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 #11: Seizures Can Be Hard to Recognize

(This blog was original posted on October 9, 2011)

            Most people imagine epilepsy as convulsive seizures with jerking, shaking, moaning, tongue-biting and loss of urine/bowel control. But many seizures are non-convulsive. Rather, the person stares blankly for seconds to minutes, or repeats short inappropriate phrases that are out of context, or he engages in activities of which he’s unaware. For example, these may include walking, turning on sink faucets, smoothing down his clothing, clapping his hands, smacking his lips, or acting fearful. The person may violently lash out at anyone who touches or tries to restrain him during the seizure. Afterwards, he will have no recollection of what transpired during the event.

Seizures can be differentiated from normal staring/daydreaming by gauging how difficult it is to gain the person’s attention. A person with blank outs due to a seizure does not have conscious thoughts, but the daydreamer will. In order to ascertain whether the person has lost contact with his surroundings during the suspected seizure an observer should challenge him to carry out specific commands (e.g., “Put your right thumb on your left ear,” or “Stand up and blink your eyes three times,” and etc.). People who are having a non-convulsive epileptic seizure will not carry out these commands, and they often deny losing contact with the environment.

After most non-convulsive seizures the person will have a period of mental confusion, called the postictal state. An exception to this is the petit mal, or absence-type seizure which occurs in children under eighteen years of age: see “Epilepsy Information” tag at the right in this blog. When these petit mal seizures end the person regains alertness immediately.

 

 

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