BLOG #137: Epilepsy: Preparing for the Holidays

 

The holidays are here. As many of us prepare to travel—and welcome—friends and family to share, people who have epilepsy should take some extra precautions to stay healthy and safe.

Covid Protection: Vaccinate! Vaccinate! Vaccinate! Booster when 6 months since your last vaccination has passed. We all know the guidelines: distance and mask when exposed to other people.

Get enough sleep: Excitement, stress and jet lag can disturb sleep patterns. Extreme sleep deprivation is known to cause seizures. For example, soldiers returning home from Vietnam during the 1960s and ’70s were so excited that they would be up for 36 hours straight. This extreme lack of sleep caused a convulsion in people who do not have epilepsy; it could certainly precipitate seizures in people who have epilepsy.

Alcohol: Alcohol is often served at holiday meals. People with epilepsy can probably tolerate a beer or a small glass of wine or spirit. However, excessive use/abuse of alcohol is more likely to bring on a seizure than in a person without epilepsy.

Nutrition and hydration: In my experience, people who have epilepsy do not need to follow a special diet; just follow routine recommendations for good nutrition and water intake.

Bring an adequate supply of anti-seizure medication when you travel: Be sure to bring enough anti-seizure medication with you to last the duration of your trip plus a couple extra days to be safe. Keep the medications in their original bottle/container with the prescription (dosage) and your doctor’s name on the label. (This information may be required if you must cross state or international borders.)

Stress: No matter how much you enjoy the festive season, holidays can be stressful for anyone. Emotional stress can definitely bring on a seizure in people who have epilepsy. If possible, minimize the amount of time you spend in a stressful environment. Meditation and light exercise are good ways to reduce stress.

Carry identification when you go out: People who have epilepsy can have a seizure at any time. During a seizure, a person cannot tell bystanders that he or she has epilepsy. When a seizure occurs, it’s usually not necessary to call an ambulance; the person will stop jerking and shaking after a minute or two and just sleep it off. A MedicAlert bracelet or necklace would reassure observers that the person has a known chronic condition that may not be that serious. This information is also useful if emergency personnel are called. Always carry a card in your wallet that states your condition (type of epilepsy) and up-to-date medications you take to control it. Be sure to include a contact address and phone number of one or two relatives that emergency personnel or a Good Samaritan can contact in an emergency. If you are away from home visiting friends or relatives, be sure to provide similar contact information about your hosts.

Wear a helmet: After eating sumptuous meals, a lot of people like to get out and exercise to work off the calories they have just consumed. Everyone—and especially people with epilepsy—should wear protective headgear (a helmet) if you ride a skateboard, bicycle, horses and even ski. A helmet will protect your precious brain from injury if you fall and hit your head while participating in one of these activities.

I wish you a happy and healthy holiday.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His emotionally hard-hitting 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 a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

 

Blog # 136: SUICIDE AND SEIZURES

 

The rate of suicide is increased in people with seizures. The relationship between seizures and suicide is complex and controversial.¹ Antiseizure medications have a black-box-warning for suicide indicating their serious relationship.²

 

Several large studies demonstrate that epilepsy increases the risk of completed suicide and suicide-related-behavior independent of these medications. Are suicidal ideations promoted by changes in neural brain-circuitry-networks that make people with epilepsy more vulnerable to mood disorders?³ These are questions that inspire neuroscience students to research and learn more.

 

Social stigma and isolation, driving restrictions, substance abuse and decreased employability likely play a major role in depression leading to suicide. People with uncontrollable psychogenic nonepileptic seizures in which they suffer involuntary convulsions (PNES) face similar psychosocial challenges as people with actual epilepsy (see my Blogs # 49 August 27, 2014 “Psychogenic ‘Fake’ Non-Epileptic Seizures; Blog # 99 October 26, 2018 “Revisiting False Epileptic Events” at LanceFogan.com) “Seizures” of PNES do not have an organic cause, however, these “seizures” are just as debilitating and real to the person as actual epileptic convulsions. They are not malingering. Because of the seizures having psychological causes they are notoriously difficult to control. Children seem not to be afflicted with PNES. Education and marriage are associated with decreased risk of suicide. ⁴

 

I encourage all persons with epilepsy, their families, and their associates to be aware of a heightened suicide risk and to monitor for a need for professional support.

