Abnormal Brain Activity -- Seizures or ADHD

[tiwood]

6y.o. son had 3 EEGs. 1st EEG stated freq. T5 sharp waves w/ some central extension. Drowiness= Alpha w/ admixed slower frequencies. Stage II-III w/ synchronous sleep spindles, vertex waves and K complexes. Impression:frequent LEFT temporal epileptical discharges consistant with interictal expression of partial epilepsy.  2nd EEG (2 months later not on meds yet) hyperventilation associated with generalized quasi-rhythmic slowing in the theta and delta freq - slowing resolved w/in 1 min post hypervent. Second wave discharges noted in occipital and left temporal regions. Independent epileptiform discharge had phase reversals at O2 and T3. Occiptial discharges were frequent while temporal discharges were seen occasionally.  No electrographic seizures were seen. Impression abnormal EEG due to age and independent occiptial & LEFT temporal epileptiform discharges.  3rd EEG (24 hour test 4 month later been on various levels of Trileptal)awake=well formed and well sustained anterior-to-posterior gradient w/ an occipital dominant rhythm consisting of 9 hertz alpha frequency which reacted to eye opening and eye closure.  Occasional spike and slow wave discharges notd over RIGHT posterior quadrant, maximal over the right occipital region, involving O2, with extensions to T4 and T6.Drowiness= ant.-to-post. gradient became attenuated and replaced with diffuse delta and theta showin.  Well-formed symetric spindles and vertex waves noted during stage II sleep.  Slight increase in freq. of spike and slow wave discharges over right posterior quadrant, sometimes in doublets.  Hyperventilation resulted in diffused slowing but no epilptiform activity.  Photic stimulation in symmetric driving response but no epileptiform discharges. Impression= automated spike and seizure detection during wakefulness and sleep abnormal due to focal epileptiform discharges over RIGHT posterior quadrant, maximal over right occipital region.  Suggestive benign focal epilepsy.
MRI was normal
1st ped.neuro put son on trileptal and it caused either major hyperactivity or lethargy depending on dose. (low dose of Trileptal 75 to 150mg per day seemed to be great but neuro said that is to low and wanted 600mg a day)
2nd ped.neuro said no epilepsy and to remove Trileptal and replace with no other drug unless stimulant for ADHD.  He feels my son is just AHDH and not Epileptic.
I am confused why doctor's can't agree and meds did not help.  Scare to take meds away if brain damage could occur but son is not doing well in school on meds.
Son had some speech/social delays, some hyperactivity off meds., staring spells (never any other seizure symptoms),paces a lot, speaks jargon sometimes (not much now),frequent nightmares, nosebleeds,sinus/ear infections,very intelligent according to cognitive test, delays fine motor skills, interacts better w/ younger kids,does interactive play but does play alone often.  Aspergers mentioned during cognitive test but 2 doc and school dont agree.
Your opinion?

[susan79912]

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[mrsmitchell]

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[vava03]

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[justme]

my son had abnormal brain activity/EEG due to sleep disorders.  He's on clonazepam which has worked wonders for him and is tolerated well (it's not a stimulant); plus it's anti-anxiety and has all but cleared up his ADHD symptoms because he sleeps well now.  I don't know about the results you've indicated, just thought extra information might be helpful in your discussions.  good luck.

[Kevin Kennedy, Ph.D.]

I know this must be confusing to you - i.e., two doctors looking at the same objective data reach different conclusions. There is certainly abnormal brain activity. The question is what the activity implies for your son. There are many children who have abnormal EEG's but really no clinical symptoms. That might be the focus of your discussion with the doctors: what can your son expect in the area of symptoms; how might the abnormal brain activity influence his daily life? One option might be to continue the Trileptal (or other anti-seizure medication) and treat the apparent ADHD with non-stimulant medication (I'm assuming the recommendation not to use stimulant medication is due to the abnormal EEG's and the fact that stimulant medication can lower the threshhold for seizures).