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Age and onset of seizures
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Age and onset of seizures

I have just turned 28 and have suffered two mild seizures in the last two months. I am now trying to learn all I can about my situation, scheduling tests, and so forth. But if it's epilepsy that I have, wouldn't I have started having seizures at a much younger age? Thank you very much for any information you can give me on this issue.
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Dear Ruth:

I am sorry to hear about your seizure events.  By definition, 2 or more afebrile seizures in a person is considered epilepsy.  Were your seizures generalized or did they start in one area of the body?  What did the EEG show?  Did you loose consciousness?  I think it would be of value to you and to figure out the etiology to make sure you see a neurologist, preferable a epileptologist. The important thing is to figure out the etiology and then treat with the proper medicaitons.  There are many reasons for seizure events, some are age related.  It will be best to see your neurologist.

Sincerely,

CCF Neuro MD
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Ruth,
I definately understand what you are going through. At age 23, I experienced several grand mal seizures on the way to work.   I had never experienced anything like this before.  The worst I had ever had was bad migraines.  My EEG showed was abnormal and it was determined that I had epilepsy.  I had one additional seizure a month later - I had allergic reactions to the medication and they believe the withdrawl (withdrawal) from the medicine caused the seizure. I haven't had a seizure since then.  I just stopped taking my anti-seizure medicine this past January and haven't had any problems.  My dr.told me that it wasn't that I just all of a sudden got epilepsy, but that the conditions were "right" at that time.  I was stressed, working long hours and even drinking occasionally.  He also mentioned that it was actually quite common for onset in the 20's.  it was a scary time, but it's important that you don't let it run your life.  I don't have any memory of the seizures.  It was actually much harder on my boyfriend.  Luckily he just happened to be driving me that morning when it all happened.  good luck and I wish you well.  If you have ANY questions/comments, please feel free to email me at s_sherd***@****.
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Thanks for the comment.

CCF Neuro MD
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Doctor,
You said that there are many reasons for seizure events, many age related. Maybe you could expound a bit... And am I understanding it right, more than 2 afebrile seizures is considered epilepsy? Is epilepsy just a symptom then and not really a disease? Can it just stop?

  My 67 year old mom (very active, intelligent)came home from work one day and during a phone call stopped talking. When we got to her she was confused,had a headache, had difficulty finishing her sentences and had lost memory (seems the last 3-4 years were effected). The ER CT scan, lumbar puncture and cardiogram were fine, as was a later vascular study of the carotid artery. That first week she experienced "shocking sensations" in her head and seemed to have headaches that were relieved by lying down (due to lumbar puncture?) When we got her into a neurologist the EEG showed a lot of activity in her left temporal lobe. The neurologist immediately started her on Dilantin which seemed to help as it restored a lot of her personality and improved her short term memory. But she still had "loss of power" spells (seizures?) where she would not be able to speak and move for a few seconds and had not recovered her memory totally.
An MRI showed nothing.
A sleep deprived EEG showed lots of activity again.A lumbar puncture was repeated to test for encephalitis (they all came back negative for herpes and the viruses they could test for)
A second MRI was again normal. Lamictal (lamotrigine) was added and there was an initial improvement, but the "spells" continued.
Currently the Dr. is adding a third drug,topiramate, with the hopes of backing out of the Lamictal later.
     Today her EEG was much better, almost normal. But she is still experiencing the seizures (or loss of power spells). She never loses conciousness or is confused afterwards. But some of her memory is still off, as is her personality.
     The doctor told us that she is an unusual case. That it could still have been encephalitis, just a mild case that didn't show up on the MRI. Or it could be a small tumor inside the brain  that is just big enough to interfere with the neurotransmitters. Or a scar (from an injury anytime in her life) that is irritated.She has a follow-up MRI in 3 months.
     Here are my questions:  does this sound correct or can you think of anything else that could be causing this? Will we just have to wait it out and see? Is it possible that we will never know if it is encephalitis? I thought the doctor told me that he doesn't actually "see" seizures on an EEG but activity that could be seizures. Do these "loss of power" spells, that seem more frequent when she tries to move her legs or arms, sound like seizures? Are they petit mal seizures? Do older people just start having seizures because of an aging of the brain? Is the personality difference ( a sort of anxiousness, also almost a more "child-like" attitude...less patient, more petty- definitely uncharacteristic of her!!) possibly due to the drugs?
What is the role of stress in causing seizures (other than compromising your immune system for a possible virus) Of course, we are hoping that this will not be a permanent thing for her...
Thanking you for any insight you can give me,
Signed, Jacqueline, (a devoted but worried daughter)


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Dear Jacqueline:

Two afebrile seizures is epilepsy.  Epilepsy is a disease, with seizures as the symptom.  When children have epilepsy, there are several forms that they will outgrow the epilepsy.  An example is benign rolandic epilepsy, most get it around 4-12 years with almost all patients having resolution of their seizures by 16 yrs.  There are some, like juvenile myoclonic epilepsy that will never outgrow their epilepsy.  There are many, many types of epilepsy and many of these have age-related onsets.  The list is far to long to present here.  I would recommend going to the library and reading, the books are several hundred pages long so to reproduce them here is impractical.  

