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- Thu Dec 27, 2007 3:05 am
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.
| Dr. Chan Lowe
- Wed Jan 30, 2008 10:51 pm
I would agree with you that this certainly sounds very suspicious for a focal seizure disorder. When the episodes begin to affect both sides of the body, does she remain alert or go unconscious. If she remains awake, this is almost diagnostic of a psychological disorder (conversion disorder or pseudoseizures). If she goes unconscious it supports the idea of secondary generalization.
Having an EEG that did not show seizure activity during a witnessed event is also very supportive of a pseudoseizure disorder. However, it is possible for both conditions to occur in a patient (a true seizure disorder and pseudoseizures). The sleepiness after the episodes supports a post-ictal phase that would go along with a true seizure disorder.
Is it possible that she has discovered a benefit to having these attacks so that she has now began to have psuedoseizures? Secondary gain issues can be very powerful.
It may be worthwhile doing a prolonged video EEG monitoring episode to see if a few of these episodes can be recorded to see if possibly some are true seizures.
These are just a few of my thoughts. I hope it helps some.
Best wishes. If you don't mind, will you keep us updated on this case? It will be interesting to see its progression.
- Tue Apr 28, 2009 4:16 pm
I am a 29 year old female who suffered similar symptoms. I was never diagnosed, however. Some doctors eluded to Psuedoseizure disorder, but never straight out told me. I suffered from what I later found out could have been a possible concussion.
At age 26, I was severely beaten by my husband at the time, where I did suffered some head trauma (I was slammed onto a hard wood floor head first.) Because I did not suffer any unconsciousness, I did not seek medical attention. My symptoms started weeks later. I began to be fatigued all of the time. All I wanted to do was sleep. I would almost always be light headed and dizzy. I would see spots as well. I was not sexually interested (which could have been attributed to a number of things, including the physical and emotional abuse.)
When I first sought medical attention, after a series of blood work and blood pressure tests, they told me I had low blood pressure, gave me some pills and sent me home. About two weeks later, I suffered my first attack. I was just finishing up at work and had just put a box which was not too heavy into a storage room. When I sat the box down and began to walk back to my desk, I noticed that I just did not feel right. I cannot explain the feeling, but I knew it was not normal. Once I reached my desk, I sat there for a moment, then noticed that the left side of my mouth start to tingle and feel as though it were going numb. My first thought was that I was having an allergic reaction to some lip gloss, but quickly remembered that I had not applied any type of cosmetic. Before I knew it, the numbness had spread from my mouth to the rest of the left side of my face and some of the right side of my face was now starting to feel numb.
I immediately stood to begin walking to my supervisor's office, as it was the end of the day and everyone else had gone home. I could barely move. My legs were as stiff as stone. I barely made it to her office, when my body just collapsed. The following was a blur. I came to when a nurse from another department was taking my blood pressure which was apparently high at the time. I can't remember exactly what it was, but I remember her thinking that I was having a stroke. She did all of the precautionary things to determine if I was having a stroke or not and I failed them all. I remember being frustrated because at that moment, I could not remember the answers to a lot of questions that she was asking me. Ironically, all of my symptoms subsided, including the high blood pressure shortly after the paramedics arrived.
I was taken to the hospital, an EKG, MRI, and CT all came back negative. In the months to follow, I suffered several more attacks - All similar in many ways and all ending with severe headaches. The worst attack was the last one where I did lose consciousness (we don't know if it was because I hit my head during the fall or not). I was also completely paralyzed from the neck down for about 20 minutes. The left side of my face in all episodes was always paralyzed.
I was referred to every kind of specialist you could think of.... Neurologists ran EEG's and did sleep studies and found nothing. I went to a cardiologist and lung specialist and they also found nothing. I also saw an endocrinologist who also found nothing.
I have not had any attacks in the last two years, but I know that they were real. I don't feel like they were "all in my head." However, I must say that I feel that I overcame them by not succumbing to them. In other words, there are times where I can feel the dizziness coming on and I know that perhaps I am doing too much. I don't give in to those feelings. I just listen to my body and I slow down. I realize I am far from Superwoman....