Stroke related seizure

[Molly Hamaker]

I had an aphasic stroke when I was 40, 6 years ago. Originally, no cause was determined. Recently it was discovered by a TEE that I have a patent foramen ovale which my neurologist now thinks caused the stroke. I am taking an aspirin a day. I recovered from the stroke with no significant permanent damage and have no health problems other than the PFO and a history of migraine headache with aura (inactive for at least ten years) and occular migraine (rarely). Last December I developed brief, episodic neurological symptoms that were similar to my stroke: loss of coordination and balance, veering to the right when I walked, and speech problems. Within a few weeks, the symptoms were happening multiple times a day. An MRI showed no changes since the stroke. My neurolgist diagnosed me with a stroke-related seizure (since the symptoms were coming from the same area of the brain as where I had my stroke) and gave me Depakote which stopped the symptoms almost immediately. I didn't tolerate the Depakote (many side effects) and eventually switched to Neurontin which I have happily taken for 6 months, three times a day. I have no side effects and the Neurontin keeps the symptoms completely in check unless I accidently skip doses. So, my questions are: 1) can you think of any other possible cause for my symptoms, 2) what are the chances they will go away so that I can stop taking medication, 3) what are the chances that the symptoms will get worse, 4) what is this type of seizure called and what can I read for more information about it (I have not found much on the subject). Thanks very much for your help.

[CCF neuro MD MM]

The explanation you have recieved sounds like a very plausible one, in particular the response to two different anti-epileptic drugs supports the fact that these problems have an epileptic basis.
Since these seizures are related to a structural abnormality
( the stroke ) it is somewhat unlikely that they will resolve and you will probably always need medication.
Since you lesion is stable the chances are you will not see aprogression in your symptoms, neurontin is a relativley weak anticonvulsant with low side effects , so the chances are that this will remain easy to control.
Your epilepsy is a focal epilepsy ( since it arises from a focus in the brain ). The seizures are partial seizures, if conciousness is impaired during the episode they would be referred to as complex partial seizures.

[Judith Bentley]

I had a so-called "stroke" while packing a suitcase in Atltanta to back home (BG, OH)and spent 3 days at Crawford-Long Hospital.
After CAT etc. put on Heparin and an MRI showed a past stroke in rt side (c. 10 yrs ago), and the new one on lft side.  My right leg/foot and arm/fingers were paralized, but gradually had use return.  But after 3 months, I am still very dizzy, and the leg and hand set-up feels like heavy magnets with poor coordination.  I am 61  and have had H B/P for 30 yrs which has been successfully treated (100 mg cozaar and now 350 mg ecotrin bid) and the neurologist here has done LP, VER, BAER to rule out MS.  The tests have been OK.  QUESTION: It has been 3 months and I have had just 2 appointments with the doctor and was just told to be patient and wait until next appointment which is Dec. 15th.  Is this normal to have to wait so long and to have to put up with not knowing if another stroke is happening or that the numbness is normal or the jerking (clonus) is just normal, banging into walls is normal?  Do most stroke patients have to wait so long.  The stress from wondering makes the heaviness and insomnia worse. If so, then I will continue trying to be patient and keep up with my work.

[Judith Bentley]

I had a so-called "stroke" while packing a suitcase in Atltanta to back home (BG, OH)and spent 3 days at Crawford-Long Hospital.
After CAT etc. put on Heparin and an MRI showed a past stroke in rt side (c. 10 yrs ago), and the new one on lft side.  My right leg/foot and arm/fingers were paralized, but gradually had use return.  But after 3 months, I am still very dizzy, and the leg and hand set-up feels like heavy magnets with poor coordination.  I am 61  and have had H B/P for 30 yrs which has been successfully treated (100 mg cozaar and now 350 mg ecotrin bid) and the neurologist here has done LP, VER, BAER to rule out MS.  The tests have been OK.  QUESTION: It has been 3 months and I have had just 2 appointments with the doctor and was just told to be patient and wait until next appointment which is Dec. 15th.  Is this normal to have to wait so long and to have to put up with not knowing if another stroke is happening or that the numbness is normal or the jerking (clonus) is just normal, banging into walls is normal?  Do most stroke patients have to wait so long.  The stress from wondering makes the heaviness and insomnia worse. If so, then I will continue trying to be patient and keep up with my work.

