Epilepsy & Schizophrenia

[GH__0]

  Thank you for taking time out of your busy schedule to respond to me.
  My need for contacting you is regarding my depression and deficits in
  Higher Cortical Function, Language modalities --auditory comprehension, verbal expression, word-finding, reading, writing, auditory processing and working memory.
  HereÕs my story: Its a long one.
  For the last 10 years IÕve had episodic lapses in my ability to comprehend language.
  A defect or loss of receptive language function in which the comprehension and sometimes expression of words is impaired. These are my symptoms. I have multiple episodes, up to a dozen or more per day. Occasionally I also experience word-finding difficulty. I have had difficulty with naming tasks. I am not able to repeat what is said to me. My Auditory comprehension and Auditory Discrimination is usually quite poor, more so when I'm stressed, tired and hungry, the symptoms are worse.
  Typically, it lasts anywhere from a brief moment to perhaps 10 to 15 seconds. I am fully aware during this and possess control over physical movement. I have had some cognitive declines. My short term memory has declined. I am frequently told that I am inattentive".  I donÕt have a problem speaking although once in while I notice my speech slurs just slightly.  The symptoms are especially prevalent on the telephone . This can occur several times during the course of a day. It usually occurs when IÕm startled, but can also occur for no reason at all. I have had this occur while doing minor things like tying a shoe- I space out for a moment and donÕt know what IÕm doing.  I have also experienced episodes of Visual Distortion. When this occurs my comprehension is totally impaired. The sensation feels like IÕm frozen or "zoning out" for a few seconds. I have no control when It occurs and canÕt affect it when it does. I remain conscious, I can hear and see everything around me but am unable to interact. This usually lasts about 30 sec to a few minutes. It has happened while speaking mid-sentence, washing dishes, watching TV etc. Even if IÕm able to screen out irrelevant stimuli, this can occur. I can have complete quiet and have the these episodes. However when there is noise present focusing seems more difficult. I have also had visual hallucinatory experiences or sensory involvement. This has only happened a few times. These occurred while sitting or standing still. I feel as though I am either much, much larger or smaller than my surroundings.
   In 1991 I saw a neurologist at UCLA who thought I might have a seizure disorder and wanted me to start an Anticonvulsant regime. Because I was starting a family I declined to start this drug regime. I had an MRI and an EEG that were both normal.  His examination report states there were episodes of language dysfunction, two episodes of which I stared blankly and did not respond each episode lasting for about 10 to 15 seconds. A distinct absence of associated movements on the right side. Romberg test was negative. A slight downward drift of the outstretched right arm. My speech was fluent but there were pauses for word-finding and occasional circumlocutions. Difficulties in naming. Unable to name 2 of eight items on Boston Naming Test, a deficient response. Difficulty naming common objects and deficient in word lists having marginal numbers. No difficulty reading material and writing sentences. No evidence of apraxia or finger agnosia. Good recall. No difficulty in answering questions concerning major events of the past. Difficulty in Mathematics. Performed simple arithmetic slowly with uncertainty.
  All of these are things I may experience daily, but not all together. Again, very generally speaking, all of these experiences are in some degree, from mild to total, of loss of comprehension of auditory, visual, or other sensations. Usually, when one of these things start, it is something I continue to experience several times during the day.
  Occasionally, I may experience 2 or 3 different types all in the same day. Sometimes, it will be a floating sensation, Jamais vu , (interpreting frequently encountered people, places or events as unfamiliar). Normal Associative deju-vu, interrupted memory, "experiential illusions" ,  A friend's voice may sound remote, or a well-known living room may appear unfamiliar, but the meaning is preserved, the voice does not become depersonalized, nor does the living room lose its identity. While feeling in this unreality state I know at the same time what reality is.
  This is a perfect explanation of what IÕve experienced:
  For example, I often feel compelled to stare for brief moments at a coffee table in my living room since, as I put it, "It just doesn't look exactly like my coffee table." After a few seconds, the feeling disappears. At no time do I think that the table has actually changed; the only thing that varies is my perception and "interpretation" of it.
  Other days, the Anomic/Nominal Aphasia (Anomia): The inability to name objects; loss of memory for words, Auditory Aphasia: The inability to understand spoken words, Motor Aphasia: Aphasia in which I know what I want to say but cannot say it, Semantic Aphasia: The Inability to understand the meaning of words, Syntactic Aphasia: Loss of the ability to use proper grammatical construction, Visual Aphasia: Inability to understand the written word, Visual Object Agnosia: The loss of the ability to visually recognize objects presented, even though some, or even all of the ability to see is intact. Occasionally an intraabdominal sensation of sinking and fear. Usually the two together.
  Anomic Aphasia:
  Word retrieval difficulties in spontaneous speech and naming tasks. The spontaneous speech of anomic aphasics is fluent and grammatically correct, but is marked by word retrieval failures. The word retrieval failures generate unusual pauses, circumlocution ("talking around" missing words) and substitution of nonspecific words such as "thing" for missing words. Also Anomia, the inability to name objects.
  (Sequencing). Interrupted memory, I interpret that to mean a stop in the brain's ability to process information. An example of what I experience is: I need to open a can of coffee. I have the can in one hand and the opener in the other. I know what each individual one is and what it is for, but cannot connect the two. The memory or knowledge is blank. It just is not there. It is as if "A" is here and "C" is there, but "B" no longer exists, and I never knew it did in the first place. The memory always comes back, usually I wait a few minutes for it to pass or I just go away and come back to it later.