 

 

1. Pompili M, Girardi P, Tatarelli R. Death from suicide versus mortality from epilepsy in the epilepsies; Epilepsy Behav 2006;9:641-648.
2. Hesdorffer DC, Kanner AM. The FDA alert on suicidality and antiepieptic drugs: fire or false alarm? Epilepsia 2009;50:978-986.
3. Kanner AM. Mood disorder and epilepsy: a neurobiologic perspective of their relationship. Dialogues Clin  Neurosc 2008;10:39.
4. Kyung-Sook W, SangSoo S, Sangjin S, Young-Jeon S. Marital status integration and suicide: a meta-analysis and meta-regression. Soc Sci Med 2018;197:116-126.

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. It teaches epilepsy, now available in eBook, audiobook, and soft and hard cover editions.

 

 

Blog #135: DOES YOUR POOCH SEEM TO PREDICT YOUR NEXT SEIZURE?

 

This anecdotal study reviewed below should promote keeping a closer eye on your pet dog’s behavior prior to a seizure. Perhaps you have already noted your dog’s altered behavior before your seizures, but you weren’t sure the behavior was meaningful. Read on. Learn of the compelling evidence that the behavior is meaningful but you weren’t sure of its significance.

The online epilepsy magazine, Epilepsy Today September 30, 2021, reviewed a new study from Queen’s University Belfast published in the journal MDPI (Molecular Diversity Preservation International) in July 2021. The study concluded that dogs could detect some unidentified odor that seems to be specifically associated with your seizures.¹

The research was led by Dr. Neil Powell. These anecdotal accounts from 19 epilepsy patients report their pet dogs give them warnings by trying to connect with their masters before their seizures occur. The researchers evaluated the dogs’ reactions to seizure-related and non-seizure-related odors. They employed a special tool called the Remote Odor Delivery Mechanism. The odors reflected three separate phases of a seizure: before, during and after. The researchers collected sweat pads from armpits from seizure patients and from non-seizure controls. The dogs reacted to the odors from seizure-patients other than their owners, too.

All 19 dogs showed a change in behavior related to seizures. They tried to connect with their owner because of some unidentified seizure-related odors compared with the non-seizure-related ones. Dr. Powell said our findings clearly showed that all dogs reacted to the seizure-associated odor through making eye contact by staring at their owner, touching their owner by nudging or pawing, crying or barking,”

This study was on dogs who had no prior training. The researchers concluded that if dogs can be trained to communicate that a seizure will soon occur this can improve the owner’s safety and quality of life. A program of targeted training for seizure prediction is being developed.

1)     Powell NA. Ruffell A. et.al.The Untrained Response of Pet Dogs to Human Epileptic Seizures. Animals 2021, 11(8), 2267; https://doi.org/10.3390/ani11082267 21 July 2021

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. It teaches epilepsy, now available in eBook, audiobook, and soft and hard cover editions.

 

Blog #134: ADVANCES IN EPILEPSY OVER THE PAST 20 YEARS

 Neurologists are diagnosing epilepsy sooner and providing better treatments, but many patients are still not seizure free and do not receive adequate medical care. The next 20 years hopefully will shrink this number. But much is still not understood about the condition, including the specific cause in too many patients.

There has been an evolution of different terms for the various forms of epilepsy but the seizures themselves are unchanged, i.e., how they spread in the brain and their electrical activity.

A once common cause of complex partial seizures, aka temporal lobe epilepsy and psychomotor epilepsy, was mesial temporal sclerosis (depicted as inner temporal lobe atrophy on brain imaging scans). Currently this specific brain atrophy is less commonly seen. Why this is so is a mystery. A leading epileptologist, Dr. Jacqueline French, speculates that a particular type of illness that caused it is no longer prevalent. Alternatively, could it be that more anti-inflammatory medications are currently used in children that usually develop it and these effectively minimize this seizure disorder? ¹

Neurologists note that nearly one-half of all comatose patients in Intensive Care Units (ICU) were having electrographic seizures on the EEG but 90% had covert seizure manifestations that were not obvious. When I personally examined motionless comatose patients I have been surprised by occasionally noting a “jumping” of the eyeballs, called nystagmus, when I would focus my ophthalmoscope on structures in the rear of the eyeballs. These movements are compatible with unsuspected seizures. In recent decades skill using ophthalmoscopes at the bedside that could detect this finding has been lost by younger clinicians; they depend on brain scans, but scans are not capable of showing epileptic activity.

