Question:
Hello everyone. This is maybe my third post and I have appreciated all of the responses that I received. I am in dire need to make some sense out of what has happened to me and I am starting to learn that some patients may know some things that my doctors do not. For this reason I look for ANYONE’S logical/sensible explanation so that I can put some issues to rest. THE PUZZLE – My name is Greg. I am a 30 year old white male and have always been very healthy both in body and mind. On a Tuesday evening in December of 1996, my father found me on the floor of my living room, lying unconscious. My last memory was watching television 2 evenings prior to that – Sunday. I worked as a school district counselor at the time and when I hadn’t reported to work for 2 days (something I would never do) my boss FINALY called my parents. My father, a physician of all things, doesn’t even take me to the E.R. He takes me ‘home’ for mom and himself to care for me. During the 48hrs. of lost time (it is assumed – repeated gran mals) I had obviously ‘made my way about my house’ - this was evident in many ways – A table in the kitchen was knocked over, I had ’staggered ?’ around and also stepped on both my cats water and food bowls. Yes, they were made of glass. My feet were badly cut – could have used some stitches dad ? - leaving a literal trail of blood showing that I had also walked upstairs during this time. My tongue was grossly bitten and I had dislocated my shoulder. I was in a funk. While at Mom’s and Dad’s, they noticed that I was very hot. Note – I also remember feeling so ‘clouded’. My father said that when he first found me, I was not even being co-operative – this is not my nature. My temperature was at 103.7. A number I will never forget. After 4 days of incredible fever and another gran mal at their house, it is FINALLY decided to take a blood sample up to lab. The tests show an acute infection of Epstein Barr Virus(mononucleosis). It is assumed that I caught this in an elementary school where I worked – I had not had any intimate contact in the previous 5 or so months. (Okay, okay, a short dry spell). Anyway, I was sick with EB virus for 5 months. The fevers greatly reduced but still painful and present. I recovered and had returned to work, still not feeling quite right – but so happy to have no fever. I then had another major gran mal … back to parents house. This time I am see a neurologist who does a CT scan only, and puts me on Dilantin. This guy is supposed to be an incredible neurologist but more tests were certainly warranted. It just so happened that my mother, a physician also, fell ill with her second and final battle with kidney cancer. The family agreed that we wanted her to be at her house and with family – NO hospice, and only one nurse who dressed the eventual bed sore. My father who was ‘friends’ with my boss got me an extended leave – this way, we sisters, dad and I agreed that I could care for mom during the day and also live at their home for safety. Mom fought it out for almost a year. During this time I did the somewhat typical denial thing. I don’t have epilepsy I remember thinking. I stopped my med’s twice and both times gran mals. Okay, I now see I need to act. I went to the number one rated epilepsy doctor in my tri-state area who works in one of the top 10 epilepsy centers in the country – Dr. French at the University of Pennsylvania. She was great – aggressive and insightful. CT scans, MRI, one of the two was done with some sort of injected die or something ? I also was given a take home 72hr EEG. Findings were – spikes originating from the right front temporal lobe. The scans, they said, showed an abnormality in the same area that was producing the spikes. My diagnosis was Right front temporal lobe epilepsy – Cortical Dysplasia was the technical term meaning ’slight scar’ They speculated that it was there since birth and that the infection of the EB virus caused complications – slight pressure on the brain that had allowed my threshold to be lowered to the point of requiring medicine. I had two more seizures and was switched to 1200Mgs. of Tegretol. 3Mgs. of Klonopin were later added. I am sure that some reading this can relate to how strange this all was for me. I had gone from NEVER even seeing a seizure to eventually having one when while with a girl-friend one night that I didn’t sleep at my parents.. Talk about feeling like a reject. I lost control of all bodily functions and was bleeding badly from the mouth. She was so caring about it – she even tried to help, costing her a trip in the ambulance with me so that they could sew up her now badly bitten finger. (she had tried to put her hand in mouth- what a beautiful gesture – she only meant to help) I later learned, no wallets, no clothes, and NO FINGERS ! I couldn’t continue a relationship, not like that. She was a psychologist and insisted that it was not at all an issue with her – my self-esteem however, was gone … I had to take a break. Mom eventually died and it is it is now close to a year later. I have had a few seizures during this year which prompted me to take my doctor up on the pre-surgery testing. What fun. I just spent 9 nights and 10 days at The