due to some attention deficits. She
was unable to perform well on reading test due
to complaints of bullered vision.
She scored zero on the test of writing and
copying. She could not write well as a result of
lack of coordination and the overlapping
pentagons were copied in a highly distorted
from which may indicate impairment in the
vision perspective abilities in the subject. the
overall performance the subject indicated
disorientation, with deficits in attention and
perception.

Interpretation of CDT

The subjects were presented a blank sheet of paper and were asked to draw a clock with hands
showing time of half past ten. The drawn clocks were interpreted according to 10-point scoring
system proposed by.
Quantitative Interpretation.

Neurological patient Healthy person

The scores of the patient was found to be 5. The total scores of the subject was found to be
This score is well above the cut-off scores 1 1. therefore, it may be said that the subject is
that indicated severe cognitive impairment in cognitively unimpaired.
the subject.

Qualitative Interpretation.

Neurological patient Healthy subject

The subject was unable to make a complete The healthy subject drew a proper circle and
circle, big enough to place the numbers. She placed the numbers at appropriate positions.
was unable to recall the numbers, and place Time display was also correct. The total score
lines instead of the proper digits. She gave up of the subject was found to be 10. this is a
the halfway during this task, and reported that, perfect score. therefore, it may be said that the
she could not remember anything about the subject is cognitively unimpaired, and his
clock. Therefore, the scores of all quadrants memory and executive functioning is intact.
and the display of the correct time were scored
as zero. The total score of the patient was
found to be o out of 10. This score indicates
severe cognitive impairment in the subject.
The CDT is especially sensitive to
abnormalities in the parietal lobe and the
subject’s poor performance reflected the fact.

Interpretation of BGT.

Quantitively Interpretation.

Neurological patient Healthy subject.

Client scored 7 which is above than that cut-off Healthy subject scored 1 which is indicating
score 5. It indicates that the client is suffering that no neurological disorder is present.
from severe cognitive impairment.

Qualitative Interpretation.

Neurological patient Healthy subject

The subject was unable to complete the given The subject completed the given task properly
task appropriately. She was unable to recall the and accurately. Therefore, it may be said that
figures appropriately, errors of rotation, he has not any kind of memory retention
overlapping difficulty, fragmentation, deficits and cognitive impairment and has
retrogression, motor Inco-ordination, cognitive functioning intact.
angulation were committed by the subject.
Therefore, it may be said she has some kind of
memory retention deficits and has cognitive
impairment and her memory and cognitive
functioning is not intact.
 Chapter#4

.
Discussion and Conclusion
Discussion
After the scoring of the test, one of the normal and one of the patient of seizure disorder a
marked difference was found in between performance of both client and a normal person.
In epilepsy Patient, stress is the most common self reported trigger for seizures. Recently
some studies have been done, to try to uncover why this is. Scientist have long thought that stress
play a role in epileptic seizures and new evidence suggest that epilepsy patient who believe this
is the case experience a different brain response when faced with a nerve wracking situation.
Researches from the university of Cincinnati performed functional MRI during a stressful
math exercise on sixteen epilepsy patients who pegged stress as a factor in their seizure control
and seven patients who did not, those who perceived stress to have an impact on their epilepsy
showed greater brain activation then the other during intimidating part of the test. (James Selph,
2016) In the present case the MRI report suggest the over activity of different brain areas during
the stressful activities as client was suffering from financial crises.
A study conducted by Andree Delahaye-Duriez et al (2016), showed that an abnormal
clock drawing may suggest executive cognitive dysfunctioning and should prompt further testing
or referral. In the present case the subject also had drawn the clock with great difficulty and
problems it might suggest disturbance in the executive functioning of the subject.
It was evident that an epilepsy results in hippocampus damage. The function of
hippocampus is in memory. (James Selph, 2016) In the present case the client was also unable to
recall her previous events and she also remained in state of temporary confusion.
Conclusion
Several laboratory tests were included in neurological examination of the patient. The
evidence of damage in frontal lobe was found. The results of MRI and CT-Scan showed that
there was severe damage in the frontal lobe of the patient. Various other tests were done for the
further neurological evaluation.
 Chapter#5
Limitations and Suggestions
Limitations
 The case was conducted in few sessions which were not enough to gather sufficient
information related to disorder.
 As the client was hospitalized so she takes tranquilizers and other drugs. This effect the
performance and mental status of the client on the test.
 Only one test was administered on the client. This test measures only. This also measures
psychological disturbance due to neurological disorders. More tests would have provided
better information of a client’s mental state.
 The sample was limited. Only one subject is taken from the normal population and her
cognitive ability is compared with that of the neurological patient. It is not necessary that
all the subjects who belong to a normal and healthy population show good performance
on test. Even a normal person could show poor performance because of many reasons.
Suggestions
 The sample size should be larger. At least five subjects should be taken from normal
population and performance of each individual must be compared with another person
and neurological patient.
 Besides the administration of performance test some psychological test such as MMPI,
anxiety scale, Beck’s depression inventory etc should be applied in order to determine
psychological impact of illness and disease.
 There should be well developed rapport with the client so that she would provide
extensive and intensive information without any hesitancy.
 The purpose of the study should be beneficial rather just to focus on the performance of
the client.
 Chapter no 5

REHABILITATION

Epilepsy patients may need to adjust certain elements of their lifestyle, such as recreational

activities , education occupation or transportation, in order to accommodate the unpredictable

nature of their seizures.

Anticonvulsant drugs are the most commonly prescribed treatment for epilepsy. The fundamental

treatment that essentially every patient receives is medication. There are more than 20 epileptic

drugs available in the market, including. Most side effects of anticonvulsants is relatively minor,

including fatigue, dizziness, difficulty thinking, mood problems or allergic reactions.

Clobazam (onfi)

Clobazam helps prevent absence, secondary, and partial seizures. It belongs of drugs called

benzodiazepines. These drugs are often used for sedation, sleep, and anxiety.

According to the Epilepsy Foundation, this medication may be used in children as young as 2

years old in rare cases, this drug may cause a serious skin reaction.

Diazepam (valium, Diastat)

Diazepam is used for treat cluster and prolonged seizures. This drug is also a benzodiazepine.
References

Andree Delahaye-Duriez et al, Genome Biology, 2016; 17 (1)

Kate Wighton New epilepsy gene network identified by scientists retrieved from

http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssumma

ry/news_12-12-2016-17-14-54

James Selph. Juvenile Myoclonic Epilepsy. Medscape Reference. June 24, 2016;

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