Newer deep-brain stimulation can effectively detect electrical onset of seizures and then “short-circuit” the abnormality thus halting seizures as they begin. Brain surgery to remove identified abnormal seizure foci has become common and is very effective in minimizing the frequency of seizures. Surgery can even cure epilepsy. Robots can place brain electrodes or even function to remove brain tissue under neurosurgeons’ control.

The past 2 decades have seen development of newer anti-seizure drugs but none, to date, are able to eliminate seizures completely. Still, half of all the 1% of people afflicted with epilepsy will have excellent seizure control when put on the best anti-convulsant for them. Genetic studies can help to diagnose epilepsy syndromes in increasing numbers. Specific gene patterns in individuals (their genomes) are now found to be associated with epilepsy that guides the best medication choice for that person’s condition.

Formerly, Sudden Unexplained Death in Epilepsy (SUDEP) was incorrectly believed to be rare, however, it is not rare; effective anti-convulsants that prevent or minimize a person’s seizure frequency has been very effective in lowering SUDEP.

The ability to track your seizures by implanting electrodes has been a very significant advance in epileptology. It is hoped that this will enable patients to predict when a seizure will occur and gain better control over their lives.

1)    Fallik D. Then and Now:20 Years Later. Neurology Today. September 2, 2021; p.14.

      Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is a family medical drama told from a mother’s point of view. It is his first novel. It teaches epilepsy. DINGS is now available in eBook, audiobook, and soft and hard cover editions.

 

Blog #133: Reflex Epilepsy

Have you experienced seizures associated with specific experiences? These are reflex epilepsies.

Reflex epilepsies are seizures that are initiated reflexively by a stimulus to which a person is exceptionally sensitive. These specific stimuli include: flashing lights; reading various phrases or word combinations; detecting particular tastes and odors; a sudden noise, touch or motion; and, rarely, laughter. Specific musical tunes can induce seizures, and seizures may even be specific to hearing a performance by a certain artist. Bathing epilepsy and hot water epilepsy are forms of reflex epilepsy that are more common in children who are sensitive to showering and bathing. Most reflex epilepsies have genetic etiologies with genetic mutations found in the SYN1 gene. In some cases, just pouring water can initiate a seizure in these susceptible people.¹

For example, a 61-year-old woman reports a seizure can be triggered if her right leg accidentally hits an object. Her right leg would start to tingle, twitch, shake and then becomes paralyzed for up to half a minute. “It’s almost as if I’m startled.” This does not occur if she purposely touches her right foot to a leg of a chair. Her seizures date back to childhood but were only recently explained after a neurological evaluation at an epilepsy monitoring unit. She’s now on anticonvulsant medications and is more careful to avoid hitting her right foot.² This is an example of a specific sensory stimulus that in susceptible people can bring on a seizure—a REFLEX SEIZURE.

Musicogenic epilepsy is demonstrated in another instance when one woman began having seizures when she heard highly emotional hymns during church services. She would blank out and drop her hymnal. Slow, emotional songs triggered seizure activity in her temporal lobe, while faster tunes did not. When she was exposed to melancholic music in the lab she exhibited fear, rapid heartbeat, crying, confusion, and lip smacking: classical features of complex partial seizures which usually emanate from the temporal lobe. EEG electrodes applied to her scalp as she listened demonstrated the epileptiform abnormality. This suggests a relationship with how our emotional brains can be affected by music. This woman drowns out any slow, emotional music that could bring on a musicogenic-seizure in restaurants, malls, stores, etc.  by walking around with an iPod playing up-tempo songs in her ears which seems to prevent her musicogenic seizures. 

In a third example, a man had seizures induced by laughing but this occurred only while watching funny programs on TV. He would start laughing, his arms would shake, and he developed clouded consciousness. He reported no seizures at any other time. ¹

Does this blog suggest to you that you may have reflex seizures associated with specific experiences?

1.     Accogli A, Wiegand G, Scala M. Clinical and Genetic Features in Patients with Reflex Bathing Epilepsy. Neurology. 2021;97:e577-e586. Doi:10.1212.

2.     Symphony of Reflexes reported by Susan Fitzgerald in Brain & Life: December 2019/January 2020; page 36.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is a family medical drama told from a mother’s point of view. It is his first novel. It teaches epilepsy. DINGS is now available in eBook, audiobook, and soft and hard cover editions.

