Many of my patients with epilepsy on follow-up appointments told me, “No. I haven’t had a seizure in over a year now. I’m doing very well.” What they probably are referring to is their past convulsion history. No convulsion has recurred. Is this the whole story? Are they fully aware of their condition.
They may not understand possible brief blank-outs of their awareness or halting of thinking of speaking. did they lose contact mentally with their environment while still not perceiving any focal numbness, weakness/ paralysis, incontinence nor visual problems?
Family and other observers may see or hear the person stop talking, a speech arrest, just as the nation recently saw on their television screens. A prominent politician suddenly froze up, stopped speaking and did not answer the reporter's question directed at him. As this occurred, he inappropriately stared off to the side, with a vacuous expression, unmoving. after a delay of nearly half a minute while his aides mored in alongside, he began to speak again.
What was that? What happened? Accounts state it was his second such
episode in two months. It suggested to me that TV watchers experienced a
man having a seizure, a non-convulsive type. Since the news reported he had
a similar episode a month before, more than one seizure is compatible with
epilepsy. If so, was his condition secondary to head trauma? He had fallen a
few months before striking his head. The most common cause of epilepsy in
the population is in the elderly population. See my past blogs on this titled,
Mortality in Older Adults with Epilepsy.
News reports stated that seizures and strokes were “ruled out.”
But physicians know that small strokes may
not always be visualized on brains scans and neurologists recognize that approximately
50% of people with epilepsy, in whom a single EEG is performed, will have a
normal EEG. In such cases, multiple EEGs or continuous EEG recording would be
more apt to find an abnormality. Epileptiform abnormalities are not constant in
the brain in people with epilepsy. Conclusion: a normal EEG does not rule out
epilepsy. The best manner of making a diagnosis of epilepsy is based on the
patients’ and observers’ histories.
Physicians will also consider non-convulsive epilepsy mimics such as transient ischemic attacks (TIA) or “mini transient strokes,” low blood sugar, migraine phenomena without headache among other conditions.
I encourage all epilepsy patients to visit their neurologist/physician with a person close to them if possible. Other people may observe phenomena, clues, of which the patient may be unaware.
Lance Fogan, M.D. is Clinical Professor of
Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting
emotional family medical
drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first
novel. Aside from acclamation on internet bookstore sites, U.S. Report
of Books, and the Hollywood Book Review, DINGS has been advertised in recent
New York Times Book Reviews, the Los Angeles Times Calendar section and
Publishers Weekly. DINGS teaches epilepsy and is now available in eBook,
audiobook, soft and hard cover editions.