  I often feel very tired even when IÕve had enough sleep. ( I do have two small children)
  I have been told that I have episodes where I have a blank look on my face or staring spells. I was once asked by a therapist Ò Where do you go when you go off like that?Ó
  I often wake three or more times in the night or lie awake three or more hours trying to sleep. I dream often.
  There are specific things which trigger any one of the symptoms/ experiences discussed: The telephone and hunger, being startled, fatigue, noise, stress and PMS, heat and anxiety.
  Onset was at 31 or 32 years of age. The symptoms began 7 - 10 years after a closed head injury on the left side from a punch in the head by a fist .
  No symtomology of:
  I never experience sensory things described as numbness, tingling, or a "pins-and-needles" feeling , sensation of crawling (formication), electricity, or movement of the part. No pain and thermal sensations. No sensory experience such as feeling in the lips, fingers, or toes.
  No visual sensations of darkness or sparks and flashes of light, stationary or moving and colorless or colored -- No "sunbursts." No red , blue, green , yellow, white or bluish white. No smell. No metallic, bitter, salt, sweet, sour, taste.
  No Auditory hallucinations such as a buzzing or roaring in the ears. There is no loss of consciousness. No convulsions or blackouts. No odd behaviors like buttoning/unbuttoning, chewing/mouth movements or other unusual movements. No pain or sensation in my head which I would not classify as a "headache". No automatisms such as lip smacking, chewing or swallowing movements, salivation, fumbling of the hands, or shuffling of the feet. No double vision. No superficial burning. No compulsive sexual behavior. No compulsive eating or binge eating. No episodes of intense religious feelings. No muscle tone lost. (e.g., the hand, arm, and face). The parts most frequently involved are those with the largest cortical representation.
  My frustrations are in my inability to communicate with people on the telephone, and in person and my overall feeling of brain dysfunction and working memory loss. My cause for concern is doing irrevocable damage to my brain based on recent research suggesting that uncontrolled epilepsy may actually cause problems with loss of brain cells, particularly in the brain region of the Temporal Lobe, causing "excitotoxicity," and may represent a mechanism by which memory (and epilepsy) may worsen with time.
  In addition I have a genetic predisposition to Schizophrenia. My father was diagnosed Paranoid Schizophrenic and died with severe dementia. He had no cognitive abilities at all. He had cardio vascular disease and suffered strokes. I donÕt know if he had cerebral vascular disease. I have a first cousin with childhood Epilepsy, on my fathers side.
  Finally, I have had opposing recommendations. A psychopharamacologist wanted me to start the drug Respirdal an anti psycotic medication, when she heard my family background. She surmised it was possible to have symptoms of Schizophrenia and not have the disease itself. My understanding after extensive research was you either have the disease or you do not. One must have positive or negative symptoms to be diagnosed Schizophrenic. Cognitive deficits alone do not fit the diagnosis. Not confident with her recommendation, I declined after researching the drugs and the long term side effects.
  The neurologist wanted me to start an anti-convulsant regime. I declined six years ago because I was starting a family, and a lack of understanding of Epilepsy.
  Seizures are an electrical "short-circuit" in the brain while schizophrenia is a neurological chemical imbalance. They are entirely different and they are treated with two entirely different classifications of drugs. In addition recent research shows that neurocognitive
  deficits in Schizophrenia responds better to amphetamines rather than traditional neuroleptics.
  Now IÕm floating down a river with no paddle. IÕm depressed and donÕt know how to climb out of the deep hole IÕve fallen in. I feel like the Titanic, sinking and weighted down with baggage. My memory has gotten so bad it worries me. Every physician IÕve seen prescribes a different classification of drugs and has no concrete solutions.
  I need closure and treatment.
  I very much need and value your professional opinion.
  Thanks in advance:
  Desperate in Los Angeles
=
Your situation is extremely complicated. It is hard to know where to start. As you surmise, epilepsy and schizophrenia are completely different entities.
It is plausible that you might have simple partial seizures in a region of your left cerebral cortex. There is in fact a childhood syndrome involving repeated seizures and progressive aphasia, though I have not personally had experience with an adult form.
Some of the other symptoms are hard to explain. There is a bit too much data for a forum such as this. My impression is that if you were able to put this amount of information together in a reasonably organized fashion, you probably don't have schizophrenia. Schizophrenic patients with whom I've had contact have had a profound disorganization of their thought process, social withdrawal, auditory hallucinations, and bizarre delusions. It is possible to have a psychosis (inability to properly discriminate reality) without having schizophrenia. I can't speculate in your case.
The first step, it seems to me, is to seek a neurologist in an academic center. Therre must be several in California (UCLA, USC, UCSD, UCSF, etc). Of course, the epilepsy group here in Cleveland Clinic is top notch. I would start with an experienced epileptologist in an academic center. You may also be referred to an academic psychiatrist. It seems that your symptoms are sufficiently complex that most physicians in private practice may not be able to approach it suuccessfully.
This information is for your general medical education. Any specific comment regarding your diagnosis, prognosis, or treatment must come from a physician after appropriate evaluation.  CCF MD mdf.