Dr. Blitshteyn opined that A.M.'s clinical symptoms are consistent with ALE. Tr. at 16-17. She reached this diagnosis after examining A.M.'s complete clinical picture. Clinically, Dr. Blitshteyn noted the following evidence in reaching her diagnosis: (1) A.M.'s localized damage to the limbic structures within the left temporal lobe and hippocampus; (2) A.M.'s severe seizures and post onset memory impairment and behavioral changes; (3) MRI, EEG, and biopsy findings revealing abnormalities in the temporal lobe; and (4) the treating physician's extensive tests ruling out other causes. Tr. at 36-37, 165.
A.M.'s EEGs were consistently abnormal with initial EEGs revealing diffuse slow activity compatible with cerebral dysfunction. Tr. at 17-18; Pet. Ex. 4 at 266. Thereafter, her EEGs showed epileptiform foci in the left anterior temporal region, with occasional emanations from the right temporal region, demonstrating localization to the bilateral temporal lobes, left greater than right. Tr. at 18-19. As A.M.'s condition progressed, later EEGs showed multiple foci of her seizures as, by that stage, her seizures had become intractable and difficult to treat. Id. They took on a life of their own and emanated from multiple sources. Id.