Fasiculations and epilepsy diagnosis

[EmzMum]

My daughter is a fit and healthy 14 year old who has been having fasiculations in her right arm, leg and face for a few months.  She is a normal teenager with some extra stress from music exams.  She was dry at night fror a year but then started wetting the bed and this continued untill recently most nights, in the last 6 months around the time of the fasiculations she has got much better and is now nearly dry.

When she first got the fasiculation in her arm and leg it lasted about 6 hrs and our GP said it was probably epilepsy as her father has it.  We went ot he hospital but they didn't think it was epilepsy as it looked very different from sudden jerks.  They even suggested it might be stress related or faked by her.  She was refferred to a paediattrician on discharge.  

THis doctor has done 2 EEG tests one away and one asleep and has had then looked at by a Neurologist who says there is some epileptiform activity and so she has epilepsy.  They want her to start either sodium valporate or lamotrogine.  

I am worried about a few things I assume the neuro made his diagnosis because he was told she was having fits but I don't think they are fits because they are very rhythmical, can last for over a day and do not cause tiredness, worsening or lack of awareness.

I had asked lots of times if the bed wetting was due to epilepsy but was told no it could not be.  But I know you can get nocturnal fits only and wonder if this is what she had and is now growing out of them.

Also the two different tablets seem to be treating different types of seizures and how will we know when they are controlled if we can't see them.

I don't think her fasiculations are epilepsy and I don't want her to start unneeded drugs can you please explain what I can do about this and whether epilepsy can be diagnosed by an EEG in the absense of fits.

Thank you for any help.

EmzMum

[DrBhaviniMBBS]

Hi,

Epilepsy can be diagnosed by EEG. Fasiculations she is having are may be known as TICS. These are simple normal movements which become repeated unnecessarily to the point til they become an embarrassment. This often occurs in the context of Psychiatric disorders.In contrast to other involuntary movement disorders, they can be readily imitated. TICS may be difficult to separate from other involuntary movements like epilepsy. She might have suffered from hysterital epilepsy. She needs a re-assurance and thorough counselling. In this, head nodding is  very common example.

[EmzMum]

Thanks very much for the reply, but the fasiculations are not voluntary movements and cannot be imitated.  All of the family has tried a lot unsuccessfully.  They are merely ripples under the skin and not head nodding, justa ripple on her cheak almost like a pulse.

If the epilepsy is diagnosed from an EEG and there are no other signs of seizures how can a doctor know when the dose is right for any medication?  And if there are no seizures is it worth medicating anyway?

Thanks again for the prompt reply and I hope you have time to reply also to this one.

Emzmum