EEG abnormalities

[vad]

Hi everyone,

I was admitted to an epileptic monitoring unit for three weeks because of frequent seizures (or so I thought). After leaving the clinic, they told me they caught 4 seizures on tape & eeg, and that it is most likely pseudoseizures. That is a big enough problem on its own because it is all in my head, but I also found out today that there was some information not passed my way. As I read today on the EMU report (had to pick up report to bring to new neurologist), they said that there may have been some abnormalities over the first 3 days, but it appears to be a non-epileptic problem.

I pasted the problems word for word below. Does anybody have any knowledge of this? My family doctor has never seen the results, but I will see her Friday. My original neurologist saw the results, but it was a 40 page document, so I have no idea if the read the days that showed the abnormalities.

In the end, I just wondered if anybody could translate any of this into plan English because my next neuro apt isn't until March 24th.

Thanks!

NON-EPILEPTIFORM Abnormality #1: Mild intermittent 1-2 Hz medium amplitude semi-rhythmic delta is seen overlying F7, T3, F9 is recorded during slow wave sleep. (From what I read, all those electrodes are around middle-front temple region on left side, so nothing right side)

NON-EPILEPTIFORM Abnormality #2: Mild intermittent low-medium amplitude monomorphic 6-8 Hz theta activity overlying left temporal structures F7, SP1, F9 (once again all left side temple area) during wakefulness and sleep continue to be seen today.

EPILEPTIFORM Abnormality #3: (I don't actually have the report for this day at the EMU, but based on what this says, there was a problem yesterday) Previously seen epileptiform abnormality overlying bilateral frontal polar-frontal regions are not recorded today.

 

[Nakamova]

Hi vad --

Welcome to CWE! I know it must be tough being in limbo, waiting for a diagnosis. Whether you experience psychogenic non-epileptic seizures, epileptic seizures, or both, it can sometimes take a while to figure out what's going on.

EEGs are very complicated to read. Usually the neurologist is the best person to analyze the specific EEG data. There are so many variables that need to be taken into account with EEGs -- where and when particular waveforms occur, the frequencies, the background surrounding them, whether the patient is awake or asleep. People without epilepsy or any other other neurological problems can have abnormal EEGs. People with epilepsy can have normal EEGs.

The non-epileptiform abnormalities could be nothing. They could be caused by a technical glitch, to a migraine, to low blood sugar, to a structural lesion, etc.

The epileptiform abnormality could likewise be nothing. They could also be caused by a glitch. Certain physiological activities can be confused with epileptiform activities, mostly related to certain stages of sleep, or transitions between stages.

So based on the info you provided, there's no definitive answer. Is there any way you can contact the original neuro who saw the results? Perhaps he or she can shed some light and help put you mind at ease one way or another.

Best,
Nakamova

 

[Endless]

Hi, Vad,

Welcome to CWE!

I agree with all that Nakamova said. I wanted to add, too, that in addition to psychogenic and epileptic, sometimes seizures are Physiological (due to a physical cause) but not epileptic. There are all kinds of seizures!

I just want to welcome you, and say I'm glad you found us!

 

[epileric]

Welcome Vad

I've had EEGs & as a kid I thought they were fun. Of course the tech let me play with it on my head while he did stuff afterwards so I got to take home my own printout.

I'm sure you've guessed F7, F9 & T3 are all specific electrodes. Here's a map of what electrode is where on your head.
http://www.edfplus.info/specs/electrodesystem.gif

 

[huskymom]

Welcome Vad :hello:

glad you were able to find this site. hang in there, it is going to be confusing for awhile, but your doctor should be able to interpret those readings in english for you. Let us know what you find out

 

[vad]

Thank you all for being so welcoming...it is appreciated

I know nobody here is going to be able to tell me what the results mean, I guess I was more of asking whether or not I should pursue this. See this is what happened:

1. I was put into EMU due to multiple seizures
2. EMU witnessed seizures but said no epileptic/cardiac activity was there, so they were diagnosed as pseudoseizures.
3. They referred me to a physiciatrist and discharged me.
4. My original neurologist received the report, then saw me. She did not mention any abnormalities found and said I did not need to see her anymore.
5. I am seeing a new neurologist for other reasons in March and I had to pick up my old documents to bring to him. I got curious and peaked at the EMU notes. Right at the beginning it says:

"Abnormalities were found in the first few days of monitoring, but later in the stay we witnessed four seizures that showed no epileptic or cardiac activity on the monitors, so they are pseudoseizres in nature. The patient may have some underlying abnormalities that are unrelated to the seizure events, but due to witnessed seizures, the first few days of abnormalities are thought to have no clinical meaning."

