treatment for simple partials

[dreamersmom]

I've written before explaining that my 12yrold started to experience something that could only be explained as "psychic seizures" they last about 5-7 seconds, cause no motor symptoms and she doesn't lose consciousness. She can talk, continue a task and keep walking. She holds her head and says, "here is comes!" To anyone else it just looks like a person with a brief headache. They occur anywhere from 0 to 3 times a day. Her contrast MRI was normal. her neuro felt that the image was clear and showed no abnormablities. The blood tests that have returned are normal. Her initial EEG was normal. We have scheduled an ambulatory overnight EEG. These episodes cause her 5 seconds of discomfort, but no lasting pain. I have come to terms that these may indeed by simple partials with no underlying cause. These events did start over the summer, and altho she's never had a brain trauma, she did do alot of diving into the pool. Once, after a friendly "diving contest" she said her vision was blurred. I made her stop and It cleared up within minutes. I hadn't even thought of it until now. She is healthy otherwise. She has been sensitive to meds in the past, so her neuro has decided to watch and keep a diary for now, and to wait for the overnight EEG test (in 4 weeks).
1) Is is true that most simple partials DO have some underlying cause? Can I rely on the MRI? What about the diving?
2) Are partials that haven't expanded beyond this focal point treated with medication? By waiting (for a change in symptoms basically) are we doing more harm?
dreamersmom

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

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.    
   Simple partial seizures (a form of focal epilepsy) do indeed often have a underlying cause.  This cause may not be apparent with the first round of tests (MRI and routine EEG).  Sometimes subtle changes in the brain can cause epilepsy with a normal MRI, such as cortical dysplasia, early hippocampal sclerosis, etc.  I would suggest and extended EEG (3-5 days or until several spells are captured). I would also suggest a PET scan to try and identify an area of hypometabolism that could indicate a seizure focus.  The diving is unlikely to cause enough head trauma to cause epilepsy, but when head trauma occurs the temporal poles and that frontal poles are most often affected.  There are theories of epilepsy (though contraversial) that repeated seizures set up circuits in the brain that promote more refractory epilepsy.  I would suggest a prompt and comprehensive evaluation.  A trial on anti-epileptic medication while you wait for your evaluation would also be indicated.  If the symptoms went away on the medication, you will have your answer.
I hope this has been helpful

[bag77]

Just wanted to say my daughter has partial seizures that started two months ago and she is 8 yrs old.  Neuro and pediatrician were great and asked for a ct and mri which revealed scarring and cyst in the brain due to a stroke at birth.  Getting a eeg and mri are important if you ask me.  Rule out everything.  If it is idiopathic than it has a better chance of total remission.

[seemore25]

Interestingly I seem to have recently experienced similar episodes...I know they are coming too, and the other symptoms are similar to your daughter's.  They, (the episodes) start by me vaguely remembering a dream, and if I focus on the memory of the dream, I can feel the episode rushing in.  It's not unpleasant, but un-nerving.  It's happened a few times in the past, but today , five times, so I'm worried about it now.  They only last a few seconds and I can shake them off, usually with a shout or "whoa..."  something like that.
I recently had my brain scanned (part of a full physical) and the results are coming soon, so I will report back when I hear anything.  I am 55 years old, male.

[dreamersmom]

seemore,
the part you say about "dream" she just reported today. Someone mentioned a tv character in a lecture at class and the brain took over, giving her warning. She held her head and thought to herself "what about this character was I suppose to remember? is this a dream? Was this IN a dream?" She says she is briefly dizzy, but can clearly hear the lecturer continuing and could even respond if by some misfortune the teacher were to call on her. she says it's the same feeling and symptoms as always. With the main tests out of the way, we even did an echo today to rule out heart problems. I don't expect any, but I feel I need to rule out any possible underlying cause. We scheduled an overnight EEG and I've made an appointment with a well-known neuro's 2nd opinion for the end of the next month. She says these episodes make her uncomfortable and I think they initially frightened her. (It would me too). I could tell she felt some relief when I told her many people experience similar experiences. I'll tell her about you, and she will feel a kinship and it will give her comfort. I hope you don't mind.
I will keep you in my prayers as well...keep me posted on how you are doing.

dreamersmom

[seemore25]

Dreamersmom,
I had an idea as I woke up today, and thank you so much for writing back.  But let me ask you, do you happen to know how many times your daugheter wakes up at night?  Rcently I have been noticing how often I have to get up to go to the bathroom, (must be a weak bladder or something), but last night (for example) I got up three times.  Every night it's the same thing.  This has been going on for months, and it prevents me from getting deep sleep.  In fact I often wake up in a dream....Ask your daughter how many times she wakes up.  I am going to try to stop drinking water before I go to bed, and possibly I wll find a diuretic at the store.  Whatever happens now, please keep in touch.  It may take awhile before I find out if this works.
By the way, is there a correlation between your code name "dreamers mom" and this?  Perhaps your daughter mentioned the dreams to you?  The dreams are a major component for me!

