Aniexty and seizures

[Heather81004]

Hi, Thank you for this site.  I will be 36 next week and in 1998 I was diagnosed and have been treated on and off since then for many different anxiety issues and depression.  Good years bad years, anyway, on Oct 5 of this year I woke with a very bad headache, which I am not acustom to I do not get headaches nor migranes, as the day went on, it became progressively worse. Which landed me in the emergency room.  Within days I was having approximately 10 - 30 seizures a day, I have been in the hospital more than I have been home including christmas week.  I have been through 2 regular eegs, sleep deprived eeg, spinal taps, mri, ct scans, my arms look like I am a serious drug user.... Anyway, I need to know can severe anxiety cause seizures??? They have told me that I have had many diagnoses on the different types of seizures that I have, but no one can tell me what is wrong, I feel like a rat already try this try that I am tired of trying all this I just want to end all this I just want to die already.      I have been on dilantain, midrin, high blood pressure medication, kappra, and adavan.  My normal medication was Klonopin and an anti depressant.  Well after having 23 seizures in one day, they immediately scheduled me with a sleep deprived eeg.  Since I got home and thoughts of suicide ran vividly through my mind because of the emotional, mental, physical stress I didn't want to live through this any longer.  I took myself off all my medications (I know not reccommended) and kept myself on my old medication.  The seizures seem to disappear. Until today. They are back, HELP what should I do, not my therapyst, not my nuerologist, no none can give my answers.  Can you advise  me in the right direction please.

[Ryan7591]

Have you ever, during the course of your life, experienced or witnessed an extremely traumatic event?

Examples...Witnessing a death, a severe auto accident, rape/mugged/attacked by someone, suffered from a serious illness...etc.

You need not cite what it is (if anything), and again the question is...have you ever experienced or witnessed an extremely traumatic event during the course of your life?

Anxiety cannot trigger seizure. The only instance where seizures could be provoked is if anti-anxiety medicine is discontinued abruptly. Otherwise, the answer is NO.

Post-traumatic stress disorder, on the other hand (which contains features seen in anxiety disorders,) may induce a serious condition known as Conversion Disorder. Pseudo-seizure is the #1 presenting symptom. They are NOT induced from any known organic disease process, but rather from emotions converted into seizures by the mind. This is a maladaptive coping mechanism used by the mind to deal with severe trauma.

I can render no additional comments without having more information from you.

-Ryan

[Heather81004]

Hi,
Yes, I have had pts for years.  If you could ask me more specific questions it will be easier for me to answer.  

I have been raped several times, went through 2 very abusive marriages.  One of my ex husbands killed my child by hitting me in the tummy when I was 5 months pregnant.  I watched my aunt die in a car accident,. I was diagnosed with post traumatic stress since 98 as well. I have panic attacks, major depression, anxiety. At the beginning of the year last year i was in a very bad skiing accident which left me out of work for 6 months.  When I was young my mom (which I was born with a silver spoon in my mouth) I was severally addited to several types of major narcotics.  Which upon of the findings of my first daughter who is turning 18, I have not done any narcotics, I have experimented with pot every now and again but not a habit.  

I have supported 2 girls completely by myself for the last 13 years with no contact from thier father ony when its convient to him, which he is still a meth head, so i protected my children from him. Never stop visitation from him seeing them he chose not to and recieve no child support.

My mother has disowed everyone in her family, her mom and dad, her brothers, my father, myself and my brother she has a relationship with. I do not live a fairy tale life though I wish I did,.  I had a friend call my mom after my stroke and the seizures, and she told him that she wants nothing to do with me or my life that she doesn't have time for me or anything about me.  And this was due because I was dating a man whom she adored, but things went terribly wrong after my knee surgery and he stole 10,000 out of my bank account, and borrowed  5,000 from her.  My girls witness him trying to kill me while doped up on medication she shoved mini muffins in my mouth and thank goodness my daughter walked in just in time. But he lied to her about everything that was going on getting money from her left and right and, told her so many different things. The breaking point was on mothers day when my youngest girl of 13, confronted him about a conversation that she over heard and he told her that I should give her away that all of our problems were here fault.  My kids are really good kids, I am not just saying that either, they are very respectful.  At that point I told him to leave my home and that when he started having these conversations with my mom.  My mother at that time, took his side and still remains a relationship with him. I begged her to please stop and please leave him out of it.  to please do not involve my girls in her childish behavior.  She till this day will try to get information from them about me. I asked her several times to please stop via email. But she still continues.

