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Re: Clarification of Epilepsy v other seizure-inducing disorders

Posted By CCF Neuro[P] MD, RPS on March 05, 1999 at 12:45:08:

In Reply to: Clarification of Epilepsy v other seizure-inducing disorders posted by Stuart on March 05, 1999 at 07:55:47:

: Dear Doctor
The diagnosis of epilepsy and seizure disorder are not mutually exclusive.  True seizure events are abnormal hypersynchronous firing of cortical neurons.  These events are induced by extracellualr IPSPs or EPSPs.  These firings would be detected on a brain wave test called EEG. There is a type of seizure disorder that is not epileptic.  This type is called pseudoseizures.  The seizure event in this case is not induce by abnormal brain hypersynchrony of cortical neurons.  There is usually, almost always, abnormal EEG activity (cortical neuronal stimulation) that corresponds to the seizure events.  These may or may not be provoked.  For instance, some types of epilepsy are induced by computer games.  Others have no known inducing event.  Since the abnormal brain electricity is in the cortex, a spinal lesion would not induce a seizure event.  The one instance that I can give you where this might happen is vast spinal cord dysfunction such as trauma that causes nearly complete paralysis of the heart and lung function and therefore producing an hypoxic state for the brain and subsequent seizure activity.  The only non-cortical lesion that I can think of is a hypothalamic lesion inducing gelastic seizures.
The type of seizure event that you described is a well known type of seizure.  The abnormality is in the cortex tissue.  Two or more of these events would be classified as epilepsy.
I hope this helps you.
I'm not sure, yet :-)
I've seen a couple of articles relating to seizures which are induced by toxins, such as alcohol.  I understand that the Federal Aviation Authority regard such seizures as non-epileptic: if a pilot goes on an AA program he can potentially regain his licence; if it's epilepsy, he can't - no matter how effective his medication.  Consequently, it seems important to distinguish between "provoked" and "unprovoked" seizures.
In my case, however, things get a little, how shall I put it, "interesting" from a diagnostic point of view.

Deja vu is unusual for me.  This instance comprised 2 days of mild dj vu, getting stronger as the day progressed into the afternoon and easing off towards the evening; weaker dj vu on the second day, disappeared totally on the third day, but I felt emotionally fairly flat.  Also noted a subsequent marked improvement in my piano sight reading(!).
My seizure-like events normally comprise strong jamais vu (in isolation) or "panic" attacks.  These latter normally start as a feeling of edginess, progressing through things not seeming right (darker, unreal), *hypo*ventilation, "kicking" sensation in chest, pain in chest (relieved by coughing), transient vertigo (similar to sliding into a scanner rather than rotational), feelings of absolute terror and doom, drenched in sweat, overheating and a strong need to visit a toilet.  When they wear off (10-20 mins), I normally feel as I've run a marathon in full field kit and if I want to drift off to sleep.  They can occur anywhere (at home, at work, driving, in the middle of nowhere, with others or by myself, night or day).  The night time attacks can be the "worst"; on one occasion I could not distinguish between reality and the nightmare I was having - I was experiencing them simultaneously.
Both my childhood and adult life contain some of the *usual suspects* as stressors (I wont' bore you with the details, but they were sufficient to visible upset a couple of the military psychiatrists who evaluated me).
I had a head injury aged 12 (extended fracture along centre line and fracture in left temporal area).
I have verbal memory and attentional deficits.  These were initially attributed to stress but later to the head injury (marked asymmetries in psychomets and excess slow wave activity in left temporal lobe).
About 5 years ago (age 38) I started getting severe pain in r hand and r foot, anasthesia in l hand, burning in l foot and l'Hermitte.  Also experienced parasthesia in l face, pain in teeth and my boss noted that the left side of my face would tend to slump near the end of the day.  Often lost ability to move arms at night. Also experiencing bad panic attacks.
An osteopath suspected I had a neck problem.  X-ray found disk narrowing at C4/5/6/7 and osteophytic growth.  Referred to neurologist.  He thought I was just suffering from stress, after ruling out carpal tunnel syndrome as an explanation for my hand problems (!?).  My boss was told that my face slumped as a means of my trying to gain sympathy by looking ill (unconsciously, not deliberately); furthermore, I was "too young" to have cervical spondylosis and the pain was caused by hyperventilation.
I have to confess that I wasn't entirely happy with this diagnosis (a pulse rate of  58 and 10 breaths per min noted during instances of parasthesia didn't seem consistent with hyperventilation). After some research and debate on my part, was given MRI which confirmed the X-ray results.  Also found several orthopaedic texts which accepted that my facial symptoms were observed in higher cervical spine disorders.
More importantly, I had correlated a couple of my panic attacks with abnormal neck movements.  For example, in one of my night attacks, the orthopaedic pillow I was using acted as a wedge so that my head was tilted sharply back (don't ask me how I managed to note or remember this, I haven't a clue!).  In another daytime attack, I had turned my head sharply whilst driving.  Consequently, at the start of my next attack, I tried moving my neck around to "neutralize" its position.  Attack stopped.  So far I've been able to stop every attack in this way.  I also keep the incidence rate down by regular trips to the osteopath.
The episode of deja vu I referred to earlier was contemporaneous with a couple of incipient panic attacks (which I could find a physical precursor for).  I also hadn't seen my osteopath for treatment for a couple of months.

I'm only too aware that people can believe all kinds of things that are merely wish fulfillment or avoidance.  In my case, I cheerfully confess that having to give up flying permanently after completing 40 hours of training for my PPL, is a strong motive for not wanting to believe I have epilepsy.  However, I also consider that I have reasonable evidence to suggest that whatever is happening is triggered by my neck.  Hence, referring back to my point about definitions, my need to clearly define when a seizure disorder is or is not epilepsy.
Sorry about the length of this missive, but I couldn't think of a shorter way of trying to put my argument over.
Thank you

Dear Stuart:
Wow, sorry that your health has such complications.  When did the seizures occur with respect to the alcohol and were the seizures partial or generalized.  With what you are telling me, the seizure-like events were partial in nature or that you didn't loose consciousness.  By definition then, these events are epilepsy.  Post-alcohol seizures are almost always generalized and called "rum fits".  These usually occur exclusively 24-96 hours after alcohol is stopped.  In addition, there are some products found in shell fish that can cause some people seizure events.  But this doesn't sound like your case.  Yes, toxins can cause seizure-like events, but they do not recur after the toxin is cleared.  What I think you need to do is see an epileptologist who can record an EEG while you have these events.  The story will become crystal clear.  Until you get an EEG then you will talk yourself into or out of the epilepsy question.
I hope that you sort the trouble out.
CCF Neuro[P] MD

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