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Re: Clarification of Epilepsy v other seizure-inducing disorders

Posted By Steve on March 08, 1999 at 16:51:45:

In Reply to: Re: Clarification of Epilepsy v other seizure-inducing disorders posted by CCF Neuro[P] MD, RPS on March 05, 1999 at 12:48:03:

: : I have recently been diagnosed as suffering from partial seizure epilepsy by a consultant neurologist at my local hospital, following an extended episode of deja vu.
My problem is that while I accept that I may have experienced seizures, I have reasonable grounds for suspecting that they are induced by some kind of spinal problem.  Several of the definitions of epilepsy that I have seen, seem to imply that epilepsy is diagnosed when the seizures are unprovoked, whereas others don't seem to make the distinction (except for febrile and alcoholic seizures).
As this distinction is quite critical to the diagnosis of my disorder, I would be grateful if you could you clarify the definition of epilepsy.
Thank you

: Dear Stuart:
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.
CCF Neuro[P] MD, RPS

I was dx'd as not having epilepsy by an extended video-EEG test (28 hrs).
However, I have found numerous references to scalp EEG's not detecting deeper electrical abnormalities in frontal lobe seizures. Could you please address this apparent contradiction to the convention that EEG's are the definitive tool for use in epilepsy diagnosis.

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