Before progressing, most of your questions should have been answered by the treating neurologist.  Since you have so many basic questions, there must be a communication problem.  If so, I would recommend that you arrange an appointment and discuss these issues with him/her.  The treatment of your mother depends on communication, and if it is not there, then your mother suffers.

Seizure activity coming from one side of the brain is called partial epilepsy.  Since she looses consciousness, it is called complex partial.  The seizure coming from her left temporal area is the reason for her memory loss.  This is the area of the brain that imprints our thoughts into memory.  This area can also effect the personality.  There is a form of epilepsy that can loss of motor function (atonic seizures), but to have it one sided is uncommon but does happen.  If her seizure activity is coming from the left side of her brain it should affect the right side of her body, unless she is generalizing (however, this would have shown up on the EEG, if the EEG was running when she had her spell).  The normal MRI is a good sign, some of the time it is tumor inducing seizure activity in this age group.  What it sounds like is that medications are being tried and pulled alittle quickly.  We have to increase lamictal very slowly and it takes several months before it reaches therapeutic levels. But obviously, I do not have all the details.  Unless the seizure activity is caused by a tumor, infection, systemic disease I am afraid that your mother will have epilepsy for the rest of her life.  Make sure the other possibilities are investigated.  

Sincerely,

CCF Neuro MD

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I have just about completed a workup for epilepsy with the only abnormal test finding by the sleep-deprived EEG (multiple temporal lobe firings left greater than right).  I'm still waiting to see how this "epilepsy" is being classified and the type of medication the epileptologist wants to use.

Loss of consciousness has never been a problem.  However, I've noted recently that my typing on the computer is becoming dyslexic ~ that is, I am reversing the order of letters and have to do a lot of corrections (that I didn't used to).  My speach is somewhat delayed periodically as I try to "spit out" the right word, but I haven't noticed as great a problem as is the case with typing.

Yesterday was the most disturbing so far.  I didn't recognize my own nephew.  Is this common in epilepsy?  After a few minutes, I was able to confirm who he was.  Face recognition is becoming more of a problem.

Could this just be a temporary "blip" or something to be concerned about (TIA?).

Thank you SO much - your help is greatly appreciated.
Thank you!!
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HELP!!
I am 26 and have Crohn's Disease.  Due to this disease I've been in the hospital 5 times in the past year.  I was taking incredible amounts of medications.  Since mid-February, I began what I call "seizures".  The docs believe them to be drug-induced.  I have since come off all pain meds and tranqualizers.  I take my Asacol, Deltasone (PRN), Zovia (pill), Centrum and Caltrate.  I was recently taken off Celexa and put on Neurontin.  The "tremors" only occur on the right side and generally occur when I am falling asleep or am really tired and relaxed.  My right side stiffens and twitches or thumps and my right side of my face puckers up.  I have difficulty breathing and gasp and swallow for air.  They occur 3-5 times a week despite the neurontin and last 30 seconds to 3 minutes.  Twice I have passed out and another time I fell and am unsure if I passed out or not.  Occassionally I release urine as well.  I get very sick to my stomach and dizzy easily.  I frequently lose feeling or go numb on one side of my body or the other.  I have headache daily.  I have run the gammet of tests. MRI: clear (good black brain), CT Scan: clear, Sleep-deprived EEG: showed some seizure movement or glitches, Heart hotler: ok, blood: ok.
What else should we be looking for?  The docs told me that since it only occurs on one side - it's not seizures, especially not epilespy.  If they are "drug-induced" and I am off all the risky drugs; shouldn't they have stopped?  Shouldn't they go away with the Neurontin?  What other tests should I ask for?  Could this be seizures?  Will they go away?  They scare me SO bad!!
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In addition to my earlier post:  I also blackout.  It use to be just when I drank then it happened monthly then weekly.  Now anytime I get stressed or tired I'm gone.  Total blackout; I don't pass out, I still function I just have no recall.  Blackouts can last a few minutes like when I drive to several hours.  My memory is so poor now that I harely remember from week to week.  Could this go hand in hand with the "seizures"??
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Dear Michelle:

Your EEG either showed spikes or sharps and hence seizure activity or it did not.  If it did, then you likely have epilepsy and from the sounds of it, your not being controlled by the medication.  If your EEG did not show epileptiform activity during an event (which should be easily captured as your events are frequent) then your brain activity is likely not inducing your seizure like events.  I would recommend that you see an epilepsy expert to help sort out things.  First you need to see if these events are truely epileptogenic (epilepsy).  Once this has been resolved, either you need another medication, or the neurontin can be stopped and other possibilities need to be sought.

