Friday, November 25, 2016

Blog #76: Recognizing Epileptic Seizures Is Not Easy

            I gave a presentation: IS IT A LEARNING DISORDER, A HEARING PROBLEM, AUTISM OR EPILEPSY? to school psychologists in Newport Beach, California, last month in order to raise epilepsy awareness. These are all prominent reasons why children fall behind in school work. Correct diagnosis is the key to greater life-success. 

            Three million American children and adults are living with epilepsy. Millions more are touched by their epilepsy including: family members and friends, educators, counselors and health providers. They all need to be alert to the symptoms of “non-convulsive epilepsy.” 
More education is needed. The general population has little awareness of this condition. 

            Typical presentations of unrecognized epilepsy include individuals complaining that they just can’t keep up in their work and/or studies. A complaint of sudden, brief, confusion spells suggests possible non-convulsive seizures. These seizures can last seconds or longer. Medical and psychotherapy professionals don’t usually put an epilepsy possibility at the top of their diagnostic considerations. Complex partial seizures and petit mal, or “absence” non-convulsive epilepsies do not exhibit obvious convulsive limb shaking, tongue and lip biting and loss of bladder/bowel control. I often hear the lament: “No one knew what was wrong with my nephew for the longest time. They thought he had a learning disorder. They finally diagnosed epilepsy.”

            Clues for non-convulsive seizures causing mental difficulties and mental slowness are derived from observation of the individual. Sudden facial expression changes suggestive of staring, loss of contact with their environment and not responding to questions, or losing train-of-thought all put forward the possibility of non-convulsive epileptic seizures. Most reliable for diagnosis is to have family and friend-observers test the person during apparent mental blank outs or sudden, inappropriate, “spacey,” quizzical facial expressions. During this time observers should ask the person to perform some action in order to test intact consciousness. Ask the person to: “put your right thumb on your left ear,” or “stick out your tongue and lift your right leg,” etc. During such a spell they won’t do it. Brain scans, EEGs and other laboratory tests are often normal and can’t be relied upon to diagnose epilepsy.

            In my clinical experience, the observer’s report may be the only “data” the neurologist gets to consider this non-convulsive epilepsy diagnosis. A trial of antiseizure medications can be prescribed despite all the negative formal testing. The non-convulsive epilepsy diagnosis is supported if medications minimize or stop these “little” spells.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.