And I try to maintain an executive managment postion at a major corporation.  I am absolutely lost. Because of my medical leave of absence, we didn't even get to celebrate christmas at all, and to top it off it was my birthday yesterday and didn't even get to celebrate it.  

I hope this helps in guiding me to the light, because every day I want to kill myself. But my girls need me and my oldest is graduating this year, I am trying not be selfish, however, I don't want to live like this anymore.

Thanks Ryan,
Hope to hear from you soon,.

[Ryan7591]

Dear Heather,

Your past social history is significant for multiple trauma(s), and your past medical history reveals seizures of uncertain origin. You've not received a clear-cut diagnosis regarding the specific type of seizures you are experiencing. It appears that you've had normal imaging of the head (negative CT and MRI), non-specific EEG findings, along with a normal lumbar puncture. That would tend to exclude organic disease as the basis for your illness. If your EEG findings were abnormal, they likely revealed fast beta wave activity, and slowed delta and theta wave activity (known as "fast and slow"). Such an EEG suggests disease, but is actually attributable to the use of Benzodiazepines, of which you took two (Ativan and Klonopin). These findings are not pathological and are of no known significance. The stroke is also questionable, unless there were clear-cut findings to prove beyond a doubt that it occurred.

In my opinion, your PTSD was not treated adequately, the overwhelming events of the past have caught up to you, and you have gone on to develop a conversion reaction as a means of dealing with the trauma. The concept behind conversion disorder is *dissociation*, a process whereby specific internal mental contents (memories, ideas, feelings, perceptions) are lost to conscious awareness and become unavailable to voluntary recall. The memories of the past become deeply repressed to the point where the mind no longer is able to process them consciously, but rather converts them into unconscious, physical manifestations. These are almost always neurological in nature (paralysis in a limb or on one side of the body, loss of sight in an eye, psychogenic seizures). These unconscious symptoms provide a mechanism for banishing anxiety-provoking, painful, unpleasant mental contents from consciousness.

A neurologist is likely to miss such a diagnosis, as your presenting symptoms could easily be misconstrued as pathological seizure and stroke (and, certainly, they suggest this). Neither is a particularly difficult diagnosis to make, and the fact that he is unable to render a diagnosis suggests that nothing is physically wrong with you.

What I would suggest that you do is schedule an appointment with a neuro-psychiatist, disclose your past social history surrounding the traumatic events (along with your current symptoms) and go from there. It is very important that you disclose everything, so that you may receive the best treatment.

In the mean time, the seizures can be partially controlled with Klonopin (Clonazepam). The effective dosage range for this condition varies from 1.5 - 4 milligrams daily. Your neurologist can titrate the dosage to the desired response.

Below is an article on conversion disorder, and the features associated with it...


Best of luck to you,

Ryan

[Ryan7591]

________________________________________________________________________

Background:

Conversion disorder is classified as one of the somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fourth Edition, Text Revision (DSM-IV-TR). Although defined as a condition that presents as an alteration or loss of a physical function suggestive of a physical disorder, conversion disorder is presumed to be the expression of an underlying psychological conflict or need.

The critical psychological conflict or stress may not be apparent initially, but it becomes evident in the course of obtaining a patient’s history: ideally, it is a psychological factor related symbolically and temporally to symptom onset. Conversion symptoms are presumed to result from an unconscious process. (Conscious/intentional production of physical symptoms is classified as factitious disorder or malingering.) Conversion symptoms are not considered to be under voluntary control, and, should not be explained by any physical disorder or known pathological mechanism (after appropriate medical evaluation).

