Posted by Solstice on December 25, 2011, at 16:52:49
In reply to Re: lamictal withdrawal effects? any experiences? » Solstice, posted by sleepygirl2 on December 14, 2011, at 17:16:26
> Hi solstice,
>
> Can I ask you something? In case you know and/or care to comment. I had seizures (reportedly) as an infant - emergency c section, placental abruption, first 9 months on phenobarbital.
> I wonder if that's something that could've had lasting effects, or is the brain very resilient at that age?Dinah - -
I am SO sorry that I somehow overlooked your post - or maybe I just haven't been on here except in a very spotty way.
Yes - seizures as an infant can definitely impact the brain. That is the first thing we ask a patient who comes to the lab for an EEG. The severity of the abruption is, of course, key. Now, the brain is indeed very resilient, but it's also very delicate at that age. Seizures as an infant are regarded as a considerable risk factor for seizures developing later on. Interestingly, seizures can 'develop' - as in they can start in one area of the brain, and later show up somewhere else. I had a young patient from Argentina a couple of months ago. Seven year old girl, developmentally delayed. Her parents moved to the US for treatment. The mother gave me reports and print-outs of previous EEG's done in Argentina when the child was five. Two years later, I perform an EEG, and the spike discharge is now on the opposite side of her brain. Two years ago it was clearly on the left parietal, and now it's on the right parietal. This child had no clinical signs of seizures.. in that she did not *have* a seizure during these spike discharges. Not all (in fact most) seizures do not have clear physical manifestations. One of the recent advances in the field is in long-term monitoring. They have learned that people in coma's (regardless of the reason for the coma), have a higher-than-expected rate of having seizures, without clinical signs - called Non-convulsive Seizures, or NCS. They are moving toward using long-term EEG monitoring to ensure a coma patient's brain is protected, because any seizure (defined as what we call an 'electrographic' seizure - where we can see it taking place on the EEG but not necessarily with the body ever moving).. but any seizure lasting more than 30 minutes is damaging the brain. If I have a patient that starts showing electrographic discharges, once they hit the five minute mark - I call the neurologist. So my point is, that not *always* - but much of the time, a patient does not have to be having an actual seizure for us to be able to detect it. They have 'between-seizure' discharges (called interictal). And convulsions are classic, but are not the only manifestation of a seizure. Simple staring spells.. or the kind of temporal lobe symptoms you describe can be a manifestation of a seizure. I had a 50 yr old male patient a few weeks ago who was bumped by a car while riding his bike, and his head hit the curb... a year ago. No damage found by MRI or CT scan, but a neurologist referred him to the lab because he reported having frequent strange taste and smell sensations. He would often have these random and unexplainable sensations of smelling rubber. That's temporal lobe. And sure enough, his EEG showed infrequent discharges at F7 and T5/T7 (the channels recording from his temporal lobe).
So much of how seizures as an infant will affect you depends on exactly where the seizure discharges originated from, how long they lasted, how frequently they occurred, how successfully they were treated, etc. Your symptoms are classic temporal lobe. Temporal lobe seizure symptoms also includes inexplicable (usually a sudden and overwhelming occurrence - rather than a build-up) of anxiety, foreboding, anger/rage, even a sense of inexplicable joy. With your history, I think it would be prudent to explore it. It could explain a lot.. and if your symptoms are being caused by discharges, it's highly likely that treatment would result in significant relief. It's possible that if you are having discharges, the Lamictal has been addressing it just enough to prevent you from recognizing it as deserving a medical evaluation.
And as an aside, the brain's normal electrical activity - neuron firing - is very random and disorganized. During what we call a 'seizure,' neurons start firing in-synch in a very coordinated and rhythmic way, and that is what is defined as a seizure. For a patient with seizure convulsions, whatever part of the body that is responding to the seizure will jerk in a very rhythmic and coordinated fashion, and it will match the electrographic discharge (for example, if the neurons are firing at 5hz per second, the body will 'jerk' at 4hz per second, simultaneously with the discharges. And by the way, people who 'fake' seizures cannot replicate that kind of rhythmicity. It is physically impossible to sustain it, unless your neurons are producing it.)
I'm guessing you were born several decades ago, before neurophysiology developed the sophistication it now has.. but any information you remember being told or have access to that would describe in as much detail as possible what took place, would be helpful. We particularly want to know how long each seizure lasted, how close they were together, how many the patient had in an hour, in a day, in a week, whatever... the age span of the seizures (i.e. started at 9 mo and lasted till age 2).. treatments, whether they were successful, and all about your current symptoms. If you don't have much historical information, that's ok.. but if you've got aunts or uncles, or other relatives or family friends that might remember something, it's enormously helpful. If a neurologist suspects that your symptoms may very well be as a result of seizures, but they aren't able to see discharges on a 'regular' EEG recording, then they can order a longer-term EEG. They'd probably start with a 23 hour, where you are hooked up in the lab and sent home with a backpack to live your life as normal for the next 23 hours (kind of like a holter monitor). Those kind of recordings are especially helpful because symptoms are often triggered by daily activities, which wouldn't take place if you were an inpatient.
I don't think you wanted this long of an answer - but please ask any more questions you may have!
Solstice
poster:Solstice
thread:1004586
URL: http://www.dr-bob.org/babble/20111208/msgs/1005565.html