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Unexplained Seizure?

A recent patient of mine had a head injury in 2004; she fell off a horse and suffered a blow to the head.  She did have a concussion and a CT scan and a MRI proved that all brain function and activity were normal.
  
In December of 2005 she was 14 when she suffered from what we call an “attack.”  We call it this because neither we, nor any doctors she has seen can give a proper diagnosis.  It went on for about 4 months and subsided. In the beginning it was merely her right arm.  It would start to shake, then jerk and then stiffen for about 5-10 minutes about once a week or two.  Afterwards she would be fairly tired.  Over the course of the 4 months the symptoms only got worse such as more violent and strong and would gradually last longer but not by much at all.  

She went to a Neurologist had an EEG, 24 hour EEG, and an EKG which all proved to be normal, however; she never had an attack during these tests.  The acting doctor immediately wanted to diagnose the patient with epilepsy.  The patient and mother refused the diagnosis and seeked further treatment.  The patient was not diagnosed, and the problem was simply left alone.  After about 4 months of this it just stopped.

The attacks stopped for about a year and a half.  In September of 2007 the patient had another attack, this time much more severe then any previous.  It last for 10 minutes and affected the right arm, partially the right leg and the face.  Since September, these “attacks” have only gotten progressively worse.  It has moved from the right side of the body to the left side now, but only affecting the left arm at this point in time.  One of the worst parts of these “attacks” is the patient stops breathing for about 10-15 seconds at a time.  The patient does not lose full consciousness but is dulled to her surroundings.  She experiences sudden burst of fear and anger.  It seems to me that she also has Jamais Vu.  The attacks now last anywhere from 10-45 minutes on average.  She was recently hospitalized again after an attack last over an hour.  During her stay she underwent a Video EEG and during so she went thru a full blown attack.  Unfortunately the results showed nothing wrong according to the EEG.  She also had an MRI, MRA and another CT.  Sadly, a sist was found behind her right eye, not attached to the brain, however; doctors say it has nothing to do with her attacks.

Within the past couple of weeks, if she has an attack, afterwards she has these unbearable sharp pains in different places throughout her body, such as her right leg, right arm, and right side of her back to the left of her scapula.  She has not been to a doctor about this yet.  She is a very strong girl but with these aftershock pains all she can do is ball up and cry.  

My thoughts are possibly Simple Partial Seizures leading into a Complex Partial Seizure.  However; she still has a lot of symptoms of Psychogenic Seizures and somewhat of a Secondary Generalized Seizure.  The biggest factor that throws me off is the duration of these “attacks.”  

Please, what are your thoughts or opinions on this case?  If you have any more questions of detail, please let me know, Thank You.
1 Responses
368886 tn?1466235284
MEDICAL PROFESSIONAL
Hello.

In the absence of evidence of any abnormality on the MRI and EEG, it will be difficult to diagnose these attacks as Epilepsy. Most important is the absence of any abnormality on EEG during the attack.

This leaves us with the possibility of pseudoseizures. We have to consider a few aspects.

Is she going to benefit from her 'seizures' in any way ? Was there any issue she was trying to avoid ? May be exams, studies or something else. First, it was in December and then after two years, it was September.

Second aspect is the situation in which she has the attacks. Is it when people are around ? Ha she ever had these attacks when she is all by herself ? I don't think so.

I am not leading to a diagnosis, but these are the things we need to consider.

Regards
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