Re: seizures

Posted By ccf neuro M.D.* on August 29, 1997 at 18:45:20:

In Reply to: seizures posted by Tom Pilgrim on August 28, 1997 at 01:28:49:








I am glad  I found this site. I have a couple of  questions for you. Questions that I cant get a straight
to.
I am a 48 year old man. I started having seizures in 1972.  At the time I was in the army.  Every
now and then  for no reason I would get a numb, tingling feeling on the left side of my face and my
left hand and arm. Sometime I would have what I called blackouts. They would only last for a min.
or so. I had no recall of what happened. I would just have drool on my face and shirt. I went on
sick to find out what was wrong with me . The army Dr. told me I was having  seizures, he called
them Jacksonen March seizures. He said they were caused from a blow to the head that I received
in the line of duty.He gave me Dilantin and sent me back to work. After the army I went back to
school, but the seizure just got worse as time went by. The Vet Admin. Dr. told me I was having
temporal lobe, psylomotor type seizures. Over the years I have been on every seizure med. out
there, and in every combination. Right now I am on Tegtrol 1600mg per day I take them, 2-200mg
qid. At the first of this month they started me on Neurontin 900mg per day and I take 100 mg of
amitriptyline per day. On the ave. I have 6 or 7 seizures in the day time,  I know I had them. I call
them full blown seizures. I also have them in my sleep and I am never aware of them until my wife
tells me about them.  I had 5 last night and do not remember them, I had one this afternoon and I
know I had it. I have never in all these years had better control than I have now, an ave. of six per
month is a good ave for me. Sometimes I have an almost seizure,   I have the numb tingling feeling ,
the aura, but no seizure. These aura will last for 2 to 5 min, and I have one of these almost every
day. Is this an another type of seizure? I think I might have 3 different types of seizures. Could that
be so? Is it very common that med will not control the seizure? A few years ago I was being
treated  at  seizure clinic in the VA Hospital at Little Rock, Ar.  They did a work up for surgery
where they monitored and watched me 24hr a day, for 10 days. The Dr. said that he could not
operate on me because the damage was in two lobes. I don't what they are talking about half the
time. I hope you can  answer these questions.
Tom P.
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Tom,
Your questions are unusually strightforeward for this forum, and I hope that the following answers will help clarify some of your confusion. Auras ARE actually seizures, but are a seizure generated from a very small portion of the brain that, when overactivated by the seizure, produce symptoms that the person having them is aware of. Your particular type of aura is called a SENSORY aura. Other types include VISUAL auras where someone may see flashing lights, PSYCHIC auras where someone, may for instance get a funny sensation of deja vu or fear, and  EPIGASTRIC auras, which cause a feeling of nausea and sometimes even vomiting. Funny smells or tastes are yet another type. At any rate, as long as the seizure activity remains confined to the small part of the brain generating the aura, the patient remains aware of the seizure and remembers it. If, however, the seizure SPREADS to OTHER nearby portions of the brain, awareness and/or consciousness may be lost. If the seizure spreads to the TEMPORAL lobe of the brain, often the affected person stares blankly, awake in the sense that their eyes remain open, but completely unaware of anything going on around them. Such seizures typically last a minute or two, and may be accompanied by semipurposeful, repetitive movements like fingers picking at your clothes, walking aimlessly, eyeblinking, lip smacking or chewing etc., called AUTOMATISMS. Such seizures are often called PSYCHOMOTOR, named after the psychiatric effects (loss of awareness) and the MOTOR or movement effects (stopping moving or the automatisms) If the seizure spreads to BOTH sides of the brain and becomes what we medically term GENERALIZED, typically consciousness is lost, the whole body goes stiff, and then begins jerking irregularly. These are the so-called "grand mal" type seizures. A given person may have auras, psychomotor seizures, generalized seizures, or a seizures that starts as an aura, then becomes psychomotor as it spreads, and sometimes even generalized after that if it spreads some more.
Evaluations for epilepsy surgery are done after all conventional drugs have failed to control the seizures, and/or have been intolerable to the patient, in an effort to find out if there is one single spot or area in the brain that serves as the starting point for all the seizures that any given person has. Such a spot, if present, may be secondary to trauma to that area of the brain, a tumor, or congenital  defects. If this is the case, the abnormal tissue can be surgically removed, and the patient POTENTIALLY cured. If the cause for the seizures affects many parts or all of the brain, however, such surgery cannot be done,as you cannot remove large parts of the brain without suffering severe brain damage. From your description of things, it sounds as if this was the case for you, unfortunately. There are some controversial nonpharmacologic treatments for epilepsy such as vagal nerve stimulators, and there are always new medications being studied, but generally speaking, once you've gone through three or more seizure drugs without achieving good control, the likelihood of anything else having a dramatic effect is small (but not impossible).
Information that we provide on the Neurology Forum is intended for general medical informational purposes only. Actual; diagnosis and treatment of your specific medical condition should be strictly in conjunction with your treating physician(s). If you would be intersted in a second opinion form the Cleveland Clinic, a world leader in epilepsy treatment and surgery, the department of neurology's phone number is 1-800-223-2273 ; ask to be connected to EPILEPSY appointments (note: this is different from general neurology appointments). I would suggest Dr. Imad Najm, Dr. Harold Morris, or Dr. Hans Lueders, all of whom are well known experts in epilepsy.