University Of Pennsylvania with an electrical box wrapped around my head the entire time. I was tapered off of the Tegretol so slowly that it was not until the last 52 or so hours that I had finally had a 0 blood level. I was however, kept on the Klonopin the entire time. The reason as some of you may already know, is that they are looking for my ‘typical’ seizure origin and that Klonopin withdrawal is very dangerous and the seizure it could cause would not show them what they were looking for. So here is the kicker – After 9 days, a doctor that I didn’t even know, comes into my room and says that he had a look at my old films and interpreted them as not showing an abnormality that was significant enough to explain my seizure activity. When I questioned this ( i was shocked ) he explained that he had seen abnormalities that small in many people who never suffer seizures. So I am thinking – this as a Top 10 facility ? Who is reading what ? What are they now saying ? Also, during my entire stay, my EEG showed no spiking this time and I didn’t even have one aura let alone seizure. They concluded that the abnormality in my case must be playing a role because the first EEG results they explained came from that very same area of the brain. They stuck with the right front temporal lobe diagnosis. They instructed me to go back on 1200 Mgs. of Tegretol but would like to stop using the Klonopin. I am now removing the Klonopin a quarter milligram/day as instructed. Here is where I need help and answers – Could the Klonopin have been enough to keep my brain from spiking during the monitoring ? Can one have spikes sometimes but go ten days without any spikes ? I will buy the fact the thee EB virus caused my first couple of gran mals, but can anyone explain the ones that I had while I was healthy ? Finally, again, some may understand this, but I have not returned to the Tegretol. It has been 5 days and I still feel okay. Does anyone think it is unwise to do this ? I feel that I need to see if my body will still seize or not so I can peace with all that has happened. I will remain off of the Tegretol until I seize or one of you gives me a reason that convinces me that I should. I am not really scared of a gran mal, but fear that if I have one and it is discovered that my Tegretol level is still zero, I will lose regained trust from my father and sisters about whether or not I am being compliant. If anyone makes it to the end of this and has information to share . P L E A S E share. I used to be a fully functional, in control and confident individual. I have since been diagnosed with clinical depression( mom’s death didn’t help, but the diagnoses preceded that.) I am tired of doctors and Tegretol and Klonopin …… I wish almost that if I were to have another gran mal … let it be the last, however, if my body shows me that it has stopped having seizures I will feel much better but will still wonder what the heck happened to me. Thank-you to all who have kept reading. Sincerely, greg
Response:
GORDON’s COMMENTS HERE AND 3-4 Places thru Editted Text (Volumes 1 thru 7!) May not be ‘Help’ but an Opinion about Tegretol. (I have used Tegretol CR/ controlled release/ for ~5 years.) There is a ‘warning’ on Healthwatch printout I get from (Canadian) Shoppers’ Drug Mart with Prescription that PROMPT WITHDRAWAL of Teg. wo. Dr. Supervision may produce ‘Rebound Seizures’. To try reduce amount of (Potentially Quietly Helpful Meds.) you may be putting Yourself at risk for some of these ‘Rebounds’. I’ve never DONE that, and am NOT a Doctor. You should speak to either your Pharmacist about above or your Doctor about alternate medications or ‘whether’ you should reduce levels w.o. his supervision. (Since MINE are ‘Controlled Release’, REbounds wouldn’t likely show up IN FULL for 4 or 5 days after last of Med’n left my system). Since my last ‘trip’ to Emerg. included being unconscious for 3+ hours, I personally wouldn’t take that risk. An opinion, Gordon. gzed wrote:
Hello everyone. This is maybe my third post and I have appreciated all of the responses that I received. I am in dire need to make some sense out of what has happened to me and I am starting to learn that some patients may know some things that my doctors do not. For this reason I look for ANYONE’S logical/sensible explanation so that I can put some issues to rest.<snip
My name is Greg. I am a 30 year old white male and have always been
very healthy both in body and mind. On a Tuesday evening in December of 1996, my father found me on the floor of my living room, lying unconscious. My last memory was watching television 2 evenings prior to that – Sunday.<snip
My tongue was grossly bitten and I had dislocated my shoulder. I was in a
funk. While at Mom’s and Dad’s, they noticed that I was
very hot. Note -
I also remember feeling so ‘clouded’. My father said
that when he first
found me, I was not even being co-operative – this
is not my nature. My
temperature was at 103.7. major gran mal … back to parents house. This time I am see a neurologist who does a CT scan only, and puts me on Dilantin. This guy is supposed to be an incredible neurologist but more tests were certainly warranted.
I don’t have epilepsy I remember thinking.
