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Re: Some confusion about Epilepsy
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Re: Some confusion about Epilepsy

Posted By Nancy  on July 05, 1999 at 09:42:51
Good Morning. Thank you for taking the time to read and respond to this question.
I am a 44 year old female who, in 1996 experienced what I percieved to be heart attack symptoms, ache in the left arm that migrated to chest pain along with a cold, clammy feeling.  No nausea.  However, along with those symptoms was a very odd sensation in my head that left me feeling as though I may black out (this never did happen). A very quick trip to the emergency room revealed normal EKG, "excellent" blood pressure and blood tests revealed no evidence of a heart attack (I was not aware until that time there was a blood test that could test for a hear attack).
To make a long story short, since that time, this rather odd sensation in my head continued, I will use the term 'dizziness' to describe it although it is not as accurate as I would like it to be. I have since been working with both an internist and a neurologist, both of whom I have an excellent rapport with and this whole thing has been a real mystery for the three of us.  I even sought a second opinion, with my neurologists blessing and that went nowhere, the second neurologist attributed the entire problem to stress.  
This 'dizziness' is aggravated by driving and sometimes can get severe enough that I need to consider positioning myself where I can get off the road if necessary, sitting behind a computer terminal or (of all things) covering my ears for any reason (I wear a phone headset in my job) and it is accompanied by a pressure in my ears.  MRI is normal and an EEG that was recently performed showed what my neurologist termed as 'high spots' that can be "consistent with epilepsy."
I am presently on three drugs: 400mg of dilantin per day, 0.5mg Klonopin three times per day and 200mg of Topomax (topamax) per day to try and get this under control.  This, after trying Neurontin, Tegratol and a couple of others that my body reacted badly to.  I have never actually 'seized' in the sense of either blacking out or having a grand mal seizure.
Does this sound like epilepsy and if so, does it have a name?  I should also mention that this 'sensation of dizziness' has also come over me in my sleep and actually awakened me so it is not solely limited to the circumstances described previously.
I said I would make this short so I had best stop here and let you respond.
I would also like to note that all of the information I have presented here, has been presented to my physicians and they are wrestling with it as much as I am.
Thank you in advance for any suggestions/ideas you may have with regard to what type, if any, epilepsy we may be dealing with here.
Regards,
Nancy





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Posted By CCF Neuro[P] MD, RPS on July 05, 1999 at 14:07:35
Dear Nancy:
What you describe is certainly consistent with epilepsy.  There are various types of epilepsy.  One type is called generalized epilepsy, this is where the entire brain has abnormal activity.  It can be expressed as loosing consciousness, tonic/clonic or generalized grand mal seizures, abnormal jerking or just straightening out of the limbs.  Another type starts in a specific area of the brain, called partial epilepsy.  There are two major types of this, one is where the patient does not loose consciousness, this can be manifested by feelings of dizziness, nausea, with or without abnormal movements of one area of the body.  The second type in this class is where the patient looses consciousness and has abnormal movements.  This too is from one brain area.  
What yours sounds like is simple partial seizures.  You don't loose consciousness but you feel abnormal.  You are fortunate that yours does not include abnormal body movements but a change in sensation.  It sounds sort of temporal lobe origin.  I am not sure what is meant by "hot spots".  Usually we think of epileptic activity as spike or sharp waves.  
I hope this helps you.  I also hope they can get your epilepsy under control.
Sincerely,
CCF Neuro MD




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Posted By Nancy on July 08, 1999 at 10:46:34
Thank you very much for your response, I very much appreciate it.  You note that you are not sure what was meant when I said 'hot spots.'  If I said 'hot spots' it was a misspelling on my part, what I meant to say was 'high spots' but I believe you addressed that when you went on to say what you normally see is 'spikes.'  In any case, this is a WONDERFUL service you are providing and please, please do continue it.  May I ask just one additional question?  
Can an EEG be influenced by 'outside' sources?  In other words, during my EEG which was performed both asleep and awake, during the 'asleep' portion someone came into the testing room unexpectedly which startled me somewhat.  Can this influence the brainwave pattern on the EEG thereby providing an incorrect reading?  Thank you again.




