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seizures
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seizures


  My husband is currently at an epilepsy center undergoing eeg/video monitoring.  He began having seizures 10 years ago which lasted 1 year. Then seizure free for 10 years. No meds,eeg and cat scans all negative. In Oct. 97 he began having seizures again.  CAT and MRI revealed two arachnoid cysts. Both cysts were of no concern to the neurologist or neurosurgeon.  Tegretol administered at 400 then up to 1200 over the past year. Seizures continued every 4-5 weeks. One break of 3 months seizure free.  Now at center, meds withdrawn and unfortunately one seizure during hyperventilation & strobe light revealed no activity on the eeg. There has been no further seizure activity. Various neuropsychologist testing proved negative.  Strobe test scheduled again for today. What next? I have witnessed these seizures and have no doubt they are real.  Lip smaking, loss of awareness, involuntary twitching of legs and trunk, etc. Dr. wants to eliminate tegretol indefintely.  He gets released tomorrow. What if he has additional seizures at home? I'm nervous that they have not researched his condition more thoroughly. Any suggestions will be appreciated. Tara
Dear Tara:
Sorry to hear about your husbands symptoms.  It sounds like your husband has undergone a very extensive workup for epilepsy.  Without seeing the seizures, evaluating the EEG, examining him, it is impossible to give you a diagnosis.  It sounds like the conclusion is that your husband is having pseudoseizures?  But if he did have a seizure during hyperventillation, were there no EEG changes that corresponded to the seizure event?  Putting this together, it does sound like he may have pseudoseizures.  These are real events that for the most part look like seizures, however they are not related to brain activity abnormalities.  Sometimes our minds and body respond to various stimuli like stress, with abnormal symptoms.  These can be abdominal pain, migraine headaches, or even seizure-like events.  It sounds like the epileptologists are leaning in the direction of pseudoseizures.  If you are still worried, it would be in your best interest (and your husband's) to get a second opinion.  I would gather all the labs, films and EEGs and get a second opinion from another epilepsy specialist.  If the diagnosis of pseudoseizures is correct, then if a seizure occurs at home, make sure that things are not around that might hurt him if he bumps into them during a seizure (i.e. move chairs from the area), wait for 5-9 minutes before you call 911, and make sure all the doctors know that your husband has been diagnosed with pseudoseizures in the past, but has had real epileptic seizures (if he has had them) in the past.  I would do this just so the ED doctors are careful do look into the possibility of real seizures but also look out that too agressive treatment is not done that might harm him (i.e. intubation and mechanical ventillation).  If it is the diagnosis of pseudoseizures, he really need psychological help.  Best of luck.
Sincerely,
CCF Neuro[P] MD




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