 

Blog # 132: A NEW REVIEW OF MY FAMILY MEDICAL DRAMA: DINGS

PUBLISHER: AUTHOR REPUTATION PRESS LLC

ISBN: 978-1649612786

GENRE: MEDICAL FICTION

PAGES: 280

REVIEWED BY:  LILY AMANDA HOLLYWOOD BOOK REVIEWS

 

Dings is a moving unabridged tome that chronicles the life of Sandra Golden and that of her family, and a medical diagnosis on her son that takes them all by surprise. Sandra is managing the home while her husband, Sam, is away on active military duty in Iraq. One day, she is summoned by the principal of the school Conner, her son, attends.

The school principal and psychologist suggest that her son goes through a psychoeducational evaluation to uncover any cognitive or emotional problems that were contributing to his difficulties in class. After several tests and sessions with a neurologist, her fears are confirmed. Her son is epileptic. It was easy to feel Sandra's despair and fear.

The work is a fantastic combination of real-life situations of a medical doctor who uses his scientific knowledge to create a medical mystery story. This exudes both great imagination and creativity. The writing style is gentle and even. I could almost hear the neurologist speaking as if he was near. Peppered with medical terms and valuable information, this is a publication which left me wiser and more aware.

 Author Fogan brilliantly blended contemporary drama and helpful information about epilepsy in an articulate manner. Throughout the story, a reader finds it easy to spell out the symptoms of the condition, the medication used, and how to help an epileptic patient. Uniquely, Dings sheds light on the commitments and sacrifices of healthcare givers in the compassion they show within their line of duty. The patience and concern that Conner's neurologist showed, was admirable.

The text seeks to demystify all the misconceptions associated with the condition and its medication. The author is descriptive, a feature which thrusts the reader into the Golden family. The writer brings out the sacrifices Army wives make for their families while their husbands are away on deployment. I loved how the author did a great job capturing the tone and emotions of the protagonist. A lot of times, the strength of the characters is what builds a story. The characters in the book are well-developed and it felt as though I was part of the story and the turmoil engulfing the family as they sought answers. The book further has a spark of Haiku poetry in its plot and provides for an epilepsy glossary and information associated with it. Overall, Dings was a plausible and solid read and by all means worth investing in. Knowledge, as has always been said, is power!

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

 

 

Blog #131: MEDICAL MARIJUANA CAN CONTROL SOME SEIZURES

 

Medical marijuana, also called medical cannabis, is derived from the whole cannabis plant. Its effect on epilepsy has recently been summarized.¹ Cannabinoids are in cannabis; these chemicals act on the body and on the brain cells. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the two main cannabinoids. THC binds to brain receptors and creates the “high” or psychoactive effect. CBD, however,  does not have this psychoactive effect.

 

Epidiolex, a mostly purified plant-based cannabidiol oil derived from the cannabis plant is a liquid that is administered orally. It was beneficial in treating people with notoriously-difficult-to-control-seizures in Dravet and Lennox-Gastaut Syndromes. The US Food and Drug Administration (FDA) approved it in 2018. In 2020, Epidiolex was also approved to treat seizures in the tuberous sclerosis complex.

 

Marijuana products sold in dispensaries and online, however, are NOT approved or regulated by the FDA because they can vary in quality and contents.

 

How the different compounds in marijuana affect neurologic diseases and epilepsy syndromes is not yet understood. When CBD was added to the benzodiazepine clobazam (Onfi), the combination improved the positive effects on seizures in children and adults with Dravet and Lennox-Gastaut Syndromes. Researchers theorize CBD may slow the sending of messages to the brain, change calcium levels in the brain that affect signals between cells, or it may reduce inflammatory effects in the brain.

 

There can be side effects of this treatment including fatigue, nausea, diarrhea, liver dysfunction and an increase in suicidal thoughts.

 

Seizure frequency in approximately 30% of people with epilepsy is difficult to control, so Epidiolex may be considered in a treatment plan after evaluation by epileptologists and epilepsy centers.

 

Remember that epilepsy-health includes taking your antiseizure medications as prescribed, getting enough rest and sleep, minimizing alcohol and do not take illicit street drugs.

