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Neurology (Expert Forum)
Temporal Lobe Seizures
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Temporal Lobe Seizures
by wondering, Dec 07, 1999 12:00AM
Thank you for your time.
I have had complete urinary retention for four years. Sometimes termed neurogenic bladder, sometimes termed atonic. I self cath.
I am late thirties and female. Three births. Hysyerectomy this year because of severe pain after a conization left the cervix too narrow for normal menstruation. I am left with one ovary.
I also have what are termed by different Dr.'s as temporal lobe seizures, migraine-epilepsy syndrome and basilar migraine. Was also told I have thoracic outlet syndrome. They started in approx. '93 and have evolved from absence type-seizures to involing involuntary movements mostltly of the left side. Facial distorion and arm movement painful muscle tightening and movement of my head. It moves mostly to the left also. I have had EEG with temporal lobe spikes although the Neuro says these were small or perhaps only one?. (the tests were at least three years ago) Phenobarbitol has cut the severity of the attacks in half but not the frequency. I have at least two a week. I get an aura. sometimes up to an hour before hand I feel sick to my stomach or a few minutes beforehand I will feel drugged, sleepy or just plain absent.It is a distorted feeling.
Also this year I was diagnosed with Fibromyalgia. My shoulders and back (all the way down) are in an almost constant state of spasm. I am currentently treating this with meds and massage but always comes back.
Two major questions I have are these.
1) In all the time that I have had atonic bladder, I NEVER lost any urine accidently. This month it happened while I was sleeping. I had a seizure before bed and then woke up in the night and had incontinence (a lot) while sleeping. This frightened me.Once again I lost a small amount during seizure.
I saw a new Neuro who says his concern is stopping this seizures only and possibly upping my phenobarb dosage as well as starting me on a antihypertensive. No test except phenobarb levels were done. Nothing back yet. Doesn't it seem odd that the nature of the seizure/bladder condition would change so dramatically overnight? I had a brain MRI two years ago and was normal.
He said incontinence is normal with seizure and would not be concerned.
2)Also ,on two separate occasions this month my left hand has turned blueish purple. Especially the fingertips. It feels as though it is being pumped up with something. A very tightening feeling along the inside of my left arm and hand along pinky and ring finger especially if I attempt to extend the arm from the side of my body. feels as though the tendons have shortened or are being far too strethed with only gentle exention. it subsided with a half an hour. I took photos to show the difference in my hands. I have yet to show the doctor. The Dr. who was on call stated that as long as I had a pulse, I was fine. I do not call Dr.s when I have "hangnail" type problems. I am curious what your take may be given the information provided. I have posted before and I thank you for your kindness in offerring this service.
I will tell you now I have had urodynamic studies and have been MRI'd for appearance of tethered cord and there is also no cervical rib. What do you think?
Thank you again for your kind time and consideration.
I have had complete urinary retention for four years. Sometimes termed neurogenic bladder, sometimes termed atonic. I self cath.
I am late thirties and female. Three births. Hysyerectomy this year because of severe pain after a conization left the cervix too narrow for normal menstruation. I am left with one ovary.
I also have what are termed by different Dr.'s as temporal lobe seizures, migraine-epilepsy syndrome and basilar migraine. Was also told I have thoracic outlet syndrome. They started in approx. '93 and have evolved from absence type-seizures to involing involuntary movements mostltly of the left side. Facial distorion and arm movement painful muscle tightening and movement of my head. It moves mostly to the left also. I have had EEG with temporal lobe spikes although the Neuro says these were small or perhaps only one?. (the tests were at least three years ago) Phenobarbitol has cut the severity of the attacks in half but not the frequency. I have at least two a week. I get an aura. sometimes up to an hour before hand I feel sick to my stomach or a few minutes beforehand I will feel drugged, sleepy or just plain absent.It is a distorted feeling.
Also this year I was diagnosed with Fibromyalgia. My shoulders and back (all the way down) are in an almost constant state of spasm. I am currentently treating this with meds and massage but always comes back.
Two major questions I have are these.
1) In all the time that I have had atonic bladder, I NEVER lost any urine accidently. This month it happened while I was sleeping. I had a seizure before bed and then woke up in the night and had incontinence (a lot) while sleeping. This frightened me.Once again I lost a small amount during seizure.
I saw a new Neuro who says his concern is stopping this seizures only and possibly upping my phenobarb dosage as well as starting me on a antihypertensive. No test except phenobarb levels were done. Nothing back yet. Doesn't it seem odd that the nature of the seizure/bladder condition would change so dramatically overnight? I had a brain MRI two years ago and was normal.
He said incontinence is normal with seizure and would not be concerned.
