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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Cerebellar Atrophy and Sleep seizuresForum: Neurology Forum
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45 y/o f. Life history of petit mal seizures, grand mall since age 17. Last seizure 11 years ago. Ongoing and worsening peti mal. New onset 9 months ago of a sleep related seizure. This occurs during the waking process. Wake confused, combative.(witnessed) Symptoms increase in severity if I am woke unnaturally, for example by a noise or disturbance. Mental confusion very reminicent of GM seizure. If I attempt to go back to sleep, the seizure occurs just at the point of "dropping off" to sleep. At same time of onset, physical instability, feeling out of step, slightly of balance with many mis-steps though out the day. There is a constant rumbling sensation throughout my body but especially when I wake or after one of these seizures. The sensation is much like being in a mild earthquake or on a large bridge that vibrates with heavy traffic. It is constant sensation. Tried lamictal for seizures but increased seizures. MRI showed cerebellar atrophy as compared to MRI ten years ago. EEG showed generalized and focal seizures. Dilantin 500mg QD for 30 years. Question: Is the ataxia due to the cerebellar atrophy, prolonged Dilantin use and will the ataxia progress? I am short on sleep because of the seizures which can occur up to 15 times per night. Your thoughts on this would be appreciated. RK.
= Cerebellar degeneration is the most common cause of ataxia, so if you have obvoius cerebellar disease on an MRI scan and these new symptoms they are almost certainly linked. Chronic dilantin use is one of the most common causes of cerebellar degeneration. The sequence of events would appear to be Dilantin causing cerebellar degeneration causing ataxia. This will probably continue to worsen as long as you are taking dilantin, since your seizure control is currently so poor you probably need to change medication at this point in any case. Your epilepsy is obviously difficult to control and you may need to be seen by a neurologist who sub-specializes in epilepsy, there are a number of new drugs availabble in the last few years and if at all possible you need to switch to one of these.
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