 

1)     A.D.Patel Can medical marijuana help control seizures? Brain and Life.org: p 23; June/July 2021

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

 

 

 

Blog #130: “DINGS”, My Family Medical Drama, Got a Favorable Review by U. S. Review of Books

May 20, 2021

 

Dings
by Lance Fogan
Author Reputation Press

 

book review by Boze Herrington

 

"I was suffering and, oddly, it was a shameful feeling... Illness had come to my family. It was going to be up to me to be strong and support my son."

Sandra Golden's life is upended one evening when her son, Conner, suffers a mysterious convulsion. Conner has been behaving strangely at school, blacking out and neglecting to finish his assignments. Sandra and her husband, Sam, are distraught when they learn that Conner could be suffering from epilepsy, a medical condition afflicting three million Americans. Between this and Sam's burgeoning alcoholism—fueled by the post-traumatic stress he suffers as a combat veteran—Sandra begins to fear that her marriage and household are unraveling. When searching the internet for symptoms fails to provide any clarity, she turns to a specialist who offers hope.

Fogan's narrative is tautly written and moves at a brisk pace, never allowing the author's impressive understanding of neurology to obstruct the book's more dramatic elements. However, parts of the book are presented in non-chronological order, flashing back to a few months before the convulsion, which changes the flow somewhat. The exposition is delivered in an accessible and compelling fashion as the reader is pulled forward by the mystery of Conner's condition and growing concern for his fate and that of this family. Although the drama is mostly small-scale, tension is maintained throughout. The description is sparing but evocative, and the plight of the characters is genuinely affecting. The reader is left with the feeling that one has gone on an emotional journey with the family. At times, some of the dialogue comes across as less than realistic, and the characters' reactions, especially at the beginning, can feel somewhat melodramatic. Overall, though, Fogan's novel is a gripping portrayal of one woman's descent into a domestic nightmare.

 ©2021 All Rights Reserved • The US Review of Books

 

This review was written by a professional book reviewer with no guarantee that it would receive a positive rating. Some authors pay a small fee to have a book reviewed, while others do not. All reviews are approximately half summary and half criticism. The US Review of Books is dedicated to providing fair and honest coverage to all books.       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 family story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

 

Blog #129: IS YOUR SEIZURE FREQUENCY PREDICTABLE?

 

The longest seizure study yet finds daily, weekly, monthly, and yearly seizure repeating cycles based on continuous intracranial EEG data collected from 2004 to 2018. Patients often tell their doctors that their seizures come in cycles. Skeptical physicians may now acknowledge their patients’ reports and approach their patients with more effective treatment adjustments. ¹

Blog #41, December 24, 2013, appearing on LanceFogan.com describes an implantable neurostimulator approved by the FDA in November 2013. The device is called the Responsive Neurostimulation System (RNS NeuroPace, Inc.). It is surgically implanted into the skull bone—not under the bone—close to the brain location where the seizures are determined to originate. Two small holes are drilled into the bone through which two lead wire electrodes are placed on the brain, or within it, close to a seizure focus. The battery-powered stimulator positioned outside the brain on the skull monitors brain activity. When the onset of seizure activity is detected the electrodes deliver stimuli that short-circuit the abnormal brain activity and normalize it before a seizure manifests. The RNS System activates only when it detects seizure activity. It aborts many seizures from manifesting even before the person is aware of the imminent seizure.

The NeuroPace stimulator detects circadian cycle data in epilepsy. Circadian rhythm is a natural internal process that regulates sleep-wake cycles and other processes in an organism. It repeats roughly every 24 hours. In some people with epilepsy, seizures occur in predictable cycles. Have you noted some of your seizures are predictable?

Circadian seizure cycles showed five peaks of epileptiform activity: morning, mid-afternoon, evening, early night and late night. If these findings pan out on further research, perhaps augmenting anti-seizure medications at predictable times may prevent some of your seizures. Knowledge of when seizures can be expected should empower patients. This knowledge can boost self-confidence. Driving ability, employment, social disablement all impact the lives of people with epilepsy; this predictable-seizure knowledge can return confidence and independence. 

This new approach to assessing seizure-frequency by constant EEG recording with the NeuroPace device shows many individuals’ seizures occur every seven, 15, 20 or 30 days. Epilepsy researchers were surprised at this predictable cyclic information and are considering whether seizure forecasting over long time periods can be done. A seven-day cycle is often not precisely 7 days; it might be 6.5 or 7.5 days. As patient’s known cycles, i.e., weekly or 15 or 20 or 30 days or longer approaches patients may predict their seizure and take safeguarding action. Researchers are excited to follow up these findings.

