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15 yr. old girl having seizures-WHY?

      Re: 15 yr. old girl having seizures-WHY?

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Posted by CCF Neurology M.D. on February 08, 1998 at 10:03:03:

In Reply to: 15 yr. old girl having seizures-WHY? posted by Jennifer on February 07, 1998 at 18:38:21:

: Hello. I have a friend who is the mother of a 15 year old girl. The girl  is in overall good health. Last December she began having some sort of seizure which her doctor is claiming to be "anxiety attacks".  Here is what happens when an episode begins:
  1) Sudden extreme headache
  2) Nausea
  3) Dizziness
  4) Trembling, shivering and shaking
  At this point, she becomes unresponsive.
  These episodes usually last 20-30 minutes.  The frequency has gone from one episode every few days to 2-3 episodes per day.
  The family's doctor ran several tests. The thyroid function test came back a bit high, so the doctor referred them to an endocrinologist, who felt that even though a bit high, it was not enough to be of concern. A CAT scan revealed nothing significant. An EEG was insignificant. Her blood sugar levels are fine, both fasting and non-fasting.  
  The family doctor has determined this to be anxiety attacks, and put the girl on 50mg of Zoloft per day. The mother took the girl off of the Zoloft because she felt it was increasing the episodes. They are to see a psychiatrist in 2 weeks. In the meantime, the principal of the girl's school wants to suspend the girl from school for the rest of the year until they decide what the problem is, and how to treat it! He claims the "attacks" are disruptive to the class.
  There are two factors which I feel play an important role in this problem. One month before the episodes began, the girl developed a severely infected abscessed tooth. The infection is so bad that they haven't been able to treat the tooth until the infection is gone (according to the dentist). Could the infection from the tooth have somehow spread to part of her brain, causing it to "short-circuit"?
  The second factor is this:
  The girl's maternal grandmother had some sort of tumor which was located behind her ear, going into her brain. She had it surgically removed. Evidently, the tumor was not seen by a CAT scan, or xrays, or any type of test except an MRI. She claims that she had the same sort of "attacks" as the girl in question, before the tumor was removed. Could this type of tumor (it was non-cancerous) be hereditary? The grandmother spoke to the family doctor, and explained about her experience, but the doctor didn't seem concerned.
  I have advised my friend to speak to the doctor, and demand that her daughter be seen by someone at Riley Children's Hospital in Indianapolis, Indiana (we live near there) and to also demand that he order an MRI.
  I just think it is extremely coincedental that the abscess developed shortly before the seizure-like episodes. Your opinion would be greatly valued, and  helpful to this situation. Thank you very much!!!
  Please answer by email, if possible.
  Jennifer Messer
Dear Jennifer,
Although seizures can present in several ways, the constellation of symptoms that you are describing are a bit unusual. In general, "grand mal" seizures  may begin with an "aura", that is, a warning a few seconds proir to the onset of unconsciousness and convulsions (shaking). The aura can be of several varieties including visual patters, certain smells, deja vu, a rising/sinking feeling in the stomach, and unnatural sensations over the body to name a few. There is a stereotypical pattern to most convulsions that is difficult to immitate.  Frequently seizures are accompained by tongue biting and incontinance of urine. Following the seizures there is often a period of confusion that lasts several minutes. (I would expect some considering the duration of symptoms that you are describing). Seizures generally are breif lasting up to a couple of minutes but most typically less than one minute. If the patients "spells" are lasting up to 30 minutes then that is close to a neurological emergency "status epilepticus" (continuous seizure or not waking up between seizures-extending beyond 30 minutes-requires prompt neurological attention) or it could be a "red flag" that the spells are not true epileptic spell (pseudoseizures).  As far as, the abscessed tooth,  causing seizures. Yes, it is possible, however, it it usually the result of bacteria spread to the brain causing meningitis or a brain abscess. In either case, there are other neurological symptoms that quickly develop such as fever, stiff neck, lethergy and focal signs on physical exam. These would get worse over fairly quickly.  From what you have described, this does not appear to be the case. In regard to the tumor, a CT scan may not be sufficient to rule this out as a possibility, especially if the scan was not performed with contrast. Ideally, an MRI scan is the preferred radiographic procedure. One negative EEG does not completely rule out the possibilty of true seizures.  I would recommend a repeat EEG, which would bring the accuracy (that a negative EEG is more likely negative) from approximatly 60% to 75%.  I would recommend getting another evaluation from a neurologist or an epileptologist (a neurologist with extra training in seizure disorders).  If you are interested, we have several at CCF, including Dr. Wyllie and Dr. Kotogal (both, pediatric epileptologist).  To schedule an appointment, you can all 1-800-CCF-CARE.  Ask for the pediatric neurology appointment secretary.  Also, if these "spells" turn out to be "pseudo" (false). I would recommend appropriate referall to a neuropsychologist or psychiatrist to evaluate the underlying reason that the spells are occuring.

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