Seemore25

[seemore25]

Dreamersmom,
I searched for your other postings (you said you had earlier) and I noticed two things which I share with your daughter.  First, and probably unrelated, is I too had mitral valve prolapse, to the extent that I had a heart valve repaired.  That was in Nov of 2000.  I understand that most murmers are not as bad as mine and that most people live normal lives with them (that is the case with my 59 year old sister!)The repair was successful, and is not a replacement, nor a transplant, but a repair, stitched and a metal ring placed around the valve.  I can tell you more if you want but I don't think this is the cause, but rather a coincidence.  The other thing you said resonates with what I said this morning, that I think my condition is brought about by sleep deprivation, or rather deep-sleep deprivation.  You said your daughter lacked sleep too!
If I'm right, .....well then let's hope this is the case.
Hang in there.  My brain-wave results are being told to me October 12th so I will discuss this with them and let you know what they say.  I also have a call in to my doctor and will run it by her too, probably tomorrow.
Dreamersmom, I'm sorry that your daughter has this problem, but I appreciate the fact that you are discussing it with me, somehow it helps me, and to consider the possibilities.
Thanks again.
Seemore25

[dreamersmom]

Hello Seemore.
You are correct that "dreamersmom" is connected to her vivid dreams and her hounding me down to tell me about them. even as a small child, dreams were a big deal. She knew they were dreams, but for the most part, they seemed to be enjoyable adventures. She was impressionable too. We had to be careful about stories we read to her, because "they might just happen!!!!". Of course, she grew out of that. She is now an imaginative writer, tackling comedy, adventure and even horror. She is notorious for daydreaming in school too, but somehow she absorbs facts enough to get the grades.


She told the doctor that the week this started, she had the worst nights' sleep. hardly falling asleep or staying asleep. It was a lazy summer week, so there were no outside pressures. But when she did fall-asleep, her dreams were especially vivid, and she told her doctor that she was fascinated by how well she could remember the details. She clearly felt there was a connection. i don't know if HE felt there was a connection. At the time, I thought it was hormonal. I related it to my hormonal experiences, which at times creates insomnia and disturbing dreams.

another poster suggested "sleep disorder", but I hadn't looked into it enough. I do know that lack of sleep, stress and poor diet seemed to precipitate more frequent episodes. I thought her sleep patterns had improved, but I overheard her tell her sister that she often wakes, and won't disturb anyone in the house. She keeps a notebook by the bed to jot down story ideas. As far as going to the bathroom at night, ... that seems to be my problem. I fear this is age-related, and I do drink alot of water.

i will investigate the effects of deep-sleep disturbance again. I'll let you know if I dig up anything. She had her echo yesterday, but I won't get the results for 3-5 days.

take care seemore--and good luck on the EEG.
dreamersmom

[seemore25]

I had my evaluation with a neurosurgeon who was "unimpressed" with my idea concerning lack of sleep.  I'm scheduled for an MRI soon and will let you know what they find.  He said my EEG was normal, and everything was in order, but that the EEG wouldn't show anything anyway.
I still am holding onto the concept of disrupted sleep until I learn otherwise.  I value and respect doctors' opinions, but I also feel that one understands well their own space and condition.  (At the very least, I am training myself to sleep through out the night so that can't be bad!)
Hope your daughter is well.  I've had no occurances since we last spoke.
Cheers

[dreamersmom]

