COMPLEX PARTIAL SEIZURES

[dandy1]

My husband 49 yrs old recently diagnosed CPE.Currently on tegratol 200mg x3.Inderal 20mg3x altace5 mg.1x.Testosterone inj. 100 mg 1 x week.  He has been having episodes for about ten years GP treated for anxiety and panic attacks. Symptoms are funny feeling, sense of warmth washes over him, with stinging tingly feelings, blank staring,repeated swallowing,unresponsiveness,post ictal confusion with aphasia expressive and receptive. He has lost consciousness 4 xs last 2 yrs.He also has HTN (2xs after passing out 185/125, 190/122) ,Hypogonadism and history of elevated cpk (200-400,)creatnine borderline high several years.He has had cartoid artery study,slight narrowing. sleep deprived eeg,and transcranial doppler,both normal.HE has been evaluated by cardiologist tilt table ,borderline positive, Echo reveals one sided thickening of the heart and pressure in the lungs (not being treated at this time.) He has also had right hand  arm tremors for about the last year now left side has begun and has experienced leg buckling.Could not perform heel to toe test,and also seems to have difficulty swallowing.
My questions:  could the hypogonadism be related to the epilepsy? Does the cpk mean anything ? Would the brain have any thing to do with the presure in the lungs?And the arm tremors, leg buckling swallowing,What could this indicate? what test should be performed to followup and get him fixed? He also has bad memory, word finding, and as of recently poor comprehension.AND Lastly how does anxiety fit into this?I believe the panic attacks were actually seizures.
Thank You for any help

[CCF-Neuro-M.D.-SH]

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.  All of the symptoms that you describe are common in complex partial epilepsy(CPE) (The epilepsy you describe is likley coming from the temporal lobe (possibly the left).  The issue of can the hypogonadism be related to the epilepsy and the answer is yes, in several different ways.  Electrical discharges from a temporal lobe seizure disturb structures in the amygdala and hypothalamus that are responsible for secreting the hormones needed to maintain testicular function.  These centers also control sexual behavior and cause disinterest in sex.  Finally, medications that activate the liver enzymes to chew things up faster including: Tegretol, Dilantin, Phenobarbital, etc. increase the metabolism of sex-steroids so that even the small amount of sex steroids that is made, the liver chews it up.  This is best treated by getting the seizures under control and then increasing the testosterone replacement until a decent level is achieved.  In cases of medically refractive epilepsy, surgery (temporal lobectomy) has been shown to improve sexual function (when succesful at stopping seizures).  
   The elevated CPK is often seen after a seizure, because seizures cause intense, contraction of muscles often with agonist and antagonist (one pushes while the other pulls) firing at the same time, which causes some increased muscle wear and tear (also often causes soreness).
   CPE does not often affect the lungs, but sometimes can cause a tonic contraction of the chest wall, making it difficult to breathe.  More concerning is the effect that CPE can have on the heart, especially in someone with heart disease risk factors (High blood pressure, high cholesterol, family history, smoking).  CPE seizures can cause life threatening bradycardia (slow heartbeat) and even asystole (heart stops) in some cases.  
   The memory dysfunction is similar to the sexual dysfunction, just different structures affected.  The hippocampus is attached to the temporal lobe and is responsible for encoding memories.  In CPE this structure can be damaged by the electrical discharges or can be causing the seizures.  Either way CPE causes this structure to dysfunction, leading to memory problems.
   I suspect that your husband was having seizures, that were thought to be panic attacks.  This is common, in that CPE is often misdiagnosed and can mimic other diseases.  I would recommend admission to a epilepsy monitoring unit(EMU) (continious EEG (brain wave test) for 3-7 days) to work up your husbands focal epilepsy (available in major hospitals and staffed by neurologist that specialize in epilepsy).  I would also recommend an MRI of the brain and a PET scan.  I would suggest that you try 2-3 medications, and if you continue to have seizures, epilepsy surgery may be an option for you.  I would make sure that he is on telemetry (heart monitor) during his EMU stay so that bradycardia can be diagnosed if present.
I hope this has been helpful