As I pasted before, you can see a few of the abnormalities. When I googled Temporal Intermittent Rythmic Delta Activity (TIRDA), which is what I see from abnormality #1, it says an MRI should be done to rule out lessions or cerebral problems.

I'm not sure whether or not the abnormalities should be brought to my new neurologist's attetion or whether the EMU is right and they are not important since they witnessed pseuoseizures. Any help is appreciated! I'm not denying this may be a mental issue, but my mental problems would not cause abnormalities.

Thanks again!

 

[Nakamova]

Hi vad --

Bring up any and all concerns with your new neurologist. That includes mentioning the abnormality that might be a structural lesion, as well as the possibility of having an MRI done.

What kinds of seizures do you have? Certain kinds can originate too deep in the brain to show up on an EEG.

 

[vad]

In the EMU I had 3 tonic-clonic seizures and 1 where I was just staring out in space for 30 secords than came to (just going by reports, no idea what it is called). Most of the time I'm told they are tonic-clonic, but they are not severe, only stiffening and mild tremor like activity.

No idea if this helps at all, but let me know anything related to the time, it is appreciated.

I just googled it and realized I can't have an MRI. I had a pacemaker implanted 2 years ago (I was 22) for periods of bradycardia in the low 40's during the day and severe bradycardia of 20-30 at night. It was also for vaso-vagal events that caused my heart to stop. I thought I couldn't have a body MRI, but apparently I can't even have a head MRI. This is extremely disappointing. Do you know of any other test equivalent to this? I've had multiple CT scans in the ER, but they were after I passed out to check for head injuries and they were all back negative.

As a side note, I also have Celiac Disease which was in the late stages and diagnosed during all my problems. Unfortunately after treatment of this, nothing got better.

Thanks for the help.

 

[Nakamova]

Unfortunately besides an MRI, the other primary brain scanning options are CT scans and X-rays. Plus the EEG, which you've had.

There is a definite link between celiac disease and seizures. Celiac disease can affect the brain, and cause lesions and in turn seizures, so perhaps that is what is going on with you. Treatment of celiac may not have led to improvement of symptoms, since the effects on the brain could have occurred before any treatment began.

There's more info on the links between epilepsy and celiac here:
http://epilepsyfoundation.ning.com/forum/topics/celiac-disease-gluten

 

[vad]

Thank you. You and everyone else have been so helpful and quick too. It is nice to see people out there who are supportive of others they don't even know. I really appreciate the help you have given me.

This may be a stupid question, but as far as I know MRI's are more detailed than CT's. Does that mean it is possible that there are lesions too small for a CT to detect? Do you know of any other abnormalities that can cause seizures, that a CT might miss?

Thanks again!!!

 

[Chel]

SPECT scan

A SPECT scan is a type of CT which offers more information than a CT, but is not an MRI. I haven't checked if it's suitable for patients with a pacemaker, but that might be worth looking into. On a SPECT scan, they can see what the blood flow is like to various parts of the brain.

Will leave you to google that one.

I'm also a coeliac (will use the Aussie/English spelling *g*), diagnosed well after the damage was done. Because you're used to label-reading, adjusting your diet shouldn't be too much trouble to you. Like most coeliacs, you probably have other food sensitivities as well. There are a number foods which you will find are seizure triggers, if you haven't already. The more I remove from my diet, the more I'm sensitive to - just like gluten foods. My latest is chocolate, after a lifetime addiction - boo hoo.

Welcome
Chel

 

[Nakamova]

There are lesions that are too small for CTs to detect. There can be lesions that are even too small for MRIs to detect. But even so, it's worth asking your neurologist about the the possible role of lesions given some of your symptom history.

 

[vad]

Thank you both, I will mention to my doctor in March about the possibility of lesions and whether a SPECT is an option for me.

