Re: Distortion of Time in relation to movement and speech

Posted By CCF neuro MD MM on March 03, 1999 at 14:02:36:

In Reply to: Distortion of Time in relation to movement and speech posted by Peggy on March 02, 1999 at 12:22:14:






My 16 year old daughter just told me about a "funny feeling" she has gotten
over the past 4-5 years (I know, I asked the same question!)  Apparently, in
the beginning it scared her but she learned to adapt her speech and movements
to her environment, and noone seems to notice (including me).  The reason it
finally came out is that she had a spell while driving which scared her enough
to tell me and we saw a pediatrician the next day.  Her original diagnosis was
partial complex seizure, and ordered an EEG which came back normal.  Since
I didn't consider her state to be "unconscious" (she was making rational
decisions, such as "I may be going too fast, so I'll adjust my speed to the
cars around me", and arrived home safely, but realized she should not have
been driving.  In researching her symptoms on the web, I came across a report
by three Canadian doctors describing a migraine variant they have named "the
rushes", which seem to fit what she has described perfectly.  They are J. Dooley,
K. Gordon, and P. Camfield who wrote in the Clinical Pediatrics, 29(9):536-538 (1990)
I have been unable to find more about this condition, but it sure seems to fit.
My mother was a lifetime migraine sufferer, as was both her parents.  My
daughter had no headache symptoms,which also fits what they're describing.
Do you have any info on this condition, and would you suggest a neurologist
or a headache specialist as the next order of business?  I would much prefer
to see a migraine diagnosis that having the stigma of an epilepsy diagnosis.
Thanks for any help you can offer.  Her occurences have varied, but she had
two in three months time, and not for a year before that.  Her pediatrician
seems to think we should put her on anti-seizure medication, even without
proof of epilepsy.  




Making a  diagnosis of an obscure migraine variant solely on the basis
of this history sounds a little premature to me, on the other
hand while the history is compatible with the more common disorder of
complex partial seizures,the EEG has been normal so no further supportive evidence is available for
this diagnosis either.
You could be right but it is a little early to come to that conclusion.
The routine outpatient EEG is normal between seizures in up to 60% of people with epilepsy
I think further investigation is need ,ideally a more prolonged EEG ,
involving overnight video-EEG monitoring if possible. The ideal situation would be
if she had one of these attacks while having the EEG recorded.
This would establish the diagnosis with certainty if it is a form of epilepsy.
If complex partial seizures are being suggested she should also have an MRI
of brain to detect any subtle scarring of other lesion which would cause
seizures.
At this stage I think that these investigations should be pursued and the more
common explanation, seizures, should be outruled or proven before any
diagnosis is given. In the meantime she SHOULD NOT DRIVE.
A neurologist who could organize these tests would probably be the next
step.