Hello Seemore, I'm glad your EEG is normal and that you haven't had anymore episodes. This is great news. The MRI is very important. I think that everyone was concerned about what my daughter's mri would reveal. If your MRI is clear (and I have a feeling it is), your experience may have been a one time thing. maybe you were stressed, not sleeping well. Maybe for you this was a migraine-type thing. You hadn't said anything, but I'm sure you've had all the bloodwork, including sugar, thyroid and Lyme tests. For my daughter, the best thing we've done is the diary. She still experiences these episodes frequently, but they appear to be cyclical. Two weeks of no activity and then, two weeks of some activity. Quite frankly, they appear to be tied into her hormone cycle. Since you have no estrogen worries I doubt this applies to you! :) I do get annoyed at doctors who "dismiss". Mine does it with a wave of the hand. Perhaps I am in denial. But if I do accept these as siezures, I still have an obligation to explore what triggers them. If we can't avoid the triggers, then we have to decide whether to medicate. The episodes are still the same: a severe disorientation/confusion with the same feeling you experience with deja vu, only magnified. They are 8 seconds in length, do not effect consciousness or muscles, she can talk, walk and do things during them BUT they are very unnerving. We have schedules an overnight EEG in the hopes of recording these episodes and at the end of November we are getting a second opinion from another specialist. The mystery surrounding this whole thing has me stressed, but I hope for you and my daughter we can find a healthy solution. My prayers as always: dreamersmom

[seemore25]

Well, just keeping in touch...I haven't had any more episodes since we communicated.  Of course I think that is because I am now getting sleep.  Funny, this morning I had to get up at 4 am to get my wife to the airport, and I forced myself to wake up in the middle of a dream.  I will try to recall the dream later today, to see if that triggers anything.
If I am correct about the sleep issue, then perhaps your daughter's cycles are keeping her awake or sleepless on those nights?  I hope that's all it is because it's an easy fix!
I am heving my MRI soon and I will relate what they do or do not discover.
Stay in touch.
Best to your daughter.

[dreamersmom]

Hello seemore, it's been awhile. I am very, very happy to hear that you haven't had anymore episodes. By now, you must have had your MRI, and I bet it's clear. I think you are going to be ok. As for my daughter, her symptoms are the same, but not worse. She did a 24hour eeg and may have had a minor episode while it was on, but the waves showed nothing. The pediatric neuro has concluded that she DOES have mild partial seizures, but because they are short in duration (8 sec), don't interfere with her consciousness or ability to talk, walk and perform thru them, he recommends no medication unless they worsen. He believes this is close to the "alice in wonderland" syndrome, coming deep inside the temporal lobe. Some studies suggest a viral trigger (like strep) and this type tends to be outgrown, but the sufferer generally develops migraines as an adult. Of course, there is always that possibility that the seizures can worsen or develop further, but his gut feeling is that it won't. Interesting isn't it? I do find that if I increase her protein intake, make her take her vitamins (big ones with minerals) and insist on a good nights' sleep, she has less episodes. The estrogen surge is not controllable, but I elimated all meat and diary products that aren't organic (organic ones weren't given estrogen). I also got rid of anythng with red dye #40. Altho unproven, some people are sensitive to it, and for my Godson with tourettes, elimination of red dye decreased the incidence of tics. i also read that Omega fatty acids reduced these partials too. you may benefit from this, since it's a very healthy supplement known to improve mood and indirectly, sleep. I have kept you in my prayers, and I am so happy to hear your good news. May you continue to remain in good health! Dreamersmom

[Tyrrell]

dreamermom & seemore25,

Your dialog has been very helpful in trying to understand the path to take with this disorder. I am a big proponent of the effect of sleep deprivation. I had my first (and most dramatic) partial seizures 5 years ago right after my son was born (I'm 42 now). I was getting only 4 or 5 hours of sleep each night with the newborn. In the middle of one day, I started having 17 second intervals of Deja Vu. This went on for over a half hour without a break...Deja vu ...5 seconds off ... deja vu.... I was lucid and could do the "remember a two syllable word "trick.  I also had a rush of the smell of sweet flowers(ironically I have practically no sense of smell). Most frightening, I suddenly felt as if my entire right side of my body was being dipped into cold water. After rushing to the ER to see about a stroke, they found nothing. Since then I have had 4 other occurrences, always including the deja vu and smell. All related to times where sleep and stress were an issue.  The last one, two months ago, also included a rush of deep sadness... very strange indeed. I have had an EEG and a MRI that were both negative. The neurologist put me on a regiment of Lyrica 4 times a day - For Life... Yikes. If it were truly sleep related, I would rather put my resources into managing that, rather than inhibiting the workings of the brain with a 4-month-old medication. When I suggested maybe attending a sleep clinic, the neurologist smirked and prescribed 6 months of lunesta! My big concern is my driving. I feel that I am still there during the episodes, but do not want to put my family and others at risk. I wish I could find concrete data showing a link between sleep/stress and simple partial seizures.

Thanks for your candidness.

Wishing you and yours the best of health.