Chel thanks for the tip of other foods. I am trying to eliminate what I can for now and introduce back in later. Do you know if a seizure caused by Celiac would mimic a pseudoseizure (funny...pseudo a pseudo :-~)? I was diagnosed with moderate flat villi, so Marsh 3B. I'm sorry to hear you are Celiac as well, but glad you know it and are healthy. Sorry about the chocolate, oh I hope I don't have to stop too!! Take care of yourself...you too Nakamova

 

[Chel]

Do you know if a seizure caused by Celiac would mimic a pseudoseizure

I consider my seizures to be caused by food triggers, not by coeliac disease. So there are some foods, for example, which are gluten free, but to which I'm sensitive (dark chocolate, at least one ingredient in chai tea, gluten free crisps, yellow cheese - to name a few). My list grows every week.

Sometimes I struggle for clarity, and at the moment I'm pre-ictal (full moon, for those who've been keeping an eye on previous discussions!). What I'm trying to say, is that those of us with coeliac disease are used to looking out for food sensitivities, reading labels, and removing foods from our diets. We have an awareness. Finding seizure triggers in foods is just an adjunct to a skill we already have.

I've been doing this gluten free stuff for 11 years now. Several weeks ago I happened to sit at lunch with a newly diagnosed coeliac, who is a medical professional who thought she was well informed. She popped open her can of diet soda and told me all about her new diet. I told her that would be the last can of diet soda she drank. It has aspartame (wheat derived), caramel (wheat/barley derived) and artificial colours (wheat derived) in it. It may be different in the US (I noticed during my holiday last year, the US often uses corn/maize where we use wheat).

So for me, to find out what is causing me to see "white noise" or feel like I've been hit by a bus, or have migraine symptoms - I just go straight back over my diet in the last 24 hours (food and drink) for the answers. Or today, I know it's sleep deprivation and probably the full moon (which conspired against me, with the dogs misbehaving).

Pseudoseizures - I'm sorry, but that term hasn't been used by my neuro in my case, and I've read it here, but don't understand it. I've tried, but I can't wrap my head around the concept. Some things are just too hard for me to understand, and that's one of them, I'm afraid.

Chel

 

[Nakamova]

"Pseudoseizures" are actually more actually called psychogenic non-epileptic seizures. They are non-epileptic because they are not categorized by abnormal brain firing. However, the majority are NOT "fake'. They are real physical trauma, provoked by psychological distress or recent or in the past.

The seizures associated with celiac are considered epileptic -- that is they do manifest as abrnormal electrical brain activity.

More info about PNES can be found here:
http://emedicine.medscape.com/article/1184694-overview

 

[vad]

Chel, have you been diagnosed with epilepsy through EEG findings?

Nakamova: Sorry for using the term "pseudoseizures", but that is what the EMU doctors used in my report. Thanks for clarifying. Maybe they didn't know as much as I thought ;-) jk

I guess there is no chance my seizures were Celiac related, as my EEG would of showed that. It is completely possible my seizures are from stress as I have gone through a pacemaker implant and diagnosis of celiac disease and autonomic dysfunction in the matter of two years (and I am just 24 now). It just frustrates me that people often associate them as being "fake".

Do you know by chance if it is normal to have abnormal findings, but still only having PNES. I just thought an abnormal finding would point to something else other than PNES. I guess also the abnormal findings could be something else unrelated to seizures and just picked up because I am on 24/7 EEG.

So much to take in haha Thank you both!!

 

[Chel]

Chel, have you been diagnosed with epilepsy through EEG findings?

Yes, I was diagnosed by EEG in Sept last year, having only had seizures (as far as we can tell) since about March. I'd had migraines (undiagnosed) for several years before that, the auras for which were possibly simple partial seizures, in the latter months.

I have tle to complement my temporal lobe atrophy, which was found by CT and MRI in December 2009 and confirmed by SPECT in May 2010. The temporal lobe atrophy is of unknown cause, possibly the unrecognised coeliac disease (therefore malnutrition), or the high number of infections I've had from being IgA deficient (also associated with coeliac disease in about 10% of cases).

So it may all tie in together, or it may not, and we might never know for sure. The trick now is to be aware of giving my brain as much nutrition, and as few food triggers, as possible.