EEG that resulted in twitching and rigidity with normal results

[MedAmic]

I am not asking for a diagnosis.  I would like to be directed as to where to go from testing of an EEG.  

I had an EEG after the neuro wanted to rule out seizure activity.  During the EEG, at the time to induce hyperventilation, I was asked to breathe in and out.  A cascade of strange symptoms followed that I never experienced in full consciousness.  Also, I was fully awake the entire length of the eeg, but the results "stated I was asleep."  

As I was breathing my left muscle in my neck started pulling downward and then I felt a weird sensation on left side of head which erupted like a burst at the top of my head.  At that point my mouth shut and I was breathing normal in/out of nose.  The burst involuntary pulled my head backward and to the left and cascaded down my body which resulted in muscle tightness and tingling.  My left arm from the shoulder to my elbow was stiff and at my side and from the elbow down was twitching.  My chest was completely rigid and tight.  While my legs were moving involuntary.  

This continued on and when I was told it was over and asked to get up, I was able to come out of it.  I felt confused and disoriented.  I sat on the side of the bed and was asked to move from the bed to the chair.  At that point, I still had not spoken and I couldn't.  I tried to open my mouth and talk, but my mouth formed an O.  At that point, my eyes starting blinking rapidly and I felt tears on my face.  After the assistant gave me a wet clothe, I was able to explain that I couldn't speak before and I certainly did not understand what just happen.

I felt fairly certain that this test would produce some insight to the myriad of symptoms I had been experiencing, but the test came back normal and only stated that "hyperventilation produced a slow buildup, but no epileptic activity".

My questions:

What is the accuracy in EEG's, what happened to me during the EEG and how is it possible that there was no more of an explanation concerning what it was?
The problems I had been experiencing I feel were exacerbated during the EEG.  Problems with speech: inability to recall names, dates or an object that I should recall instantaneously causing me to appear unresponsive.  Twitching in my head, pulling in my neck muscles.

Should I have a Video EEG?
I have never fallen or passed out making it visibally obvisous to everyone that I had a seizure.  What will this test tell me that a normal EEG didn't.  Should I have another EEG done, instead of a Video eeg. I don't understand what the video EEG will find that the normal eeg didn't and I can't afford to be having unnecessary tests

My neuro didn't seem concerned with my experience during the EEG, but wants to order a video EEG.  In addition, I went to neuro for a second opinion of a PET scan in which "abnormal metabolism" was reported, but according to neuro he doesn't agree with this diagnosis.  


I am not certain where to go from here..if I should start over with another doctor, if so what specialty.  I understand you cannot diagnose.  I am asking for direction.  Any insight into testing or explantions would be appreciated.  Thank you.

[Abhijeet Deshmukh, MD]

Hello MedAmic.

About slowing of EEG, you can consider pervasive developmental disorders, depression, and post concussion syndrome as the causes. Slow waves are brain waves less than 8Hz. These waves are called as delta and theta waves.  Slow waves can not be normal in an adult who is awake. They are normal in NREM stages 3 and 4 of sleep.

MRI and PET scan:

If PET scan is normal, it means all the areas of the brain are taking up good amount of sugar. This is rare with a lesion. An MRI which is normal can confirm the findings of a normal PET scan.

The slow build up may not significantly alter the amount of sugar uptake.

The PET scan should be ideally interpreted by a Radiologist, preferably a Neuroradiologist.

PET scan and EEG are two different procedures, running on two different principles. But they are basically trying to catch some dysfunction of the brain. While EEG can go on recording the brain activity for half an hour, PET scan is more like a cross sectional procedure.

A video EEG will not be able to prove a PET scan either correct or incorrect.

A raised aspartate level will probably show diffuse changes on the PET scan.

Regards

[MedAmic]

One simple question to your previous post:

What could "slowing" during an EEG mean if it is not a seizure?

[MedAmic]

Dear Dr. Abhijeet Deshmukh, MD

I know you must see many patients and I appreciate your time in responding to my post.  

I wanted to state that the PET scan was of the brain and it was ordered because of the symptoms listed in my previous post.  The initial results of the PET by the radiologist interpreted it as "diminished blood flow to the parietal lobe" and suggested correlation with a recent MRI of the brain which came back as normal.  

According to the test, nuclear medicine stated the radioactive solution injected did not metabolize correctly in the parietal lobe.  Before having this test, the research I found suggested this test was easily interpreted by the colors of the picture ie. hot spots, dark colors, light colors.  

The PET has been subjectively interpreted differently by MD and Neuro who find nothing wrong with it.

My questions:
Does a normal MRI of the brain conlcude that the PET was in fact normal?

Does the "slow buildup" during normal EEG confirm the PET results were abnormal?

Who do I need to see for clarification of the PET test?
  
Will having a video EEG confirm or dismiss the PET scan?

Most recently I have had amino acid blood plasma testing.  The amino acid urine testing I've already completed came back normal, but Aspartic acid was increased at 242 while the max is 62.  Could this be the cause for the abnormal PET scan? And could this be a factor in my hormone problems?

Again, thank you for your assistance and I appreciate your suggestions.  


    

[Abhijeet Deshmukh, MD]

Hi.

This is a bit unusual, but not rare. What you had during the EEG could have been a seizure. But it is obvious that the EEG did not quite show an 'epileptic activity'. It did show slowing.

I would now go for a video EEG with the similar excitation procedures. What it does is help the doctors have a clearer picture to come up with a diagnosis.

A PET scan will be of help only if you have a stable lesion in the brain. You can not expect similar symptoms to occur during a PET scan.

Regards