I stopped my med’s twice and both times gran mals. Okay, I now see I need to act. I went to the number one rated epilepsy doctor in my tri-state area who works in one of the top 10 epilepsy centers in the country – Dr. French at the University of Pennsylvania. She was great – aggressive and insightful. CT scans, MRI, one of the two was done with some sort of injected die or something ? I also was given a take home 72hr EEG. Findings were – spikes originating from the right front temporal lobe. The scans, they said, showed an abnormality in the same area that was producing the spikes. My diagnosis was Right front temporal lobe epilepsy – Cortical Dysplasia was the technical term meaning ’slight scar’,….there since birth and that the infection of the EB virus caused complications – slight pressure on the brain that had allowed my threshold to be lowered I had two more seizures and was switched to 1200Mgs. of Tegretol.
<*******THE HIest DOSE OF TEGRETOL I WAS EVER ON WAS 2×400mgs for FAIRLY SEVERE TEMP
Lobe Ep./Gordon/********
3Mgs. of Klonopin were later
added.
I had gone from NEVER even seeing a seizure to eventually
having one
when while with a girl-friend one night that I didn’t sleep at my
parents.. Talk about feeling like a reject. I lost control of all bodily
functions and was bleeding badly from the mouth.
I have had a few seizures during this year which prompted me to
take my doctor up on the pre-surgery testing. What fun.
I was tapered off of the Tegretol
so slowly that it was not until the
last 52 or so hours that I had finally
had a 0 blood level. I was
however, kept on the Klonopin the entire time.
The reason as some of you may already know, is that they are looking for my ‘typical’ seizure origin and that Klonopin withdrawal is very dangerous and the seizure it could cause would not show them what they were looking for. So here is the kicker – After 9 days, a doctor that I didn’t even know, comes into my room and says that he had a look at my old films and interpreted them as not showing an abnormality that was significant enough to explain my seizure activity.
****REST OF THIS IS MEDICAL/I have no input for/Gordon/***** They stuck with the right front
temporal lobe diagnosis. They
instructed me to go back on 1200 Mgs. of
Tegretol but would like to
stop using the Klonopin. I am now removing the
Klonopin a quarter milligram/day as instructed. Here is where I need help and answers – Could the Klonopin have been enough to keep my brain from spiking during the monitoring ? Can one have spikes sometimes but go ten days without any spikes ?
************Finally, again, some may understand this, but I have
NOT********* returned to the Tegretol. It has been 5 days and I still FEEL okay.********** Does anyone think it is unwise to do this ? I feel that I need to ********see if my body will still seize or not******** so I can peace with all that has happened.*****
****(OR ‘AT Peace’-see my ‘rebound comment ABOVE’ /Gordon/********* I
will remain off of the Tegretol until I seize or one of you
*******gives me a
reason that convinces me that I should. I am not
really scared of a gran
mal, but fear that if I have one and it is
discovered that my Tegretol level
is still zero, I will lose regained
trust from my father and sisters about
whether or not I am being compliant. If anyone makes it to the end of this and has information to share . P L E A S E share. I used to be a fully functional, in control and confident individual.
*********TIMES CHANGE/ You have ALSO/ may be TIME to also speak to a Clinical Psychologist or ? if you don’t get enough ‘referrals/contacts’ from THIS GROUP.****G.R
***
I have since been diagnosed with
clinical depression( mom’s death
didn’t help, but the diagnoses preceded
that.)
********I am tired of doctors and Tegretol and Klonopin **** ****See ‘Psychologist’ comment above******…… I wish
almost that if I were to have another gran mal … let it be
the last,
however, if my body shows me that it has stopped having
seizures I will feel much better but will still wonder******* Thank-you
to all who have kept reading.**
**//It’s O.K., I had to read ‘The Illiad’ in College!:-
// (1)Speak to your Doctor or Pharmacist TODAY about RECOIL Seizures I inserted ‘in text (editted) above’. (2) STAY with this group, there are often Other links to seizure types, meds., other stuff –I’ve SEEN THAT ‘Rasmussens…’ before, it’s either an ‘out of use name for Complex Partial Seizures (maybe w. no discernable source or ?)’. (3)Next post (although I DON’T know how to do it NOR do I want to Discourage ‘posts’) try keep 1st Post ‘under 12 pages’
. WE REALLY DO WANT ALL POSTS HERE, but I don’t know how many Megabytes my Server will ‘hold’ before it ‘times out’ (It’s NOT too Bright, as SERVERs go–it Thought Chivas Regal was a Boat!
