Syncope or Seizure

[jan]

Dear Dr.,
I have posted a couple of times about this subject. I was diagnosed with neurocardiogenic syncope about 2 yrs. ago. Spells have chg'd (or I am hav'g something new occur), now dr.'s are divided on whether it is syncope or seizure.
I just had a 3rd EEG while in the hospital because of another loss of conciousness (diff. than the 1st). Nobody has let me know what the results mean. My primary says he doesn't really know and is hold'g out for syncope still. The neuro who ordered it wasn't my neuro, my neuro didn't order it because she is on leave of absence from that hospital. (I faxed it to her last week).
This is what the prelimary report says:
Basic trac'g is composed of posterior dominant 8-9 Hz activity at med. to high voltage and anteriorly dominant 20-25 Hz activity. EKG is reg. sinus rhythm. Photic stimulation was uneventful but hyperventilation of 3 mins. resulted in frequent bisynchronous bursts of slow wave activities with left sided preponderance.
Impression: Abnormal records due to abnormal hyperventilation response for an adult with slow wave bursts seen dur'g hyperventilation with left sided emphasis. This tracing is compatible with cerebral dysfunction being sensitive to hyperventilation with mildly left sided emphasis. Further follow up study and clinical correlation are recommended including hypogycemia, seizure disorder, migraine.
Here is a repeat of my history:
Mitral Valve Prolapse,Mitral Regurg.,Tricuspid Regurg. (all mild),Inappropriate Sinus Tachycardia,Neurocardiogenic Syncope (near fainting),Irritable Bowel Syndrome(constipation),Raynaud's,Costochondritis (about 11 mos. now),sleep disorder (fragmented sleep and excessive and dominant alpha waves into all sleep stages),Granuloma Annulare,another keratosis they want to biopsy (to see if it is autonomic or something "old men" get),I am sensitive to meds,Fibrocystic breasts,Cervical Spondylosis with degen. spurs and radiculopathy. My last neuro suspected Postural Ortho. Tachy. Syndrome, too. MRI shows a spot neuro is now saying is old stroke, could have happen'd in utero. Rt. sided problems with strange sensations. Now add to this the newly developed buzzing and blacking out.
My questions are: Would this mean the dr.'s who think seizure are correct? Could the "spot" be causing this abnormality and have nothing to do with syncope or seizure?
At this point I am still have appts. to go to local univ. hospital to see cardiac EP and neuro. Any ideas or suggestions of what they might do?
Any help you could give me would be greatly appreciated. Thank you.

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

Dear Jan:

The intrepretation of an EEG is somewhat subjective.  There is nothing that truely points to a seizure in the report.  The background is of normal frequency.  The focal slowing seen in hyperventillation is a normal finding.  The only mild abnormality is the "mild left sided emphasis".  I am not sure what that means, either focal slowing on the left or lateralized slowing on the left?  This does not mean seizure activity or epilepsy, it is as the report suggests a possible cerebral area of dysfunction.  I would not think this is seizures and would not start seizure medication.  I might suggest a tilt table test with concommittent EEG.

Sincerely,

CCF Neuro MD

[jan]

I have on 2 occasions hallucinated while taking ambien. Is it ok to continue taking it since I realize at the time that that is all it is?

[jan]

THANK YOU SO MUCH!!!  You are so kind to answer my posting, especially on a holiday!!! Now I can relax. :o)