Re: EEG---Spiking??

Posted By Cathy on May 02, 1999 at 11:02:45
I am a seizure patient.  I take 500mg. of Dilantin per day, Zoloft 100mg.,
Synthyroid .01., folic acid 1mg., and Vitamin B-12.  A month or so ago I had an eeg ran.  At my last neuro visit, he said that my EEg showed spiking.  I don't know why I did not ask him, but for some reason I failed to do so, but could you tell me what spiking is and how it affects my seizure disorder?  Was I having a small seizure during the eeg to cause this?  I also have mild sleep apnea.  I seem to always think of something that I wished I had asked after I leave the office.  What signifigance does the spiking have in determining if a person is an epiletic.  Should I have had spiking even though I am on 500mg of Dilantin? (I am a large person).
If I were to stop my dialntin would I be having full gran mal seizures?  Am I having mini seizures?  Should I stop driving?  Thank you.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 02, 1999 at 20:25:41
Dear Cathy:
Sorry that you are having some confusion about your EEG.  When we do an EEG we are trying to look how the brain's electrical state is functioning.  There are standards that have been elucidated in normal brains that constitute what we call "normal brain activity".  We have found that when we see "spikes" or "sharp" waves on the EEG this is epileptiform brain waves or abnormal electrical activity.  When we see these, we call this abnormal and can conclude that epilepsy is possible.  There are people who never have a seizure who have these spikes or sharp waves on their EEG.  But most people who have epilepsy have these on ther EEG, either when they are having a seizure or between seizure events (normal periods) or both.  It sounds like in your case, you have some spike activity during your non-seizure periods (this is frequently seen with people who have epilepsy).  As long as your medication is keeping you seizure free then great.  In the vast majority of the time, seizure medication does not remove or eliminate the spikes or sharp waves from a person's EEG.  As long as you are not having seizures, then your medication is correct.  I hope this answers your questions.
Sincerely,
CCF Neuro[P] MD

[Cathy__0__0]

Posted By Cathy on May 02, 1999 at 23:00:19
Thank you very much, I understand so much better now.  I would like to ask you another question though.  Is it possible that my having mild sleep apnea, with extreme daytime fatigue could possibly be the cause of my seizures.  Both of the episodes of grand mal seizures that I had followed childbirth.  Is it possible for a person to only be prone to seizures after their body goes through a trauma.  If so, would it be necessary to take medication constantly?  Is it true that the more siezures that a person has that they are more apt to continue having them?

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 03, 1999 at 11:46:57
Dear Cathy:
Since you have spikes on your EEG, likely you will need to stay on anti-epilepsy medications.  With an occasional seizure, having one does not increase the chances of having another seizure.  However, if one has constant seizures then the chance of having more is increased.  Fatigue is known to lower the seizure threshold and that may account for your seizures at the time you had them.  We all manage epilepsy alittle different, so I would check with your neurologist before changing or stopping your medications.
Sincerely,
CCF Neuro[P] MD

[De__0__0]

Posted By Dee on May 06, 1999 at 14:02:53
I've been searching for information relating to my 6 yr. old son.  His EEG shows "sharp waves in the right parietal region" and "bursts of high amplitude slowing with admixed sharp waves".  About a week and a half ago my perfectly healthy son went from one minute being okay to suddenly screaming about pain in his left hand and then started jerking his head, stopping, hands shaking, stopping, legs jerking, stopping, and so on.  This has continued every day with some days being better than others.  He also showed an arachnoid cyst on his MRI in the area where the abnormal EEG is.  The Ped. Neuro. seems to think both test results are not related to his sudden movement disorder.  He is doing no further testing, so we are on our own.  What do we do now?

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 06, 1999 at 16:16:18
Dear Dee:
I guess I am unsure of the order of things.  Does your son have an abnormal EEG as you describe before the event you mentioned, or did he have the event and then the EEG and MRI?  If he had the right parietal EEG abnormality after the event you describe then your pediatric neurologist may be correct.  I say maybe. First, pain is usually located more in the superior temporal lobe.  However, the other events might be related to the events described if the EEG abnormality was near the SMA zone. It may be possible that the pain event was due to something else and only perceived as pain. Is your son on seizure medication?  
I would agree that the archnoid cyst is not playing a part in the seizure activity. Unless the archnoid cyst was really large, it would not cause a problem.  
I would say, if your son had this event, then the EEG and MRI were performed,   his event was related to the abnormal EEG.  The finding of an archnoid cyst was just a circumstantial finding and not related to the EEG and seizure event.  
I hope that I am assuming correctly.  But most importantly, I hope that your son's seizure activity is under control.
Sincerely,
CCF Neuro[P] MD

[De__0__0]

Posted By Dee on May 07, 1999 at 10:58:00
Thank you for your reply.  The order of events was first the pain, then the jerking and shaking and then the tests.  He had never had an MRI or EEG before.  (The MRI showed the cyst to be only 2 x 1.5 cm and located "just below the right cerebellopontine angle between the cerebellum and medulla.")  Prior to all this he has been basically healthy.  I say basically because he had a virus three weeks before all this and his only symptoms were running a 102 temp for one day, very lethargic for a week and a half (not wanting to play or watch TV - just laying on the sofa) and complained of a sore throat only once.  I noticed several days after the onset of symptoms that his hands appeared to be a little red and puffy.  There was a rash around both wrists that looked like eczema, but it was painful to him when I touched it.  The neuro. thought this might have been related to his sudden onset of the movement disorder, such as ADEM, and did an ASO on him, which was negative.  We're still waiting on the Anti-DNAase.  The only thing that came back questionable was  his serum copper level at 152.  Someone else has told us we should have it repeated.  
My husband and I were first told by the neuro he felt these were just tics and said we could use medication if we wanted.  We opted not to at the moment.  I really wanted to find the cause, if at all possible, rather than treat the symptoms and forget about it.  Things just happened too suddenly.
After a follow-up call from me to the neuro I related how my son had a particulary bad day with shaking so bad in his hands that it was like someone with Parkinson's (which I know it isn't of course).  He then called these movements seizures, which he was adamant about from the start that it was not in any way any sort of seizure.  He then said we could use seizure medication if we wanted.  Again, we declined and we are now trying to get a second opinion.  I just don't feel like we should let this go.  The one thing that has remained consistent is that he "itches" basically all over, but more so in his toes of his right foot.  I'm wondering if this too is related to the abnormal activity in that area of his brain.  His personality has changed and I'd do anything to get my boy back the way he was - basically our golden child (we have four children).  I feel so helpless and when he starts these movements sometimes they bother him to the point he'll sit on his hands or give me an excuse like, "I was just trying to act silly."  I don't want to draw attention to it around him, so I make no mention of it when it's going on.  Life is different and I wish I could understand what was happening and why.










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