Sincerely, greg
**********also trying to be helpful and Sincerely, Gordon.
Response:
SUMMARY REMINDER – Looking for specific insight to – Does the absence on ‘one-time’ present spiking mean that my brain WILL not spike again ? Can they just stop forever ?? Does anyone know if the Klonopin alone could be responsible for controlling my seizures and spiking while my 10 days of being monitored ?? Can anyone provide insight as to why I continued to have gran mals AFTER I was healthy from the EB virus ?? Based on the doctors ‘wishy-washy’ findings, is it safe for me to conclude that Tegretol or any drug, is NO longer needed in my specific case ? ? Could the Epstein Barr have been enough to start seizures in a healthy adult body that had always been free of seizures ? Finally, any insight as to how the doctors could interpret data SO differently that some doctors see Cortical Dysplasia while one read the film as showing only a minute abnormality ? (keep in mind – they were ALL reading the same films ? Thanks-again and Love to All – greg
Response:
Hi Greg, With most of us not being docs, it is hard to give you exact answers, other than to hypothesize. I can tell you that from my own experience, I have had several top neuros look at my eeg’s and video and come up with differing opinions. The one thing that they do agree on is that because there are differing opinions, I need to be on medication. This brings me to my point for you. Several years back, I was put in the hospital for monitoring. The "specialist" decided that I wasn’t seizuring and sent me home on just a very minimal dose of Tegretol. I ended up going into a very bad seizure cluster several days later and ended up back in the hospital. The end result was they decided to put my meds back up and the seizures were brought under better control. I have heard that there are times when patients come in for monitoring, that nothing significant shows up or that they don’t have seizures at all, so your experience isn’t out of the norm. In my non-medical opinion it seems quite reasonable that leaving you on the one medicine did help to keep you "quiet", so to speak. It makes sense. If the doctors sent you home on medication, it is because they believe there is a good chance for you to have continued seizures. With that being the case, were I in your shoes, I would continue to take the medication. You don’t want to go chance going through status seizures. You have grand mals, so you are dealing with the "big one’s" you don’t want to chance continued grands. (or any other type) Why you had continued seizures after the EB had gone, is something you might want to ask your neuro. It sounds like you get along with your primary neuro, so continue talking with her. If you had a Predisposition for seizures, already. (Based on the finding in the MRI), then if something happens to bring down the seizure threshold, then yes, an otherwise healthy person can start having seizures. I began having the most seizures after I took a medication that brought down my seizure threshold. That threshold has never gone back up again. Kind of like it just popped right on out. I hope this helps some for you. Like I said above, some of your questions need to be answered by your doctor. I wish you luck and hope that you can get answers and get your seizures controlled. It sounds like you have had a pretty rough time of it, the past couple of years. Oh and one last thing, try not to be embarrassed by the seizures. I know that is a hard one, even for me. But if you are with caring individuals, who say they are not bothered by your seizures, accept their friendship. They are the one’s who can give you support when things are rough, don’t turn that support away. Take Care, Kathleen – Hide quoted text — Show quoted text -gzed wrote in message <7mqgm0$2s…@nntp5.atl.mindspring.net
… SUMMARY REMINDER – Looking for specific insight to – Does the absence on ‘one-time’ present spiking mean that my brain WILL not spike again ? Can they just stop forever ?? Does anyone know if the Klonopin alone could be responsible for controlling my seizures and spiking while my 10 days of being monitored ?? Can anyone provide insight as to why I continued to have gran mals AFTER I was healthy from the EB virus ?? Based on the doctors ‘wishy-washy’ findings, is it safe for me to conclude that Tegretol or any drug, is NO longer needed in my specific case ? ? Could the Epstein Barr have been enough to start seizures in a healthy adult body that had always been free of seizures ? Finally, any insight as to how the doctors could interpret
data
SO differently that some doctors see Cortical Dysplasia while one read the film as showing only a minute abnormality ? (keep in mind – they were ALL reading the same films ? Thanks-again and Love to All – greg
Response:
Does the absence on ‘one-time’ present spiking mean that my brain WILL not spike again ? Can they just stop forever ??
No the absence does not mean it will never happen again. Yes it can just go away. But, once you have a seizure disorder it can always return given the right trigger. My first dr said once the brain learns to seize it likes to seize. But the longer it goes without seizing the more likely it is to not seize. So the emphasis is put on stopping the seizures from occuring and this is why they will use potentially toxic drugs toward that end.
Can anyone provide insight as to why I continued to have gran mals AFTER I was healthy from the EB virus ??
Same as above. The brain learned to seize. The EB may not have been the cause but rather just a trigger. Once the brain learns to seize it develops other triggers.
Based on the doctors ‘wishy-washy’ findings, is it safe for me to conclude that Tegretol or any drug, is NO longer needed in my specific case ? ?
NO !!!
Could the Epstein Barr have been enough to start seizures in a healthy adult body that had always been free of seizures ?