Though classified with somatoform disorders including hypochondriasis and body dysmorphic disorder in DSM-III and DSM-IV, conversion disorder is classified as a dissociative disorder in ICD-10, keeping its long association with hysteria (Dissociative Disorders in DSM-IV). Clinical descriptions of conversion disorder date to almost 4000 years ago; the Egyptians attributed symptoms to a "wandering uterus." In the 19th century, Paul Briquet described the disorder as a dysfunction of the CNS. Freud first used the term conversion to refer to the development of a somatic symptom to help bind anxiety around a repressed conflict.

Pathophysiology:

Presenting symptoms can range far across the field of clinical neurology. Conversion reactions usually approximate lesions in the nervous system’s voluntary motor or sensory pathways. Symptoms most commonly reported are weakness, paralysis, pseudoseizures, involuntary movements (eg, tremors), and sensory disturbances. These losses or distortions of neurologic function cannot adequately be accounted for by organic disease. Functional MRI (fMRI) and transcranial magnetic stimulation (TMS) studies have shown different activation patterns in patients with conversion symptoms and healthy control subjects; this is in keeping with the "involuntary" nature of conversion symptoms. Patient's whose symptoms are limited to pain or sexual functioning are not classified under conversion disorder; likewise, patients already classified as demonstrating somatization disorder or schizophrenia are also not classified under conversion disorder.

Diagnostic criteria for conversion disorder as defined in the DSM-IV are as follows:

One or more symptoms or deficits are present that affect voluntary motor or sensory function that suggest a neurologic or other general medical condition.
Psychologic factors are judged to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit.

-The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).

-The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.

-The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder.

According to psychodynamic theory, conversion symptoms develop to defend against unacceptable impulses. The primary gain, that is to say the purpose of a conversion symptom is to bind anxiety and keep a conflict internal. A fairly transparent example would be leg paralysis after an equestrian competitor is thrown from his or her horse. The symptom has a symbolic value that is a representation and partial solution of a deep-seated psychological conflict: to avoid running away like a coward, and yet to avoid being thrown again.

[Ryan7591]

According to learning theory, conversion disorder symptoms are a learned maladaptive response to stress. Patients achieve secondary gain by avoiding activities that are particularly offensive to them, thereby gaining support from family and friends, which otherwise may not be offered.

Frequency:

True conversion reaction is rare. Predisposing factors include extreme psychosocial stress, and perhaps, rural upbringing. Some psychiatrists suspect that western society has incorporated Freudian notions of unconscious motivations and conflicts: conversion reactions have become too obvious to serve their purpose.

Incidence has been reported to be 11-300 cases per 100,000 people.
Cultural factors may play a significant role. Symptoms that might be considered a conversion disorder in the US may be a normal expression of anxiety in other cultures.
One study reports that conversion disorder accounts for 1.2-11.5% of psychiatric consultations for hospitalized medical and surgical patients.

Mortality/Morbidity:

Patients diagnosed with conversion disorder may go on to demonstrate serious, traditional medical illness. This has been happening less and less often over the years (29% in 1950s down to 4% in 1990s). Unfortunately, emergency physicians may find themselves sorting out new neurologic symptoms in settings of terrible time pressure: populations statistics may be of little reassurance for any specific individual.

Sex:

Sex ratio is not known although it has been estimated that women patients outnumber men by 6:1. This is of little help when evaluating an individual patient.

Age:

Conversion disorder may present at any age but is rare in children younger than 10 years or in persons older than 35 years.

In a University of Iowa study of 32 patients with conversion disorder, however, the mean age was 41 years with a range of 23-58 years.

In pediatric patients, incidence of conversion is increased after physical or sexual abuse. Incidence also increases in those children whose parents are either seriously ill or have chronic pain.

History:

Degree of impairment usually is marked and interferes with daily life activities. Prolonged loss of function may produce organic complications such as disuse atrophy or contractures.

