Thread: Roll Call 34
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Old Sep 05, 2014, 01:08 AM
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Sometimes psychotic Sometimes psychotic is offline
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Quote:
Originally Posted by Crescent Moon View Post
It's not that absolute. Sometimes there is a single symptom, but oftentimes there is more than one symptom. There are characteristics of the symptoms that make them more - or less - likely to be temporal lobe seizures. The other thing is that having been diagnosed with psychosis/hallucinations, you can have BOTH. In fact, a brain that already has something going on (like psychosis/hallucinations) would be even more likely to be prone to the kinds of brain irritations that cause seizures.

So as for your having more than one modality, it's possible to have more than one symptom that is related to temporal lobe seizures, and it's just as possible to have a combination of temporal lobe seizures along with hallucinations related to a psychotic disorder.

Another thing about these kinds of seizures is that they can wax and wane. There can be a period of time when there are a lot (for example, during a stressful period at work when you're experiencing a lot of sleep deprivation). Then there can be periods of time when they seem to subside for a while. So in my experience, it is more common for them to wax and wane than for them to be regular and frequent.

Another thing to know is that the only temporal lobe seizures that will show up on an EEG come from the lateral surface. Deeper temporal lobe seizures (like olfactory that usually comes from around the uncus) would be VERY unlikely to show up on an EEG, even if having a seizure while the EEG is running. During most EEG's, we are looking for what we call interictal abnormalities or discharges. For a fair number of people, even if they aren't having a seizure, subtle abnormalities can show up during an EEG. To give it a fair chance, the EEG needs to last a good 45 minutes, and the person must be sleep deprived and then allowed to get drowsy and fall asleep. Drowsiness and early sleep can be ripe for abnormalities that don't show up when the patient is awake. Anyway, that said, not all seizure disorders have interictal discharges. A perfectly normal EEG does NOT rule out epilepsy. If the symptoms continue and nothing was caught on a routine EEG, standard practice is to then order a long term monitoring in an Epilepsy Monitoring Unit. It's a hospital stay that can last anywhere from a day or two up to a week. The goal is to capture an actual episode of symptoms. Another way to evaluate if symptoms continue is to go ahead and prescribe medications useful for temporal lobe epilepsy, and then see if the symptoms disappear. That can lead to a formal diagnosis of epilepsy, because the only other option would be to do a grid placement of electrodes on the surface of the brain.

Anyway, I hope you get a well done EEG, and I hope that neurologist you're seeing reconsiders his absolutes about epilepsy.
I think that's why I'm getting the EEG anyway....I think he's more a trust the machine kind of guy.....I know they told me to block off 2 hours so I'm not sure how long the actual EEG will be but he told me to get only like 4 hours sleep so I could fall asleep or at least try because that was the best activity....

The resident was originally talking ambulatory EEG and MRI but the attending guy was talking let's do the cheapest first which I think is fine.....he said if it came back weird we would do an MRI....he seemed most interested in the knocking but thought it should be identical....

Here is the thing.....pdoc may be leaning bipolar and you can use anticonvulsants for that as well....it may not matter what I have formally if I still can take the meds.

Basically I was ready to just trust the guy and say....if this is a waste of time let's not do it but then he was all I think we'll get it done to put everyone at ease etc etc. I'm fine with that.

You have to understand I can read about these things and recreate them for some reason with my hallucinations....it's all a game somehow for whatever part of me is sick like diagnostic challenge...last time I thought I was diabetic and bought ketone test strips....consciously I had no idea they even existed but the voices told me to go to the pharmacy and get some.....some part of my brain recalls this stuff and then incorporates it into my psychosis....it's like I told him the only reason I'm getting this worked up was the original psych thought it might be....ie an actual doctor said it might be the case instead of my own mind.
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