YES. Everyone with a seizure disorder has a seizure threshold and it is different for each person. PS: I’m no dr, just basing it on what I’ve learned over the years. donna
Response:
Hi Greg, **This is another third try to post a reply. Hope it finally works** Didn’t get far into your posting before I made my putative diagnosis: TLE. I also have TLE, and because my Dr. encourages us to attend his weekly (free) group session, I have learned quite a bit about TLE, as well as more about epilepsy. I also have ADD, and have always had a gift for seeing what others do not see. Some call this global thinking. I had some similar experiences, and lost my job of 27 years teaching science (biology). Don’t feel bad about your long posting. I’m notorious for that. Take your posting as a sign of a man who provides excellent descriptions for the reader, and who also has excellent analytical abilities. You are not crazy, simply touched with the same curse that beset me. I was seriously depressed several times, and lost all hope of being able to function well enough to keep my job, and support my family. I was misdiagnosed, and given wrong drugs, which eroded my cognitive abilities, and led to even more serious problems than you have been beset with. Another sign of your intelligence is your skepticism about your Drs. (including dad). Many neurologists and psychiatrists (and most psychologists) know little about ADD, and a lot less about TLE. I could tell you some interesting stories, but you don’t really need more to scare you! Sufficit to say that you are smart enough to get some answers from people who although not licensed doctors, have life experiences that most so-called experts never had, and many of who could never truly understand. I had a head trauma from a bicycling accident which triggered my TLE. My memory (which always sucked due to the ADD) got much worse. I had learned ways of compensating for this, but I couldn’t undue incorrect diagnoses, and poor med choices. I also couldn’t get rid of a feeling of impending doom. My scientific, literate self tried to fight my demons, but therapy and meds didn’t help when those that supposedly knew, didn’t really know what they were dealing with. Enough about myself, just say that I have revealed enough for you to feel that I really do empathize with you. When I can, I read postings, and hope what I have learned the hard way can prevent the meltdown that I went through. Your careful and complete chronical of events leading to your situation have actually given me a hypothesis which may explain partially what may have led to the lowering of my seizure threshold. I too have had Epstein-Barr, and slept for long periods of time when It was diagnosed years before my cycling accident. I always thought that the Wellbutrin I was put on when I was hospitalized began my undoing. Zyban (used for smoking cessation) is Wellbutrin under another name, and they warn potential consumers now in the commercials not to take it with a seizure disorder. Oh well! Now to trying to help YOU. Your depression may be from the TLE, not from the untimely death of your mother. Depression is NOT a diagnosis, as my brilliant (but eccentric) psychiatrist who knows more about TLE than probably most if not all neurologists. You must get to the root cause of the depression, which takes a Dr. that is a good diagostician, as well as one who will take the time to get a goog history. Your excellent detailing of your history probably helped with a correct diagnosis. To my knowledge, I have only had simple partial seizures. These can be small lapses in attention, where you can go into a brief staring spell. Certainly much better than the gran mal’s that made a bloody mess of your tongue and life. Don’t be so sure of that! At the end of my posting, I will include some notes taken from a presentation on TLE that my Dr. gave. I’ve posted it several times before, as I suspect that many who have TLE are misdiagnosed, and go through life destroying events due to misdiagnosis & mismedication. Be thankful that you may be at least probably diagnosed properly, although somebody may have guessed well as you don’t seem to have had the proper tests. EEG’s are almost worthless in diagnosing TLE. I had a BEAM test (a kind of a highly computerized EEG), and a SPECT test. The SPECT is the best test as it has the best chance of definitively providing evidence for TLE. An MRI, a much more sophisticated test than a CT scan, is generally worthless in finding the locus of a seizure. Unless a tumor, or onother physical problem is causing the brain to seize, these tools are according to my Dr. pretty much worthless. Seizures are electrical in nature, and you can have a seizure like a simple partial seizure while having an MRI, and no one might ever know. I am not familiar with a 72 hr EEG, because to my knowledge my Dr. doesn’t use it because the other tests are superior. I have been compliant with my Carbamazepine (Tegretol). I don’t want to lose my driving priviledge, nor do I want to be responsible for an accident that might kill someone else. However, even though this drug is the "gold standard" treatment for TLE, the side effects are real, and can pose other problems. My seizures caused me enough of a living hell, and I don’t wish to revisit that horror again. So my advice to you is to become compliant. The are many worse drugs than Tegretol. My main side effect is somnolence (sleepiness), and some dysphasia (forgetting of some words when I want to use them. My dosage is 2,400 mg/day – a very high dosage as warranted by my monthly bloodwork. Fortunately for me, my Dr. is one of the foremost authorities on meds (that is why I ended up seeing