 

1)      Neurology Today: Longest6 seizure study yet finds daily, weekly, monthly and yearly cycles. Reviewed by Dan Hurley in the March 18, 2021 issue, page 10-11.

 

 

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

 

 

 

Blog #128: A FAMILY DEALS WITH UNRECOGNIZED EPILPESY: Excerpted from Dr. Lance Fogan’s novel, DINGS Chapter 24, Part 2

 In the Neurologist’s office—making the diagnosis

 

The doctor looked at me. “Mom, can you tell me what happened?”

I described that evening: Conner sneezing and coughing in his sleep, his high temperature, hearing the strange noises coming from his bedroom, finding him jerking all over the bed, the wet sheet and blanket, all that blood in his mouth…

“My tongue got bit. It still hurts!” Conner blurted. He opened his mouth. “Thee?” He lisped as he protruded his tongue.

We all looked at the almost-healed blue laceration.

I heaved a sigh to slow my breathing. I put my cold fingers under my thighs to warm my hands. “Then there was that rush to the hospital and Dr. Choy.”

Dr. O’Rourke glanced again at the hospital notes in front of him on his desk. The neurologist smiled and drew a deep breath.

Before he could continue I sat forward and interjected, “Doctor, I, uh, we were hoping”—I flashed a glance at Sam’s querulous face—“Uh, we were hoping to stop the Dilantin as soon as possible. Do you think that we can?”

“We’ll see, Mrs. Golden. Dr. Choy did a thorough job screening Conner for causes of that seizure. I see that he put Conner on Dilantin. That medication may not be necessary. Your boy is a bit old for his convulsion to be secondary to just a fever, though. Let me find out a bit more. I need more information.”

I beamed at Sam and squeezed his hand. Yes! He was confirming what I had learned from the Internet. The neurologist just said what I had been praying for. I leaned back in my chair.

But, he said that he would investigate further. That was when I pictured a detective with a baying hound that scurried right and left over the ground smelling out prey. So there it was again. Something wasn’t right for these doctors. Dr. Choy had said something like that about the convulsion and Conner’s older age, too. What wasn’t Dr. O’Rourke telling us? I got the feeling that he was taking care not to terrify my already-shaken family. I don’t exactly know why—I felt some ominous undertone.

Dr. O’Rourke asked, “Has Conner ever passed out or fainted in the past?”

“No. But, you know, I wanted to ask you: Sam’s brother had something similar when he was an infant. He had a fever then, too. That was the only time it happened though. Right, Sam?” Sam nodded. “I’ve heard that seizures can run in families. Is that true? God, I hope not…” My voice trailed off.

“They can.”

I clasped my hands and leaned forward. Then I sat on my fingers again.

Dr. O’Rourke turned and addressed his patient. “Conner, have you ever blanked out when you’re thinking about something?”

“Uh, like…what?”

I looked at Conner. Sam did, too. Why did Conner say that? I got this uneasy feeling that Conner somehow understood what the doctor was hinting at. Sam’s mouth dropped open. He looked at me; his eyes narrowed.

The neurologist cleared his throat and leaned forward over his desk. “I mean, let’s say that you’re thinking about something, or watching a movie or a TV program, or someone is talking to you. Does it ever seem as though you suddenly missed what was happening? Like your mind went blank all of a sudden. I don’t mean daydreaming; everybody does that. When you daydream, your mind is still thinking of something—like you zone out—but you know it. Let’s say something is important to you and you are really paying attention.”

Dr. O’Rourke stole a quick glance at Sam and me. Then he looked back at Conner and continued, “And then, all of a sudden, the scene in the movie or on the TV screen has changed, and—” He clapped his hands once. “Suddenly you don’t know what happened, even though you were following the story really closely. Has that ever happened to you?”

Conner leaned forward in his chair and dug his fingers hard into the edge of the doctor’s desk. I saw white at their tips. “Well, um, sometimes I get these, uh…you know, I get this funny, this ding feeling. I don’t know, I—I—and then something else has happened and I don’t know what.”

What? Sam and I looked at each other. My jaw dropped. My body tightened and my voice was loud. “What do you mean, Conner? What ding feeling? What are you saying? When does this happen?”