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Posted By CCF Neuro[P] MD, RPS on July 08, 1999 at 16:50:21
Dear Nancy:
This service is for the general public.  You can ask what you want and I hope that the financial means to keep this forum going remains intact.  We are here to help you.  No, the best EEGs are done asleep and awake.  The technician is suppose to awaken you if necessary to make sure all the tests are performed as required.  It just so happened that someone did it premature.  Best of luck to you.
Sincerely,
CCF Neuro MD




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Posted By Nancy on July 08, 1999 at 22:05:45
Thank you so very much for your time and your help!




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Posted By CCF Neuro[P] MD, RPS on July 09, 1999 at 12:44:02
You are welcome.
CCF Neuro MD




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Posted By Kathy on July 13, 1999 at 12:24:55
I'm sorry I had to piggyback on to this as a follow-up, but I'm at the end of my rope!  When I was a child, I had several EEGs and was diagnosed as having (to use the old terms) petit mal, grand mal, and temporal lobe/psychomotor epilepsy. The petit mal seizures were nearly continuous, and no medication ever really stopped them. (I'm now 40, and I still have the rolling up of the eyes, and the unresponsiveness; my neuro thinks it's "just habit.")  The grand mal were well controlled - only two in 10 years; the temporal lobe was generally controllable, except for a few minor spells over the years, mostly consisting of audio and visual disturbances. In my early 30s, I underwent a hysterectomy and the resulting "surgical menopause," I now take 1.25mg Premarin.  A few years after that, (mid-30s) I was diagnosed as having bipolar affective disorder.  Now my "grand mal" seizures are occuring 2-4 times a month, with biting of the tongue (quite severe), multiple and severe bruises from falling, and probably the worst, the feelings of fear, anxiety, and confusion afterwards.  My husband has seen them 3-4 times, and has described the typical tonic-clonic movements, the suddeness, and the silence during the seizure.  The aura that I am starting to associate with these seizures is a strong feeling of deja vu, and a disruption of the flow of time (it would be as if you sliced up a roll of film and rearranged the pictures; some moments would seem very familiar, others very unfamiliar). At my last EEG, my neuro stated that I had "transient disrythmia."  Because of my bipolar disorder, he is now calling these pseudoseizures.  Can someone have epilepsy and then outgrow it?  My personal thoughts are that: 1) it could be a hormonal balance; 2) My neuro put me on Ativan, (2/mg/day) instead of an anticonvulsant; 3) My EEG appears half-way normal because the electrical activity is further in the brain than the probes can reach.  All the diagnostic clues that I can find point to epilepsy, not pseudoseizures.  The only exceptions are that I'm NOT incontinent, and I'm not sure if I do this in my sleep.  Your input will be so valuable for me...thank you so much for your time.




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Posted By CCF Neuro[P] MD, RPS on July 13, 1999 at 12:48:15
Dear Kathy:
It is difficult to make a comment without being able to see your EEG, video of your seizure events, and do a proper physical exam.  Temporal lobe epilepsy should be easily visualized on a normal EEG.  Tonic/clonic seizures are very characteristic and therefore shouldn't be mistaken for something else.  If you have a video, I would video one of these events and show your epileptologist.  For the most part, generalized tonic/clonic seizures produce incontinence of urine.  One of the things that we do at the Cleveland Clinic is do video/EEG monitoring and try to correlate the seizure activity with the EEG.  There should be a correlation, especially in your case having temporal lobe epilepsy.  You might suggest this to your epileptologist.  Although many people who have epilepsy also have pseudo-seizures, it is something that should be worked out.  You need to know this as if this turns out to be pseudo-seizures, you don't want some ER intern intubating you for something that isn't real seizures.  Also, ativan can be used for seizure control.
Yes, people do outgrow some forms of epilepsy.  Just because you have bipolar disease does not mean that you also cannot have epilepsy.  I hope you get things worked out.
Sincerely,
CCF Neuro MD










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Some confusion about Epilepsy Kathy 7/13/1999
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Re: Some confusion about Epilepsy CCF Neuro[P] MD, RPS 7/14/1999
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Re: Some confusion about Epilepsy Dee 7/14/1999
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Some confusion about Epilepsy CCF Neuro[P] MD, RPS 7/15/1999
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Re: Some confusion about Epilepsy Dee 7/15/1999
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Some confusion about Epilepsy CCF Neuro[P] MD, RPS 7/16/1999
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