Blog #56: Is It PTSD or Is It Non-Convulsive Epilepsy?

            When one is exposed to danger or highly stressful events the body naturally defends itself with a “fight or flight” mechanism to avoid harm. Post-traumatic stress disorder (PTSD) occurs when the fright and stress occur when the danger is no longer present. Combat is not the only precipitating factor. Other physical and emotional traumas can cause this form of mental stress: car and other accidents, child abuse, rape, muggings, etc.

            PTSD symptoms include re-experiencing the stress-inducing situation in bad dreams, flashbacks and frightening thoughts. Angry outbursts, being easily startled, feeling tense and stressed without any obvious, immediate trigger, feeling guilty, depressed, worried, emotionally numb, avoiding places, events or objects that remind the person of the experience and not recalling the triggering dangerous event are all common symptoms of PTSD. But, there should not be a lapse in thinking; there should not be blanking out. These are not PTSD symptoms. These symptoms suggest non-convulsive epileptic seizures.

 

            Veterans returning home after various types of head trauma associated with combat and nearby explosions commonly return with symptoms suggesting stress. But, are these symptoms of PTSD or symptoms of epilepsy? Both are common after concussions and severe head traumas? Differentiating non-convulsive seizures from PTSD can be difficult, especially if doctors are not looking for them.

            Sudden brief loss of thinking and train of thought, sudden inappropriate stares and inattention, sudden emotional outbursts, sudden hallucinating metallic tastes and offensive smells―as burning rubber—are all symptoms of non-convulsive epileptic seizures; these can easily be misdiagnosed. This mis-diagnosis by primary-care physicians as symptoms of stress, especially in combat veterans, usually leads to psychiatry referrals. If the psychiatrists and other physicians aren’t looking for post-head trauma epilepsy the patient can be incorrectly labeled with PTSD and inappropriately started on medications that commonly makes epilepsy worse.

            Patients and their families should now be aware of how PTSD can be misdiagnosed because PTSD symptoms seemingly overlap to be confused with non-convulsive epileptic seizures.

 

 

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.

 

 

 

 

 

Blog #3: Concussions Are Brain Traumas That Can Cause Seizures

Every so often, Sports Illustrated honors an athlete who must “retire” from a sport because of a head injury (concussion). As a neurologist, I agree that this is a prudent decision. Imagine my frustration and disappointment when, earlier this year, the Pentagon announced that it would not award a Purple Heart to military personnel who suffered “only” a concussion in combat. I knew that this was a grave error.

            A concussion is a disruption of normal brain function that is caused by a traumatic force to the head. Loss of consciousness is not necessary. Most symptoms are transient. These include: disorientation with confusion, slowed movements, loss of balance, slowed thinking, slurred speech, headache, drowsiness, nausea/vomiting, and blurred vision.  Repeated concussions can cause irreversible brain damage and epilepsy (recurrent seizures).

When the patient is checked by a doctor, the physical examination, brain scan, and electroencephalograms are likely to be normal. If the person experiences prolonged or chronic post-concussion symptoms, a neuropsychological evaluation can accurately detect whether a concussion has caused mental dysfunction. Unlike most other conventional war wounds, concussion does not produce an obvious physical abnormality. Even if the person is bleeding, he may not lose consciousness. But concussions can cause long-lasting psychological and physical symptoms that impact their emotional lives in the form of Post Traumatic Stress Syndrome.

            For the first time in my life, I wrote to my congressman to say that it was wrong for the Pentagon to not honor soldiers who have had a concussion. Even though I explained the medical reasons for my argument, I never received a satisfactory response to my letter. But several weeks later, for whatever the reason, the Pentagon reversed its decision: soldiers who have suffered a concussion now qualify for the Purple Heart medal.

 

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.