Seizures, PTSD and sleep disturbances following a road traffic accident

[Una]

In February 1999 my daughter was injured while travelling as a passenger on a bus while visiting a friend in Scotland. The bus rolled a number of times and my daughter was left suspended from the arm of the seat by her jacket. She banged her head on the window but cannot remember if she was knocked unconscious. She had minor injuries and was immediately discharged from hospital but could not travel home alone. We collected her and she saw our family doctor 4 days later - he diagnosed whiplash. She continues to have neck and back pain.

Following the accident Rachel started to experience seizures.She was away at college so they only came to our attention in July 1999 and diagnosis and treatment was sought. She continues to have a seizure once a day usually in the evening. They always occur from a standing position and are very sudden. She is unconscious for 30 secs – 2 min and makes no movement except for flickering eyelids.

Tests have eliminated epilepsy, cardiac problem or an unstable hairline fracture of the neck as the cause of the seizures. Clomipramine was prescribed by the psychiatric consultant on the grounds that is might be cataplexy but this had no effect. No positive diagnosis has yet been made.

She has been diagnosed as having "severe and chronic" post traumatic stress disorder. She has nightmares flashbacks
and anxiety. She finds getting to sleep very difficult - often
staying awake all night.

I have read of research on injury to the Recticular Activating System. Is it possible that all these symptoms are related to this and is there any treatment

[CCF-Neuro-M.D.-JT]

Sorry to hear about your daughter's accident and her subsequent problems. The RAS is the part of the brain that helps us maintain consciousness.  Experimental damage to this region in animals causes a state of coma.  In humans, however, the clinical manifestation depends on the area of the RAS in the brain that is affected.  With damage to some parts, you can develop transient coma and unresponsiveness and with others a prolonged state of sleep.  However, the amount of brain damage needed to produce these dramatic presentations is usually quite extensive. Your daughter's symptoms and daily non-epileptic seizures (as you describe) do not appear to represent the typical case.  For a more definitive approach, consider seeing a neurologist and see if they think an MRI brain would be appropriate after a history and physical exam.  

Another test that would be very helpful is a video-EEG monitoring that could capture one of these spells in the evening.
If she has normal background EEG activity during one of her unresponsive episodes, then it would tell you that
1)these are not seizures (of epileptic origin)
2)she has not truly lost consciousness which would point away from damage to the RAS.
If these symptoms are felt by a specialist to be related to post traumatic stress disorder, then she should be treated with appropriate medications as prescribed by a psychiatrist. This as well as talking about it may help some of her symptoms. Best of luck to you and your daughter.

[fudbudkins]

It is interesting that epilepsy has been ruled out - how extensive was the testing?  In many cases, epilepsy has an idiopathic etiology.  In the case of PTSD the onset of seizures may in fact be linked to an aquired epileptic condition and may well elude detection by an EEG unless certain conditions arise during the monitoring.  The anxiety you experience may trigger   neurochemical imbalances resulting in seizures; a kind of electric storm arising from a limbic trigger response.
In such cases, valproic acid may offer some relief as it aids the brain in establishing homeostasis by enhancing the regulatory properties of neuro-transmission. I would urge you to pursue this possibility with your neurologist and request some sleep monitoring etc.

[ZUZU]

I am a vietnam vetram who has been dealing with seizure disorders for the past few years. I have had a MRI and video_EEG.
Everthing was normal. I have been searching to some form of link to PTSD and its ability to lower ones threshold to have seziures.
I attend a weekly group session of PTSD vetrans who are all on the same depakote as I am, yet I am the only on who has had a seziures.
Has thier been any studies or publications/sites that devote more to the connection of PTSD and the lowering of seziure threshold.***@****

[seizurefree]

In the summer of 1986, I was 15yrs. of age, and took a bad fall, hitting my head, knocking me unconscious for up to 30 minutes. This resulted in a seizure disorder that I'd never thought could happen. But it did. And has changed my life forever.
  I started taking Dilantin (Pheytoin), and once I quit drinking w/ freinds on the weekends back in 1986 the seizures quit.
  Una, don't give up! There are very qualified Neurologists out there.