[CCF Neuro[P] MD, RPS]

Dear Ms. Bentely:

I cannot answer your quesion concerning "normal" for appointment times because that is physican related.  Your symptoms might be from your stroke, and certainly the symptoms point in that direction.  As far as resolution of the symptoms, that depends on the extent of the stroke and rehab.

Sincerely,

CCF Neuro MD

[kd]

In late September, I had numbness in my right ring and pinky finger which spread to the rest of the hand (I could not grasp), climbed up my arm, into the right chest, shoulder, face, tongue, and scalp.
I went to the ER and since it was the weekend, they admitted me for observation, putting me on heparin.  CT scan, etc. was ok. On Monday, they did  and EEG which showed left temporal focal seizure activity.  They put me on Dilantin and after 5 days I went home.  I ended back in the hosp the next week with Dilantin toxicity and at that time they did an MRI (which I was scheduled for anyway).  The MRI/MRA showed lesions in the parietal area.  My neurologist told me that the seizures were associated with the lesion.  It wasn't until I got a copy of the reports that I realized there were lobe differences.

Question
1:  Can a focal seizure in the temporal lobe be associated with a lesion in the parietal lobe?
2:  Both of my hands are affected by "tremors/mild jerks" causing me to drop small objects and double click on the mouse when I don't intend to, etc. Grasping is difficult.  Would the left temporal lobe problems cause difficulty with the left hand? (Sometimes it is worse than the right.)
3: Will this go away with time?
4:  I'm not driving and it is problemmatic.  Should I consider this a long time thing that I should just learn to compensate and start driving again?
Thanks.

[CCF Neuro[P] MD, RPS]

Dear KD:

The EEG, if read by a epileptologist should be fairly localizing and the site of your epilepsy is likely temporal.  If the parietal lesion is near the temporal lobe then likely it could be inducing a epileptic focus in your temporal lobe and causing you seizures of the type you describe.  Likely what is happening is that your seizure activity starts with the right side of your brain and can spread to the other side of your brain giving you both right and left sided seizures.  Unless you control the seizure activity, the symptoms that you describe will likely remain.  You should not drive until you are seizure free for a period of time, each state has their own requirements.

Sincerely,

CCF Neuro MD

[Becky]

I had a T.I.A. in 1990 when I was 28 y.o.  I lost blood flow to part of my brain for 4 hours. Afterwards I had partial aphasia. After having every test known to man it was determined I had a spasm in a blood vessel to my brain when shut off blood flow to the area of my brain where the speech was located. Six weeks after the fact a SPEC scan still showed decreased blood flow in the area of my brain where my speech was located and I was also asked if I ever experienced depression. I totally recovered from that incident and subsequently found out I have Raynaud's Syndrome and have been having suffering from Partial Complex Seizure Disorder ever since.  Nothing has ever showed up on an EEG but it has on a PET scan. The PET scan shows I have a focal lesion and also some other abnormalities in metabolism and the vascular system in my brain.

In the last six or eight weeks I have been having frequent seizures, probably six or seven.  This after moving across country, finding a new job which requires me to commute an hour each way and moving back home with my parents.  I went to see a neurologist I had seen previously and since nothing has ever shown up on an "EEG" he continues to believe I have "pseudo" seizures because I also have a history of depression.

What are the chances of this?  I am to take a sleep deprived EEG on Friday, the 3rd of December, if this comes back negative too, am I to commit myself to the looney farm and quit taking my medication?  My last seizure I was deep asleep and my dog woke me up needing to go outside, after letting him out I fell back into bed and had a seizure.  My seizures always occur late at night or early in the morning.  I am taking Neurontin 400mg 6 x day and Topomax (topamax) 200mg 4 x day (just raised from 2 x day).

By the way I asked for a different referral and switched neurologists.  I don't think I'm crazy.  Who would want to give theirself a seizure?  I even asked him if he didn't have a copy of my PET scan and didn't it show abnormalities and he said yes but that still didn't mean I didn't have "pseudo" seizures.  

I appreciate any help you can give me.  Sorry to take up so much of your time and space.

[Mozzer75]

A related discussion, Stroke meds was started.