Re: Please help!!!

Posted By Julie Palmour on April 16, 1999 at 00:32:18
: : : Topic Area: Epilepsy
: : My daughter is 10 years old.  She has no significant medical hx with the exception of a febrile seizure at 3 years associated with strep.  In Nov. of 97 she suffered a seizure and within 24 hours was running a fever of 104-105 with hallucinations, photophobia, generalized weakness, nausea, etc... She was seen at a children's hospital.  No spinal tap was done and blood work done at my insistance.  The results of the blood work indicated a positive mono test with a 53 Atypical lymp count.  She had very slow resolution, missed 37 days of school.  Continued blood work showed immune compromise with low white counts, low platelets and ultimately a B6 count of 2.  B6 supplements showed marked improvement.  No more seizure activity until March of 98.  Seizure occured with precipitating factor of stomach complaints for about 3 weeks.  Resolution from this seizure was faster than the first.  Within five days she had a severe virus. Neuro placed her on Tegretol which she took for 5 months 300mg per day.  Also, sleep deprived EEG showed normal. An immunologist said she had a high concentration of adnovirus in her stools and her blood work continued to be marginal.  Continued to monitor with blood analysis which eventually normalized.  Withdrew Tegretol in August 1998.  Very healthy and normal activity with no seizures until March 99. With no warning except the stomach complaints for about 3 weeks prior to the seizure and reports of deja vu, which she had no idea about what it was, she suffered another seizure while shopping in a mall.  The seizure like the others began with severe onset of stomach complaint, hot flashes then progressed to confusion, finger licking and then a full seizure.  She did not loose body functions and was somewhat responsive just following.  She was awake but confused and very anxious.  Vomited and then quick resolve.  She has a mild sinus infection and sore throat.  No other serious illness and no fever like before.  We have an MRI scheduled for next week.  I am so confused as some say this is viral related but this time she does not appear to have a serious virus.  I feel like we are missing something.  Please advise. Thank you so much for this service.  Julie Palmour




Dear Ms. Palmour:
I am sorry to hear about your daughter.  Although the seizure events have been related to viral illnesses, it does seem like your daughter has epilepsy.  It has the flavor of a temporal lobe epilepsy.  The aura that she experiences and the way you describe the seizures, that is what it sounds like.  When they perform the MRI next week, make sure they get thin temporal lobe cuts to really get a close look at the temporal lobes (esp. hippocampial areas).
Even though you daughter had a normal EEG, there are times that the EEG will not show any abnormality.  This happens about 30% of the time and a positive EEG might take a few times before it occurs.  This is usually a good sign in that between events the brain is normal.  I suspect that the illnesses that she has had just lowered her seizure threshold.  It is always difficult to tell whether the high fever along with the mycoplasma infection might have induced her epilepsy, but it is always difficult to tell.  
I hope that your daughter becomes seizure-free soon.
Sincerely,
CCF Neuro[P] MD




Thank you so much for your quick and to the point response.  From reading other postings I too suspect the temporal lobe problem.  Could you please just suggest to me what to think or do if the MRI shows nothing.  Also, could a case of encephalitis cause the temporal lobe damage?  Is it possible that she could outgrow this?  Thanks so much-this is the first time I have felt any peace through this whole issue.




Dear Ms. Palmour:
My gut feeling is that your daughter's MRI will show hippocampal sclerosis.  But, even if there is a normal MRI the symptomology is still temporal lobe and likely the damage is just so small an area that the MRI cannot pick it up.  Yes an encephalitis can cause temporal lobe damage, but usually it is pretty devastating and the child is neurologically in poor condition.  There is always the possibility that she can outgrow her seizures.  But the majority do not.
If it is temporal lobe and it is focal (meaning mainly one temporal lobe) she may be a candidate for seizure surgery. We see patients with temporal lobe epilepsy post surgery to have a 70-80% chance of seizure freedom.  
Best of luck, and let us know how your daughter does.
Sincerely,
CCF Neuro[P] MD




I am so grateful for your help, advice and knowledge leading up to my daughter's MRI.  It was completed last night and this morning we received notice of a completely normal test.  As you suggested I insisted on thin temporal lobe cuts.  Now what?????  In the meantime, we have also received word that her B6 count was back down around the time of the seizure.  Her family doctor has put her back on the B6 supplement x 5 days.  She is also finishing a round of Suprax for an infection.  My husband and I want to try keeping her as healthy as possible, 10-12 hours of sleep a night, vitamins and as little stress as possible and see what happens.  As she only had one seizure in the past year, two in the previous, we are hoping she is building a greater threshold.  At this time we feel we can monitor her closely but I still have such a deep feeling we are missing something important.  I have exhausted all of my knowledge and my ability to research the topic.  I would welcome your summary on this and again I thank you and all of your fellow doctors for so unselfishly giving of yourselves to those of us so desparately looking for answers.  God Bless.











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