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Neurology (Expert Forum)
Normal eegs
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Normal eegs
by 2112, Sep 23, 2006 12:00AM
I am a 32 year old female that had no medical history untill 2 years ago. I was in a accident where I was knocked out for 30 minutes or so. CT, mri, and all other tests have been negative. I noticed about 2-3 months after the accident I had a hard time keeping track of time. I would become confused, and lost. I would wake up and find my self on the ground, not know how, I got there, where I was, or who I was. I went to a neurologist, because my pcp thought I might be having seizures. I had a extended eeg, and was in the hospital for 5 days. Nothing showed up, so he said that he didn't think I was having seizures, but couldn't be sure, and to continue taking tegretol. I think I am losing my mind and have seen psychologists and psychiatrists hoping they can help me figure out my problem. They all have said this is a neurological problem, and there is not much they can do for me. I discontinued the tegretol, because it was hard to function, while taking it. I was confused more often, so I got a second opinion. This neuro said that he thought the confusion was caused from seizures, and put me on depakote. My question is why if my eeg was normal, why am I still being told this could be seizures? I was monitored for 5 days wouldn't have something showed up? I havn't been as confused or disoriented since starting the depakote, but these thing do still happen every so often. Is there anything I should do to keep these "event" from happening? Any info is apprchiated.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Sep 28, 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 are consistent with seizures. When the head encounters trauma, such as a car accident, there are typical places that are injured, the anterior frontal lobes (behing your forehead/eyes) and the tips of your temporal lobes (behind your ears). Also there can be diffuse injury to the axons (wires) in the brain called diffuse axonal injury (DAI) and may give rise to confusion, headaches, and personality cahnges. The ddamage to the temporal/frontal lobes can be to small to see on MRI, but can still give rise to epilepsy. The difficulty in diagnosing these conditions is that the seizures/epilepsy may not show up on the EEG, unless you have a spell while hooked up to the wires. Often when people are brought in for an extended EEG, they may not have their spell and require a second visit. Sometimes sleep deprivation and photic stimulation may be of help to produce a spell. I am glad you are feeling beeter on Depakote, but I would advise caution with this medication. It has the highest rate of brith defects and often has unwanted side effects such as weight gain, hair loss, and fatigue. You may try other medications such as lamictal or Keppra, which seem to be associated with less side effects and may be a effective as depakote in some people. If you need to continue on Depakote I would recommend that you take 1mg Folate daily, and carnitine to help with the side effects. You should also talk to your neurologist about any plans to have children. Another thing that may be helpful is to get a PET scan, which can often show areas that are damaged and may give rise to seizures.
I hope this has been helpful.
The symptoms you describe are consistent with seizures. When the head encounters trauma, such as a car accident, there are typical places that are injured, the anterior frontal lobes (behing your forehead/eyes) and the tips of your temporal lobes (behind your ears). Also there can be diffuse injury to the axons (wires) in the brain called diffuse axonal injury (DAI) and may give rise to confusion, headaches, and personality cahnges. The ddamage to the temporal/frontal lobes can be to small to see on MRI, but can still give rise to epilepsy. The difficulty in diagnosing these conditions is that the seizures/epilepsy may not show up on the EEG, unless you have a spell while hooked up to the wires. Often when people are brought in for an extended EEG, they may not have their spell and require a second visit. Sometimes sleep deprivation and photic stimulation may be of help to produce a spell. I am glad you are feeling beeter on Depakote, but I would advise caution with this medication. It has the highest rate of brith defects and often has unwanted side effects such as weight gain, hair loss, and fatigue. You may try other medications such as lamictal or Keppra, which seem to be associated with less side effects and may be a effective as depakote in some people. If you need to continue on Depakote I would recommend that you take 1mg Folate daily, and carnitine to help with the side effects. You should also talk to your neurologist about any plans to have children. Another thing that may be helpful is to get a PET scan, which can often show areas that are damaged and may give rise to seizures.
I hope this has been helpful.
The only way to diagnose a seizure properly is for the patient to have one while undergoing an EEG. Because you didn't have a seizure for five days, the doctor concluded you /probably/ weren't suffering from seizures. All a negative EEG tells you is that you didn't have a seizure during the time you were hooked up. Such a diagnosis cannot be considered statistically strong if your symptoms are intermittent (i.e. your symptoms occur at intervals sometimes greater than five days). If you did unambiguously experienced confusion, being lost, etc., during the EEG, and nothing showed up, then seizures can probably be safely ruled out. Considering your past brain trauma, I'd bet something is wrong.
EEG's are notoriously tricky to read, and one doctor's opinion of "normal" can vary quite a bit from another's. Unless you are having active seizures, it can be very difficult for the doctor to diagnose many different problems, especially if the problem is isolated to a small area. It can also be difficult to pick up widely diffuse but otherwise relatively minor afflictions.
Just keep working with your doctor, and keep track of anything out of sort.
Best of luck!