simple partials or intrusive thoughts

[dreamersmom]

My otherwise healthy 12yrold daughter complained last month of silly memories or flashbacks intruding on her. She would be doing anything, and these thoughts were brief, irrelevant and were recognizable as past events. She was conscious and had no other sensory or motor symptoms. The only other thing going on at that time was that she had trouble falling asleep and her dreams were vivid (not scary). Her menses was late and was strong when it finally came. When she was very little, she had alot of anxiety and a stomach ache medicine worsened it and gave her OCD symptoms with intrusive thoughts. The med was stopped and she returned to her old self, with even less anxiety. She remains concerned about germs and can get obsessive about various things, but she is well-rounded. I wondered at first if these thoughts were OCD intrusions. The last month of the summer, she had many of these interruptions and she used the words "like deja vu" but not exactly. She said she wasn't feeling anxious but she felt confused because the thoughts didn't belong. After her menses and my nutrition boost, she's had none. I honestly thought it was just hormonal. However, her our neurologist believes these are simple partials. Of course, he has ordered tests (blood, MRI, EEG) which we have scheduled.

I have a few questions. Can these episodes really be simple partials? They seem too "simple"? How can I differentiate them from intrusive OCD thoughts or just hormone/tiredness related? What percentage of "simple partials" develop into grand mals-- especially since they hadn't? thank you.

[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.

   The symptoms you describe can be seen in OCD (obessive compulsive disorder) and/or temporal lobe epilepsy.  Temporal lobe seizures can cause deja vu type episodes without other features, but this is rare.  Simple partial seizures (a focal seizure that does not cause loss of conciousness) can evolve into a larger seizure (ie complex partial, or generalized seizure [grand-mal]) under certain conditions such as sleep deprivation, alcohol use, or worsening of the underlying process causing the seizures (growing tumor or bleed from a vascular malfromation, etc.).  I would agree that it is important to evaluate for epilepsy, before pursuing a psychiatric diagnosis, because the treatments are very different.  I would make sure the MRI is with contrast.  Also, interpreting the results of the EEG can be difficult.  The standard EEG is 20 minutes long, awake.  If she does not have a "spell" during this time, you can miss the seizure activity.  The seizure activity can also be missed if it is too deep in the brain to be read on surface EEG (For example: in the mesial temporal lobe or mesial frontal/parietal lobe).  I would recommend getting a 2 hour sleep deprived EEG if the first is negative, and if that does not reveal results, I would suggest an admission to an epilepsy monitoring unit (EMU).  In an EMU you will have 3-7 days of EEG recording, to capture your events.  They can also place sphenoidal electrodes to get a better look at the mesial temporal lobe.  After a comprhensive evaluation for epilepsy is completed, then I would consider other diagnoses.

I hope this has been helpful.

[vega1318]

What is your message exactly?  You can't push Lyme into every possible clinical scenario out there.   I am sorry, but this is simply misleading and dangerous.  I can't believe they're still letting you post here.

[bilbo5911]

I think the Lyme info is helpful, but I do agree that there is a danger to trying to "push" that diagnosis.  



Part of the problem stems from the fact that Lyme seems to have symptoms that are similar to a whole host of other illnesses. For example, symptoms of depression include fatigue, insomnia, unexplained body aches, anxiety (which are also symptoms of Lyme) and apparently 1 in 5 Americans struggle with it every year.  Now that's alot of Americans and while I'm sure some of those may have Lyme has the underlying cause, alot of them simply have depression. I think Hikerunner is good about pointing out that Lyme is only ONE possible cause (without pushing the diagnosis).



The thing about health problems (and I'm trying to be sensitive here and believe me I've had my share of "undiagnosed" suffering the past several months) is that it's really easy to let "the quest for diagnosis/or the disease itself become your life".  One of the ways that happens is in rushing off to every possible disease out there that could be a cause of one's symtpoms and trying to learn more about it.  The best bet is to just take things a step at a time, follow your doctor's advice (including the one on this forum) and go from there.  



Again, for some people on this board, they've been through all the testing in the world and definately would be smart to look into Lyme.  But, Vega has a real point --- it's silly for everyone to worry about MS, Lyme, and all the other host of illnesses all at once. Gotta rule 'em out one by one.  And it does strike me that the doctor on this forum does seem to be pretty good about pointing out Lyme when he actually suspects it.  

[vega1318]

I have nothing against caring and trying to come up with reasonable solutions.  Heck, none of us are doctors here and we're only trying to make sense of all of these symptoms and come up with the best possible explanation.  But it really bothers me when someone tries to take other people's real situations and squeeze them into a commercialized response -- notice, all of the prior posts are in the same exact format, all that changes is the symptoms taken from the original post.  That is not an individual way to approach and help others.   I am sorry, but I think there's some secondary gain here.



I know doctors who then get bombarded by questions from their patients after they hear misleading information such as this which, in many cases, does not apply to their symptoms.  There's obviously, nothing wrong with getting a doctor's opinion on Lyme, but using it in every single case is just misleading and not informative.



OK, sorry for the rant :)

[dreamersmom]

Thanks for your replies. As for Lyme, the quick test was negative, and another is still pending. And yes, I am leaving no stone unturned (thanks for noticing). I have to say, that I really don't think it's lyme anyway.



her contrast MRI and EEG were normal. I also feel as tho they are NOT intrustive thoughts. My hunch is that there is an underlying psysiological cause. She continues to experience these episodes, but so far they have not progressed to include any other symptom, do not effect consciousness and last about 3 seconds. Her doc has decided not to medicate for now, but to keep a diary of events and to we have scheduled an ambulatory EEG in a few weeks. In addition, we are following up with an ECHO of her heart because either a murmur or other sound indicating Mitral Valve Prolapse was heard. i have no idea yet as to whether this has any connection to what she experiences.



I hope we get to the bottom of this and the condition does not worsen.

thanks all,



dreamersmom