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Neurology (Expert Forum)
Simple Partial Seizures and medication
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Simple Partial Seizures and medication
by Elisabeth, Sep 08, 2006 12:00AM
When I was 19 I began having complex partial seizures and had an EEG that showing spiking in the left parietal lobe. After trying four medications my seizures were well control with Gabitril (meaning nonexistant!) and at 21 I stop all seizure medication. I'm now 27 and have had OCD since childhood and have been taken Prozac (50 mg) since last spring. I'm doing well and feel that I'm getting my anxiety and depression under control. My question is this...In mid-August I I woke up in the middle of the night with sharp pins and needles in the right arm, mild numbness in this arm, and numbness around my mouth. I asked my Psychiatrist if this could be due to the recent increase in Prozac and she said that it's a possability but I should see my GP to rule out any medical problems. My GP referred me to a neurologist who after taking my history (he did not really examine me....) said that he couldn't rule out that I had had a simple partial seizures and offer to re-start medication sue to the fact that I'm commuting and loosing my liesnce would be a big problem. He offer to restart Gabitril or try out Keppra. I decided to try Keppra and a month later I was doing okay on it but decided to discontinue because I was still only taking one pill (250 mg) and was really sleepy all the time. My question is this.... what is your opinion about me re-trying Gabitril? I am somewhat reluctant to take an anti-convulsant when I only had one "episode" and have not other complaints since then.
Thank-you!
Elizabeth
Thank-you!
Elizabeth
Doctor's Answer
by CCF-Neuro-M.D.-SH, Sep 09, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe of numbness/tingling on your right side at night is consistent with possible recurrent seizures from your left parietal lobe. The left parietal lobe is the area the brain that contains the primary somato-sensory area (touching/feeling area) that serves the right side of the body (it is crossed). Seizure activity often occurs at night and seizures, especially partial seizures go unrecognized. Unfortunately, these partial seizures can spread at times to become a larger seizure (Generalized tonic-clonic/ grand-mal). Anti-epileptic drugs help protect the brain from seizure spread. I suspect that you are having more of the seizure episodes (in your sleep) than you know. I would restart the Gabitril (if it worked for you in the past), for now. Most improtantly I would recommend that that you get an EEG (electro-encephalogram, or "brain-wave test"). The initial EEG is often 20 minutes. If this is not revealing I would suggest a 2 hour, sleep deprived EEG with sleep. On occasion, patients need to have EEG monitoring (3-7 days) in an epilepsy monitoring unit. I would recommend this for you, because you could go to sleep, and your neurologist would be able to tell if you are having additional seizures in your sleep. I would also see a epilepsy specialist neurologist in a major medical center. There are many options for epileptic patients now that were not availible in the past. I would also suggest a high resolution MRI (with MP RAGE sequence) to evaluate for a source of your seizures (for example: cortical dysplasia, tumor, vascular malformation, etc., or may be normal).
I would caution you against driving, swimming alone or heights until this issue is resolved. If one of your seizures spreads, you could endanger your life, as well as your loved ones and innocent strangers. If your seizures are known to be controlled (6months in some states, 1 year in others) then driving is permitted.
I hope this has been helpful.
The symptoms you describe of numbness/tingling on your right side at night is consistent with possible recurrent seizures from your left parietal lobe. The left parietal lobe is the area the brain that contains the primary somato-sensory area (touching/feeling area) that serves the right side of the body (it is crossed). Seizure activity often occurs at night and seizures, especially partial seizures go unrecognized. Unfortunately, these partial seizures can spread at times to become a larger seizure (Generalized tonic-clonic/ grand-mal). Anti-epileptic drugs help protect the brain from seizure spread. I suspect that you are having more of the seizure episodes (in your sleep) than you know. I would restart the Gabitril (if it worked for you in the past), for now. Most improtantly I would recommend that that you get an EEG (electro-encephalogram, or "brain-wave test"). The initial EEG is often 20 minutes. If this is not revealing I would suggest a 2 hour, sleep deprived EEG with sleep. On occasion, patients need to have EEG monitoring (3-7 days) in an epilepsy monitoring unit. I would recommend this for you, because you could go to sleep, and your neurologist would be able to tell if you are having additional seizures in your sleep. I would also see a epilepsy specialist neurologist in a major medical center. There are many options for epileptic patients now that were not availible in the past. I would also suggest a high resolution MRI (with MP RAGE sequence) to evaluate for a source of your seizures (for example: cortical dysplasia, tumor, vascular malformation, etc., or may be normal).
I would caution you against driving, swimming alone or heights until this issue is resolved. If one of your seizures spreads, you could endanger your life, as well as your loved ones and innocent strangers. If your seizures are known to be controlled (6months in some states, 1 year in others) then driving is permitted.
I hope this has been helpful.
The issue here is you are a case of a complex PS who failed more than 3 AED in the past (Called a refractory case) and you had a clear focus on the EEG.
I'm not sure if those seizure were at night also and similar to this one? if it was, then simply you may have not been free of seizures and you may continued to get them while you were asleep.
Plus the SSRI like prozac lower the threshold of seizure occurance.
I suggest a refferal to a specialized center to do a full investigations including a 24hr video EEG and MRI with epilepsy protocol and a disscussion for any other therapeutic options!.
About to go back to Tigabine instead of kepra? my openion, kepra is a better mood stabelizer on top of its AED, but generally for your information that the AAN (american academy of neurology) practice parameters are as follows for a refractory simple seizure:
1-Lamotrigine can be used as monotherapy
2-There is insufficient evidence to recommend gabapentin, levetiracetam (Kepra), tiagabine, zonisamide, or pregabalin as monotherapy for refractory partial epilepsy.
Hope this is helpful
Bob
did anyone ever discuss with you a connection between OCD and seizures? I don't know if there is, but I'm just asking. My daughter had OCD-like behaviors when she was very young, which went away. Now over four years later, she complained of intrusive thoughts. I just that it was OCD coming back. Instead she complained of silly, changing thoughts that made no sense. They interrupted what she was doing, but she was fully conscious and was more annoyed than anything else. Her neuro thinks it's simple partials. she has no other seizure symptoms and she has no other OCD symptoms. Last month, at the time she had these thoughts at the most, she had trouble falling asleep and when she did, her dreams were vivid. Her menses was off too.
I don't know what your OCD is like or if your partials were of a sensory type, but did you ever experience these thoughts? Had your partials ever spread to a complex seizure or grand mal before meds?
dreamersmom
Elizabeth
Every now and then, she says a "thought" interrupts what she is doing. It has no bearing on what her task is...watching tv, walking, writing. The thought was the same at first (her special toy) and later it could be anything. All she knows is that out of no where, her mind insists on trying to remember something. Did you ever get that feeling of frustration when you're trying to remember a face or where you put something? so she'd see the toy and her brain felt like, "what about that toy????" It is brief, she if fully conscious, can talk to you and perform a task as well (like changing channels) and only feels slightly dizzy. Then it's gone and she goes on her merry way. When she was younger, she had alot of anxiety, and a medication they put her on for motion sickness gave her full-blown OCD. When the medication stopped, the OCD was gone. Five years later, she remains fastidious and can be obsessive about her interests, but the anxiety level is minimal. When she initially told me about the "toy vision" I assumed it was OCD. Then I thought she was tired or hungry. She seemed annoyed by these disruption. The neuro thinks they are simple partials and she is being tested. I am very concerned about giving her meds that will spark OCD, so I'm very worried about making the proper decision. Since it affected "memory" and had the same sensation as deja vu, it seemed more simple partial than intrusive thought. that's why I am confused now.
dreamersmom