He turned toward me. “A lot. When it happens at school Mrs. Dorsey gets mad at me.”

“Mrs. Dorsey gets mad at you? What do you mean? Why? What happens?” I grabbed his arm.

I looked at Dr. O’Rourke. He sucked in his cheeks and his lips pursed as he slowly nodded his head one time. His eyes moved down to my hand that gripped Conner’s arm. Otherwise, he maintained a placid expression as he watched us.

“She asks me if I…um…if, uh…I need more time to do my tests. Like that spelling test. She said I needed more time…um…to finish.”

“Did you finish? Did you need more time? Which was it?”

“I—I don’t know. I don’t know!” Conner’s chin quivered.

Dr. O’Rourke picked up his pencil and held it poised over his notepad. “What you’re telling us is very helpful, Conner.”

I released Conner’s arm and leaned back in my chair. As my legs straightened, my shoes kicked the bottom of the neurologist’s desk. What was he saying? None of this made sense.

Dr. O’Rourke licked his lower lip. “How often does this happen, Conner? This ding?”

Conner shrugged. “I dunno…I dunno. I don’t!”

“Well, what would you say? Does it happen every day? Does it happen every few days, or every few weeks or months?”

“I dunno. A couple of times, I guess.”

“Did it happen today?”

“No.” Conner sniffled.

“Did it happen yesterday, Conner?”

“No.”

“Does it happen a lot?”

 “It doesn’t happen every day…I think.” He shuddered and hiccupped back a sob. He looked at me. Tears started to roll down his cheeks. His chin trembled. When I leaned over to wrap my arm around his shoulders he sobbed louder. “I’m scared. I’m scared, Mom!” He wiped his cheek with his sleeve.

I stared out and couldn’t move for a moment. I was in slow motion. Everything was in slow motion. I took some tissues out of my pocket and began to wipe his tears. My ice-cold hand shook. “Don’t be scared, honey. You’re doing fine.”

My gaze darted between Conner and the doctor. Sam stared at our son; his cheek muscles rippled.

“Yes, you are doing just fine, Conner. This is very good, very helpful.” Dr. O’Rourke kept his gaze fixed on his patient. “Now, do you ever imagine that you smell something that’s not really there, that nobody else can smell? Do you ever get a taste that just came into your mouth without eating anything?”

Conner gave a tiny nod.

“Is it a smell or a taste, Conner?”

 “I think I smell something…um, uh…but I don’t know what it is.”

“Well, is it like something bad, Conner? Like, burning rubber? Something like that?”

“Yeah!” Conner’s face brightened. He nodded vigorously. “That’s it! That’s what it is. It smells like the things Daddy burns in the yard at work.” Animated now, he scrunched up his nose and his body rocked back and forth as he nodded. “It’s gross,” he added.

I couldn’t believe what I was hearing. I looked at Sam. What was Conner talking about? Why had he hidden this?

The neurologist continued, “And then what happens, Conner?”

“I don’t know!” Conner wiped his nose on the cuff of his shirtsleeve.

Dr. O’Rourke turned to me. “Have you ever witnessed one of his ding spells? Have you talked with his teacher about them?”

“I don’t even know what Conner is talking about. I’ve never seen anything like that!” I looked at Sam. “Have you? He’s never said anything about them to me.”

“No. I’ve been away so long. I served in the Army in Iraq this past year, Doctor. I just got back two months ago.”

Dr. O’Rourke held his gaze on Sam. “I see.”

“The school had him evaluated by a school psychologist because he wasn’t completing his class assignments,” I volunteered. “Everybody thought his problem was stress from, you know, because his father was deployed in Iraq. I arranged for him to be treated by a psychologist, Dr. Frank Thomas. Conner has already seen him a few times.”

Conner lowered his head and curled his fingers in his lap.

“I know him.” The neurologist nodded.

“Could these spells be causing him to fall behind in school? You know, it turned out that his teacher from last year thought he could do better work then, too. They had no idea why he was not. And now, you’re saying that these things…these things could have…could have been going on for a whole year, Doctor?” I turned to Conner. My eyes narrowed and my voice got louder. “Conner, these have been happening for a year? Or more? Why didn’t you say something, honey? Why didn’t you tell us?”

“Sandra.” Sam reached for my hand. I snatched it away.

 

 

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.