2)Also ,on two separate occasions this month my left hand has turned blueish purple. Especially the fingertips. It feels as though it is being pumped up with something. A very tightening feeling along the inside of my left arm and hand along pinky and ring finger especially if I attempt to extend the arm from the side of my body. feels as though the tendons have shortened or are being far too strethed with only gentle exention. it subsided with a half an hour. I took photos to show the difference in my hands. I have yet to show the doctor. The Dr. who was on call stated that as long as I had a pulse, I was fine. I do not call Dr.s when I have "hangnail" type problems. I am curious what your take may be given the information provided. I have posted before and I thank you for your kindness in offerring this service.
I will tell you now I have had urodynamic studies and have been MRI'd for appearance of tethered cord and there is also no cervical rib. What do you think?
Thank you again for your kind time and consideration.
Doctor's Answer
by CCF Neuro[P] MD, RPS, Dec 09, 1999 12:00AM
Dear Wondering:
Sorry about your epilepsy. Phenobarbitol is not the medication we usually use for temporal lobe epilepsy. You might want to investigate whether another medication such as tegratol might be more beneficial and also help with the fibromyalgia. Your physician is correct in that when seizures generalize they can and often do cause incontinence (even in patients with a neurogenic bladder). Thoracic outlet syndrome involves two types, one is vascular and really is a medical emergency and needs to be dealt with by a vascular surgeon. The other is neurogenic and is truely over-diagnosed. Unless it is EMG confirmed, it doesn't exist. Your vasoconstriction might be due to various things and I would see your neurologist about what might be causing this condition.
Sincerely,
CCF Neuro MD
Sorry about your epilepsy. Phenobarbitol is not the medication we usually use for temporal lobe epilepsy. You might want to investigate whether another medication such as tegratol might be more beneficial and also help with the fibromyalgia. Your physician is correct in that when seizures generalize they can and often do cause incontinence (even in patients with a neurogenic bladder). Thoracic outlet syndrome involves two types, one is vascular and really is a medical emergency and needs to be dealt with by a vascular surgeon. The other is neurogenic and is truely over-diagnosed. Unless it is EMG confirmed, it doesn't exist. Your vasoconstriction might be due to various things and I would see your neurologist about what might be causing this condition.
Sincerely,
CCF Neuro MD
I am not on Tegretol because of a severe allergy/toxicity problem I had with it last year that landed me in the hospital for a week. Tegretol and Mono were found to be the cause. I had pancytopenia. I was on Tegretol for three weeks pryor. Temp went to 104 and had a bad rash.
I have tried Depakote wich made me feel ill all the time so phenobarb was then tried. My current level is 42 for phenobarb.
My Neurologist was not overly concerned with the vasoconstriction and stated simply that he did not know what might cause this. He felt that my theory of the neck and shoulder spasming so badly could not be causing it to happen, His report,although, stated that I had "severe" spasming of the neck and shoulder region. I am seeking second opinion shortly.
Would you advise that I ask for an EMG? Why would a Neurologist NOT do one in the face of all these difficulties? Any danger? What other reason might cause the problem with the hand turning color and becoming painful besides the TOC?
Thank you for your response.
I am not on Tegretol because of a severe allergy/toxicity problem I had with it last year that landed me in the hospital for a week. Tegretol and Mono were found to be the cause. I had pancytopenia. I was on Tegretol for three weeks pryor. Temp went to 104 and had a bad rash.
I have tried Depakote wich made me feel ill all the time so phenobarb was then tried. My current level is 42 for phenobarb.
My Neurologist was not overly concerned with the vasoconstriction and stated simply that he did not know what might cause this. He felt that my theory of the neck and shoulder spasming so badly could not be causing it to happen, His report,although, stated that I had "severe" spasming of the neck and shoulder region. I am seeking second opinion shortly.
Would you advise that I ask for an EMG? Why would a Neurologist NOT do one in the face of all these difficulties? Any danger? What other reason might cause the problem with the hand turning color and becoming painful besides the TOS?
Thank you for your response.
I still would not use phenobarbitol in a normal functioning adult. But there are various ways to treat illness and I would follow what your neurologist has you on. I would not get an EMG as you do not describe the symptoms of neurogenic thoracic outlet syndrome.
CCF Neuro MD
I did not assume that up to six seizures a week would be thought of as anything near normal. I also understand that these Dr.'s here are trying to control an abnormal situation and are doing the best they can as you stated.
Phenobarbitol can be very sedating, especially in an adult. People do get use to it and there are some adults on this medication that are considered normal intelligence. It is an older medication and so the management is well known. It covers a wide variety of seizure types. However, we know that it is a mitochondrial poison. It affects many other types of medications. But again, you are being managed by someone else and they are undoubtly doing what is best for you.
Sincerely,
CCF Neuro MD
Thank you again.