Sense of impending seizure off and on

  
  Patient  Detail
  ---------------------
  Name:    Faysal Saeed.
  Sex:       Male
  Age:       27 Years
  Hight:     6 feet
  Weight:  80 Kg
  
  Q:  I was first time  find this problem in March 91, aged 19 yrs. I feel
  for episode for the previous one month during which I would feel a little
  anxious, then lose awareness for many minutes; then I would slowly become
  aware; followed by inappropriate or irrelevant talking, during this period
  I was noted to exhibit slowness and clumsiness of movements. Later
  I would recall one or two questions of events during the episodes.
  I a have a car business in which I am  active.
  Physical neurological examn was normal. A note about EEG findings of feb 91
  states that there was epileptic activity arising deep in the right
  hemisphere with a normal background activity.
  I put on Tegretol  and failing control, on Phenytoin (June 91), later on
  valproate, as I was continuing to  have a daily seizures with absences
  and stiffening. The seizures continued. Mysoline had also been used in the
  interim without benefit. In Sep/Oct. 92 Sabril was added, with immediate
  response which persists, except that lately I feels sense of impending
  seizure off and on but no actual seizure. At present I am  on Sabril 750
  mg,  Tegretol  400 mg and Valproates (Epilim) 1200 mg daily. The Levels are
  with in therapeutic range.
  I want to take advantage of a  web clinic to review my  case for more
  improvement. I feels sense of impending seizure off and on but no actual
  seizure. This situation reveals itself through the little difficulty in
  speak or read. I also feels a change in body temperature and a feeling
  of anxiety.This situation lasts anywhere from a brief moment to perhaps
  15 to 20 seconds I  fully aware and possess control over my physical
  movement  but cannot verbally communicate at all. Past attempts
  to speak resulted in incomprehensible, slurred speech. Reading is also
  difficult during this. Approximately every two  weeks, I will have this
  situation,   similar in characteristics, followed by  few minutes of little
  difficulty in speech and reading comprehension but cannot verbally
  communicate at all. Past attempts to speak resulted in little
  incomprehensible, Any valued suggestions from your side for my Physician,
  Dr. Akhter Ahmed (Neurologist) for more improvement in my case?
  If you require any more detail from my Physician . then Pls. advise me by a
  reply e-mail.
  Waiting for the  positive reply from your side soon.
  Yours faithfully,
  
  Faysal Saeed.
  
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I think it is very probable that the symptoms you describe are in fact seizures, which are partly controlled to the point wher they do not progress into complete seizures but instead cause these minor symptoms and then progress no further.
The best way to prove this would be by having an EEG and checking to see if there is epileptic activity in the EEG at the time when you experience these feeling of inmpeding seizures.
This is an indication that your seizures are not fully controlled on your present medicication,you either need to increase the dose of the drugs you are taking at present or switch to a new medication to control the problem.
if medications do not work thete is a possibility that epilepsy surgery would be useful in your case.
These seizures sound like temporal lobe seizures, here in the Cleveland clinic we have an epilepsy surgery program in which we remove the abnormal area of the brain in carefully selected patients who have seizures origionating in one specific area. this is performed in patients who do not respond to mediacation.