him in the first place). My ADD warrants an Rx of a psychostimulant (I take Adderall) to counter some of these side effects. I am also taking a very new med called Provigil which is approved for narcolepsy, but working very well for me. My Dr. knows a lot about ADD also, so I feel confident in what he gives me. Besides, I thoroughly read the inserts anyway as I will always be skeptical of Drs. & medicines for the rest of my life. Getting back to the cause of your probable TLE, have you had any head injuries (car accidents, falls, etc.) which rather than the E-B virus may have caused your TLE? I know a lot more about ADD than I do about epilepsy, so I will not in good conscience be able to be able to comment on some of your other questions, for now. I know a lot about a number of psychtropic meds, but Klonapin isn’t one of them. My Dr. has patients on it, but I don’t remember what it is used for. You conspicuously left that out, which may mean something (kinda like you may be embarrassed to say why you are taking it). Maybe not, but you were very detailed about other things. Or, maybe it ’s an "add-on" that makes the Tegretol work better? I take a bit of Lamictal also, which helped my cognitive abilities to be restored after it was robbed by the high doses of Lithium prescribed for my so called bipolar disorder. You are asking some good questions, in the right place. And believe it or not, there are people who read long posts. They can be the most interesting ones, and the easiest ones to feel that a non professional like myself, might be giving good advice. Many of us have "been there, and done that", and are hear to help someone to avoid some of our worst experiences. Hope I have helped a bit. PS – I just read both of the follow-up messages you have received so far. Gordon’s reminded me of "kindling". I don’t fully understand the biochemistry of the process, but in some individuals, stopping the Carbamazepine abruptly for a period of time can render the drug useless in its ability to help you when you begin it again. Somewhere in the many articles I have received from my Dr., kindling is explained in detail. Ask your pharmacist about this penomenon. THERE IS GENERALLY NO BETTER MED FOR TLE, AND YOUR ACTIONS MAY COMPROMISE THIS! I have also been on Vaproic acid (Depakote), but had to stop it because it elevated the ammonia level in my blood. Gordon gave you good advice! PPS – Know for your further reading pleasure, I include the notes about TLE that I mentioned above. If You are located anywhere near central NJ, USA let me know, and I’ll invite you to group session. *** BTW, it is late and I may be tired, but check out what Dr. Mueller says about Whole Brain Epilepsy, Gran Mal and Carbamazepine. I hope this doesn’t apply to you!!! *** Can I assume that you may have had a complex partial seizure? *********************************************************** This is a repost of some notes taken during a talk by a former researcher at NHI, professor at Princeton & Rutgers, and psychiatrist who is an expert in diagnosing TLE and other difficult to diagnose neurologic & psychiatric condidtions including seasonal disorder, currently in private practice in Princeton NJ: PETER S. MUELLER, MD EPILEPSY (with particular reference to TEMPORAL LOBE EPILEPSY) April 1998 There are two types of epilepsy: 1. WHOLE BRAIN EPILEPSY includes GRAND MAL and PETIT MAL (carbamazapine is not helpful) II. FOCAL EPILEPSY – especially TEMPORAL LOBE EPILEPSY There are two types of TEMPORAL LOBE EPILEPSY: 1. Secondary Grand Mal epilepsy – created by the spread of the focal seizures activity to the whole brain (80% of all grand mal seizures) 2. PARTIAL SEIZURES, of which there are two types. A. COMPLEX PARTIAL SEIZURES – these are readily accepted as an entity by judges, neurologists, and others, because they include: a stereotyped sequence (ictus) with auras, motoric symptoms (automatisms), and clear-cut unconscious episodes, after which person is sleepy and groggy, but then fully recovers. The patients always are unconscious for a few minutes during the episode. Bad news for patient is limits on driving unless seizure free by medication for 12 months. Good news is that it is readily recognized (90% show on an EEG during an ictal episode). B. SIMPLE PARTIAL SEIZURES – which are far more common but which are less easily … read more »
Response:
Do you use aspartame, a seizure triggering drug (NutraSweet/Equal, Spoonful). #9 on the FDA report of 92 symptoms is memory loss. It also triggers Epstein Barr and Chronic Fatigue Syndrome (they are different). Email h…@dorway.com for a map of the 500 pages on aspartame on www.dorway.com and the FDA report. Regards, – Hide quoted text — Show quoted text -Betty"gzed" <g…@mindspring.com
wrote: Hello everyone. This is maybe my third post and I have appreciated all of the responses that I received. I am in dire need to make some sense out of what has happened to me and I am starting to learn that some patients may know some things that my doctors do not. For this reason I look for ANYONE’S logical/sensible explanation so that I can put some issues to rest. THE PUZZLE – My name is Greg. I am a 30 year old white male and have always been very healthy both in body and mind. On a Tuesday evening in December of 1996, my father found me on the floor of my living room, lying unconscious. My last memory was watching television 2 evenings prior to that – Sunday. I worked as a school district counselor at the time and when I hadn’t reported to work for 2 days (something I would never do) my boss FINALY called my parents. My father, a physician of all things, doesn’t even take me to the E.R. He takes me ‘home’ for mom and himself to care for me. During the 48hrs. of lost time (it is assumed – repeated gran mals) I had obviously ‘made my way about my house’ - this was evident in many ways – A table in the kitchen was knocked over, I had ’staggered ?’ around and also stepped on both my cats water and food bowls. Yes, they were made of glass. My feet were badly cut – could have used some stitches dad ? - leaving a literal trail of blood showing that I had also walked upstairs during this time. My tongue was grossly bitten and I had dislocated my shoulder. I was in a funk. While at Mom’s and Dad’s, they noticed that I was very hot. Note – I also remember feeling so ‘clouded’. My father said that when he first found me, I was not even being co-operative – this is not my nature. My temperature was at 103.7. A number I will never forget. After 4 days of incredible fever and another gran mal at their house, it is FINALLY decided to take a blood sample up to lab. The tests show an acute infection of Epstein Barr Virus(mononucleosis). It is assumed that I caught this in an elementary school where I worked – I had not had any intimate contact in the previous 5 or so months. (Okay, okay, a short dry spell). Anyway, I was sick with EB virus for 5 months. The fevers greatly reduced but still painful and present. I recovered and had returned to work, still not feeling quite right – but so happy to have no fever. I then had another major gran mal … back to parents house. This time I am see a neurologist who does a CT scan only, and puts me on Dilantin. This guy is supposed to be an incredible neurologist but more tests were certainly warranted. It just so happened that my mother, a physician also, fell ill with her second and final battle with kidney cancer. The family agreed that we wanted her to be at her house and with family – NO hospice, and only one nurse who dressed the eventual bed sore. My father who was ‘friends’ with my boss got me an extended leave – this way, we sisters, dad and I agreed that I could care for mom during the day and also live at their home for safety. Mom fought it out for almost a year. During this time I did the somewhat typical denial thing. I don’t have epilepsy I remember thinking. I stopped my med’s twice and both times gran mals. Okay, I now see I need to act. I went to the number one rated epilepsy doctor in my tri-state area who works in one of the top 10 epilepsy centers in the country – Dr. French at the University of Pennsylvania. She was great – aggressive and insightful. CT scans, MRI, one of the two was done with some sort of injected die or something ? I also was given a take home 72hr EEG. Findings were – spikes originating from the right front temporal lobe. The scans, they said, showed an abnormality in the same area that was producing the spikes. My diagnosis was Right front temporal lobe epilepsy – Cortical Dysplasia was the technical term meaning ’slight scar’ They speculated that it was there since birth and that the infection of the EB virus caused complications – slight pressure on the brain that had allowed my threshold to be lowered to the point of requiring medicine. I had two more seizures and was switched to 1200Mgs. of Tegretol. 3Mgs. of Klonopin were later added. I am sure that some reading this can relate to how strange this all was for me. I had gone from NEVER even seeing a seizure to eventually having one when while with a girl-friend one night that I didn’t sleep at my parents.. Talk about feeling like a reject. I lost control of all bodily functions and was bleeding badly from the mouth. She was so caring about it – she even tried to help, costing her a trip in the ambulance with me so that they could sew up her now badly bitten finger. (she had tried to put her hand in mouth- what a beautiful gesture – she only meant to help) I later learned, no wallets, no clothes, and NO FINGERS ! I couldn’t continue a relationship, not like that. She was a psychologist and insisted that it was not at all an issue with her – my self-esteem however, was gone … I had to take a break. Mom eventually died and it is it is now close to a year later. I have had a few seizures during this year which prompted me to take my doctor up on the pre-surgery testing. What fun. I just spent 9 nights and 10 days at The University Of Pennsylvania with an electrical box wrapped around my head the entire time. I was tapered off of the Tegretol so slowly that it was not until the last 52 or so hours that I had finally had a 0 blood level. I was however, kept on the Klonopin the entire time. The reason as some of you may already know, is that they are looking for my ‘typical’ seizure origin and that Klonopin withdrawal is very dangerous and the seizure it could cause would not show them what they were looking for. So here is the kicker – After 9 days, a doctor that I didn’t even know, comes into my room and says that he had a look at my old films and interpreted them as not showing an abnormality that was significant enough to explain my seizure activity. When I questioned this ( i was shocked ) he explained that he had seen abnormalities that small in many people who never suffer seizures. So I am thinking – this as a Top 10 facility ? Who is reading what ? What are they now saying ? Also, during my entire stay, my EEG showed no spiking this time and I didn’t even have one aura let alone seizure. They concluded that the abnormality in my case must be playing a role because the first EEG results they explained came from that very same area of the brain. They stuck with the right front temporal lobe diagnosis. They instructed me to go back on 1200 Mgs. of Tegretol but would like to stop using the Klonopin. I am now