-Weakness, paralysis, pseudoseizures, involuntary movements (eg, tremors), and sensory disturbances (eg, aphonia, deafness, blindness) are the most frequent complaints. Symptoms often enable patients to avoid an unpleasant situation at home or work, attract attention, or gain support from others. This may become evident through careful questioning.

The symptom must not be under voluntary control. Determining the symptom may be difficult, since it usually cannot be identified by observation. Features suggestive of voluntary control consist of variability, inconsistency, obvious and immediate benefit, as well as a personality that may suggest dishonesty and opportunism. Symptoms, if voluntary, tend to be self-limited and of brief duration.

La belle indifférence was considered a classic feature of conversion disorder. It is characterized by the inappropriate and paradoxical absence of distress despite the presence of an unpleasant symptom. Patients often deny emotional difficulty. Unfortunately, la belle indifférence, histrionic personality, and secondary gain are clinical features that appear to have no diagnostic significance. They can easily be absent in patients with conversion disorder; they can be easily be present in patients with traditional neurologic disorder.

Physical:

Absence of a physical disorder is an important diagnostic feature. Individuals with conversion disorder often have physical signs but lack objective neurological signs to substantiate their symptoms.

Weakness:

Weakness usually involves whole movements rather than muscle groups. Weakness affects the extremities more often than ocular, facial, or cervical movements.
With the use of various clinical techniques, weakness of one limb can be demonstrated to cause contraction of opposing muscle groups. Discontinuous resistance during testing of power or give-way weakness may exist. Muscle wasting is absent, and reflexes are normal.

Sensory symptoms:

Sensory loss or distortion often is inconsistent when tested on more than one occasion and is incompatible with peripheral nerve or root distribution.
Discrete patches of anesthesia or hemisensory loss that stop in the midline may be present. Classic dermatomes in patients with numbness usually are not followed.

Visual symptoms:

Visual symptoms include monocular diplopia, triplopia, field defects, tunnel vision, and bilateral blindness associated with intact pupillary reflexes.
Optokinetic nystagmus may be observed in patients with apparent blindness when exposed to a rotating striped drum.

Gait disturbances:

Astasia-abasia is a motor coordination disorder characterized by the inability to stand despite normal ability to move legs when lying down or sitting.
Patients walk normally if they think they are not being observed.
Occasionally, while being observed, patients actively attempt to fall. This contrasts with those patients with organic disease who attempt to support themselves.

Pseudoseizures:

During an attack, marked involvement of the truncal muscles with opisthotonos and lateral rolling of the head or body is present. All 4 limbs may exhibit random thrashing movements, which may increase in intensity if restraint is applied.
Cyanosis is rare unless patients deliberately hold their breath.
Reflexes (eg, pupillary, corneal) are retained but may be difficult to test due to tightly closed lids. Tongue biting and incontinence are rare unless the patient has some degree of medical knowledge about the natural course of the disease.
In contrast to true seizures, pseudoseizures primarily occur in the presence of other people and not when the patient is alone or asleep.

Causes:

True etiology is unknown. Most clinicians presume conversion reactions are caused by previous severe stress, emotional conflict, or an associated psychiatric disorder.
Many studies confirm high incidence of depression in patients with conversion disorder. As many as half of these patients have personality disorders or display hysterical traits.
In children, conversion disorder often is observed following physical or sexual abuse.
Children who have family members with a history of conversion reactions are more likely to suffer from conversion disorder. In addition, if family members are seriously ill or in chronic pain, children are more likely to be affected.

[Heather81004]

Wow that was a lot of information, are you in the medical field or just very knowledgeable.  With your permission may I please print out our discussions and bring it to my neurologist and my therapist?  You have given me more insite in a few days than in years...... thanks

[Ryan7591]

Hi Heather,

No, I'm not currently in the medical field. I had to drop medical school due to health issues and severe PTSD/panic disorder. I had entertained the thought of pursuing a BSN as of late, but refuse to settle for that. So, an electrical engineer I shall remain for all of eternity.

You are free to print anything you'd like on here. This is public domain. I wish you nothing but the very best. Keep us updated on your progress.

--Ryan