CCF Neuro MD
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Thanks for your quick answer.  My EEG DID show three spikes over a period of less than 60 minutes.  However, other tests were fine.  Should I be demanding other tests or the same tests rerun?  Also, can epilespy only effect one side of the body?  My "seizures" only occur on my right side.  The Neurontin seems to ease the stiffness and the "seizures" tend to occur less but still occur almost daily.  No one in the family have ever had this kind of thing happen.  THANKS
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Dear Michelle:

If you had spikes on your EEG during an interictal (non-seizing) EEG, then you have epilepsy and it sounds like a partial epilepsy.  It also sounds like the neurontin is not controlling your seizures.  You might either have to increase the dose of the neurontin or try another medication.

CCF Neuro MD
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I hope you don't mind, but I wanted to add a question to this post.  As I previously stated in my above post, I was diagnosed with epilepsy at age 25 (I think I put 23 above, that's wrong).  I had never had any other problems prior (other than migraines). I had approximately 3 grand mal seizures on April 20, 1995 and then on May 19, I had one more grand mal - although the doctor thinks that seizure was caused by the sudden withdrawl (withdrawal) of medicine - I was having a hard time finding a medication that I wasn't allergic to.  Anyway, I stayed on Depakote for approximately 5 years (at varying dosages).  I have been off the Depakote since January of this year, and I haven't had ANY seizures since May 19, 1995. I am interested in having kids within the next year.  I realize I may run the risk of having seizures during that time, but will I pass epilepsy on to my child???  I can't seem to find any research that tells me.  I would really appreciate your feedback.  I wish I had more "technical" information to give regarding my condition, but unfortunately I don't.  thank you for your help
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Dear Sheila Sherd:

We think that many forms of epilepsy have a genetic component.  Thus far, there have been about 15 genes associated with epilepsy, but mostly febrile seizures (not really epilepsy per se), absence epilepsy, frontal lobe epilepsy, juvenile myoclonic epilepsy, and benign rolandic epilepsy.  The age of onset of your seizures and the description of your seizures would not likely place you in these entities.  However, since there are many types of epilepsy that have not been found to have a specific gene associated with them you may have one of these, or just a type we call idiopathic, meaning we think there is a reason (genetic or congenital) but we do not know exactly what it is.  There is a higher chance that a child will have a seizure event, but likely not much higher than the general population (8-9%), or epilepsy (1%).  I wouldn't worry too much about this and would plan your life the way you want it.

Sincerely,

CCF Neuro MD
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I was wandering about some recent tests I had done.  My neurologist said I most likey have complex partial seizures.  What will this mean for me?  I had an eeg and mri done today and don't yet know the results.  I saw some of my pictures from the MRI and noticed on the side view that there were two seperate spots above and behind where my ear would be.  Do MRI's show bone?  I was also wandering why I would be getting seizures at this age ( 20 ).  Thanks a lot
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Dear Beth:

Sorry to hear about your newonset seizures.  Complex partial seizures means that your epileptogenic activity starts in a focal area in the brain and then spreads covering most of the cortex.  Thus, you loose consciousness.  The MRI is to see if there a focal abnormality they can pick up such as an area of neuronal migration abnormality, arterial-venous malformation, venous angioma, hippocampal sclerosis, tumor etc that might have induced the seizure events.  The EEG is a test to see if there are electrical abnormalities in the same area. The MRI shows all the structures in the brain, so bone would be included.

Sincerely,

CCF Neuro MD
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Dear Michelle, Beth, and all others with concerns about epilepsy,

     I just want you to know and understand that although epilepsy does come with it's inconviences, it's all on your outlook.  I'm 28 yrs old and have had epilepsy for 23 of those years.  I'm a rare case so please don't worry!  I've led as close to a normal life as possible with the exception of the driving privelidges.  In 1995 I had my neuro surgery at CCF, but unfortunately if was not a success, it was a shot in the dark to begin with I'd like to add.  You may find that many of the Anti Epileptic Drugs(AED's) do cause many of the symptoms that you've described, problems with face recognition and so on.  I just recently had a Vagal Nerve Stimulator inplanted at CCF, and so far everything seems to be a success.  I've had seizures after the implant but none have been of a convulsive nature, only automotor seiz's where I become a little confused as to what I was doing just prior.  I'll take that any day over a Tonic Clonic seiz.  I can't say enough about the doc's at CCF, they've been wonderful about me and my unusually difficult case.  One thing that I've found solice in is to talk back and forth with others who know what I'm going through so if anybody would like to email me you can do so at :
***@****

I wish you all the best of luck and no more seizures :)  I hope that you have more luck in gaining control through the use of AED's then I have.

Take care and most importantly know you and your body's limits and don't abuse them.

Sincerely,
Heather
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thanks for your comments.

CCF Neuro MD
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