removing the Klonopin a quarter milligram/day as instructed. Here is where I need help and answers – Could the Klonopin have been enough to keep my brain from spiking during the monitoring ? Can one have spikes sometimes but go ten days without any spikes ? I will buy the fact the thee EB virus caused my first couple of gran mals, but can anyone explain the ones that I had while I was healthy ? Finally, again, some may understand this, but I have not returned to the Tegretol. It has been 5 days and I still feel okay. Does anyone think it is unwise to do this ? I feel that I need to see if my body will still seize or not so I can peace with all that has happened. I will remain off of the Tegretol until I seize or one of you gives me a reason that convinces me that I should. I am not really scared of a gran mal, but fear that if I have one and it is discovered that my Tegretol level is still zero, I will lose regained trust from my father and sisters about whether or not I am being compliant. If anyone makes it to the end of this and has information to share . P L E A S E share. I used to be a fully functional, in control and confident individual. I have since been diagnosed with clinical depression( mom’s death didn’t help, but the diagnoses preceded that.) I am tired of doctors and Tegretol and Klonopin …… I wish almost that if I were to have another gran mal … let it be the last, however, if my body shows me that it has stopped having seizures I will feel much better but will still wonder what the heck happened to me. Thank-you to all who have kept reading. Sincerely, greg
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hi greg ; # 1 get back on tegretol ! if doc says so never down grade ur self and the answer to y u had the seizures is because a person who has epilepsy is more likely to get more seizures when they have a virus in them like u did and the answer of the klonopin when i went through sleep eegs i was winged off all medicines and at the time was taken klonopin also did u go for a pet scan also it is stronger than a MRI EVERY time i went in i never seizied also but they can tell just by the spikes i would get another opion i;ve been to clevend ny florida to see if i can get operated on all say the same so now i went for the vegal nerve stimulator i;ve had epilepsy for 24 years i;m 34 now so belive me i know what u r going through i got worset also when my dad died at sisters wedding of a heart attack if i were u i go to get another opinion ….chris
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Dear Greg, You have been through a tough time…I am sorry, nothing anyone of us says can make that better. I have left frontal lobe epilepsy which originates in a tiny scar which they feel was caused at birth (my mother was in labour for over 30 hours!). The seizures only started after our arrival in South Africa. I had been given all the necessary vaccinations for the trip and my parents told me that I reacted badly to them, developing high fever, etc. The theory is now that they caused a meningitis that went undiagnosed or treated and this lowered my threshold ….. hence the seizures a few months later at the age of three. I am now 53, so you can understand that medicine had not made the advances that it has today. My epilepsy was really bad as a kid, but looking back now I realize that one of the problems was my parents inability to accept the fact that I was epileptic. I was carted from doctor to doctor and none of the medications were give a chance as they would take me off them the moment they noticed that I became a little duller of slower than usual. Epilepsy was something to be ashamed of then and they battled to get me accepted by a normal school …. had they not fought so hard and found a private school run by nuns, to take me, I would have ended up in a special school for the metally retarded!! I am not sure how others in this group feel, but personally, my life became easier once I left home and was free to face and accept my epilepsy without feeling guilty about letting anyone down. Epilepsy is a terrible blow to ones self image and sense of self worth … THAT is the most serious "side effect" that I have had to deal with. Periodic depression also seems to come with the territory. When I left home I decided that I would no longer try to hide my condition and made of point of warning potential friends about the seizures and what to do if I had one. A dear friend at university nearly lost his finger trying to help me <LOL
I accepted the need for medication and have learned to cope with side effects. Perhaps my greatest "handicap" has been that epilepsy is such an invisible thing, most of the time, and that I was so "normal" between seizures. This meant that my parents, especially my mother, never really understood that there were days where just being, was an effort. I have been labelled "lazy" and a "cold fish" and "difficult" and, and, and….. I am none of those, I am just a person with epilepsy who struggles with depression that can’t be explained, who has "off days" when everything is an effort, who has dreadful feelings of guilt and of not being good enough, pretty enough, clever enough, perfect enough….. Here I have found people who understand all this… just as you will. All the emotions that you are going through are quite normal… just don’t beat yourself up about them. The first step is to stop regarding the way you were as "normal" and your present condition as "abnormal"…. Your normallity has just changed a little. I would encourage you to make your neurologist your "partner" in developing a your new modus vivandi. Best wishes, Dorothy
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