Re: Epilepsy

Posted By CCF Neuro MD on April 07, 1997 at 22:03:09:

In Reply to: Epilepsy posted by Merton  on April 07, 1997 at 22:01:41:







: This Message was posted by: Merton S Zatman -  3/23/97 9:17:00 AM
Message:
I have suffered 2 what appear to be seizures. Both at night while asleep. The first on 29 January the second on 8 March.
There have been many examinations and tests. these included aa CT scan which gave the conclusion that there were no
structural abnormalities and things were normal for someone of my age, which is 61.
Last Monday I had an EEG at the National Hospital for Neuroloogy here in London.
The report came through on Friday evening and the comment was "unequivocally abnormal. There are epileptiform discharges
recorded from the right frontotemporal region. There localised nature and associated background suggest an underlying
vascular/structural abnormality.
This latter phrase is worrying.
The report also said "there is posterior alpha activity at approx 10Hz bilaterally, intermittent theta and sometimes delta
recorded from right frontotemporal region. In addition there are spike and slow wave complexes recorded from this region.
OB:Enhances the right frontotemporal abnormalities.
PS:Some following bilaterally "
I do not understand any of this.
I have also had ECG, blood pressure and many physical and blood tests and a 24 hour heart monitor. all of which produced
reports that all was normal
My doctor has prescribed carbamazepine.
Ifeel perfectly OK and have done so throughout, there is no histiry of epilepsy in my family nor I have I suffered any injuries or
serious ilnesses, although since childhood I have suffered with allergies, hayfever and an allergy to shellfish.
I know that further tests/examinations are being arranged, to include (Ibelieve) a brain MRI scan and I may well hear about
these during the week. I only saw the consultant at 630 Friday evening and the EEG results had only been faxed to him that
afternoon.
If anyone can explain things to me or advise what it all means and entails I will be most grateful. I would be particularly pleased
if any guidance can be given
Merton



  =


The new onset of seizures in a gentleman in your age group is always concerning for the possibility of an underlying disease
process such as a tumor, stroke, vascular malformation, subdural hematoma (often poorly visualized on CT scan) infection, or
other structural underlying pathology, since most inherited or lifelong epilepsies begin much earlier in life. It is not absolutely
impossible, however, for epilepsy to begin this late in life, but certainly it is unlikely. Your normal CT scan suggests that there is
no groosly obvious cause for the seizures. The EEG you had is clearly supportive of a structural lesion in the right frontal lobe.
The MRI scan you are going to have is a more sensitive test for such underlying disease processes--- I would be sure that this
is done WITH contrast agent (gadolinium) so as not to miss a subtle, infiltrating tumor or other disease process that might be
promptly operable upon or otherwise more easily and successfully treated now, but be otherwise undetectable for months if
contrast is not given and the disease process progresses. The remainder of the EEG report you describe is simply medical
jibberish stating that other than the clearly abnormal region in the right frontal lobe, your brain is functioning very well. I should
emphasize to you that the right frontal region of the brain is one that is often a clinically "silent" region of the brain, and can be
massively involved by a disease process without even so much as a single obvious symptom, other than nonspecific things like
headaches or seizures that don't point you to any particular region of the brain. I can assure you that you are in expert medical
hands if you are being treated at the National Hospital for Neurology in London. I'm sure you will receive a thorough and
accurate assessment by the consultant there when you see him or her. Certainly continue with your Tegretol and have the level
followed especially early on, since it tends to first get high and then subsequently drop because of your body metabolizing it
more and more rapidly with time. The nocturnal occurrence of your seizures is the rule rather than the exception for many
seizure types--- sleep, or sleep deprivation/exhaustion are common precipitants for seizures. If you were to develop any fixed
neurologic deficit such as numbness or paralysis of half of your body, trouble speaking, swallowing, or understanding other
people's words, or any other persistent unusual symptom between now and the time of your MRI scan, go to the emergency
department immediately.