Neuros quick to blame mental illness

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jenagade

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I seem to be posting a lot this week, probably nervous about my impending video EEG and visit with yet another neuro.

Anyway getting to the point. I have had depression and anxiety for over 10 years now, both fully under control and has been for most of that time. Two years ago I had my first seizure and was having a few a week. When I went to see a neurologist he was gearing up to go down path of partial seizures... that is until I mentioned the depression and anxiety, since then he is quick to blame nearly everything that happens on my antidepressants.

This is despite the fact that I have always been on the exact same dose during my treatment for seizures and the only time I have adverse affects is when my antiseizure meds are changed.

Recently I was hospitalised because after transitioning between Tegretol and Lamictal my seizures got much worse, and this was at the point the Lamictal should have taken over. While I was in the hospital they added Keppra and Clobazam and things calmed down after a few weeks, but I still had the odd seizure. My neuro ordered a sleep deprivation EEG which came back normal (note I had 2 EEGs previously which came back with seizure activity), and instantly he said well I don't know what more I can do for you, I will order a video EEG but I don't think that will show anything, you should go see a psychiatrist about PNES.

I saw my psychiatrist, who has been treating me for 6 years and was the one who referred me to the neuro in the first place, and she said conclusively that there was no was these are PNES and that there is absolutely nothing mentally to suggest it may be.

I feel like my neuro didn't really give things a chance before resorting to blaming mental illness for the seizures.
 
Thanks :) fingers crossed the video EEG sheds some light on the situation
 
Good luck. Let us know how it goes. I am glad you have a psychiatrist you can trust.

I notice that your experience parallels mine in a number of ways. When I was reading about your neurologist's "wisdom" I was thinking WOW, they are like that in New Zealand as well as in the USA? I really did not realize that neurologists who behave that way exist the world over. Fortunately there is another neurologist on your horizon!

Again, good luck to you!
 
Sounds like more lazy medicine to me. How about they just look at history of EEG reliability from one test to the next or look at an MRI before saying such things??
 
Good luck. Let us know how it goes. I am glad you have a psychiatrist you can trust.

I notice that your experience parallels mine in a number of ways. When I was reading about your neurologist's "wisdom" I was thinking WOW, they are like that in New Zealand as well as in the USA? I really did not realize that neurologists who behave that way exist the world over. Fortunately there is another neurologist on your horizon!

Again, good luck to you!

Yes there definitley are bad neuros in NZ, the problem is we don't have a huge choice of them either, my one is supposed to be the epilepsy expert in my region, but he is also renowned for being a big asshole (something I only found out recently). I'm seeing a neuro as a one off in the hospital which is doing my video EEG because I have to go out of town for it, but when I get back I'm going to see a new one who hopefully will be my new permanent one.

Its strange, 2 years ago I was sad that the diagnosis was epilepsy, now its what I want to hear because the PNES path is so much foggier.
 
Oh boy, I can totally relate. We went in for my daughter's Video EEG last week, partly to see if the "episodes" she was having on a daily basis were seizures, and partly to do a Phase 1 surgery evaluation.

We had gone back and forth for months about whether these brief episodes she was having were simple partials (as I thought) or an "anxiety reaction" since she also struggles with anxiety and depression - and this despite the fact that these sensations have preceded complex partial seizures that have generalized on 8 occasions since July! On the first day of her VEEG she had a bunch of really strong auras that did not show up on EEG: during those episodes her EEG was completely normal. Her interictal EEG is also fairly normal, with only nonspecific abnormalities. You should have seen the docs faces during rounds - I could tell that they were sure that what was going on with her was psychological. I was so discouraged that once again I was going to have to push for them to take this seriously. And then when I sat down with the attending a bit later, he was asking me all sorts of questions about her t/cs that I knew were pointing towards PNES - are her eyes open or closed? does she bite her tongue? is she incontinent? how confused is she afterwards? (open or blinking; yes sometimes; no never; completely nonresponsive for 10 minutes, totally confused for at least a 1/2 hour)

What made all the difference was that I had a video of one of her big seizures. As soon as the attending saw it his whole attitude changed. She then went on to have 3 big seizures in the next 12 hours - and her seizures do NOT show up on EEG until they move from aura/simple partial seizure to a complex partial, at which point they invariably secondarily generalize to a tonic/clonic. So we are probably never going to see an EEG tracing during her aura or simple partial seizure unless we end up pursuing surgery and use depth electrodes. That's just the nature of her seizures.

Once they saw these seizures (which were quite serious since she desatted very dramatically during at least 2 of them) they admitted that simple partials frequently do not show up on EEG. I still think that they are frustrated that they cannot see them (so am I), but there's nothing we can do about it.

All of this is to say DON'T GIVE UP! If your seizures ever progress to complex partials or tonic/clonics, see if you can get one of those episodes on video. You need to find a neurologist that listens to you and will pursue this so you can get the help you need.
 
Unfortunately, depression/mood disorders often times do accompany epilepsy, depending on where in the brain the seizures begin. I have temporal lobe epilepsy, starting in the left temporal lobe, deep in the hippocampus, which controls speech, memory and moods. So sometimes, dealing with the depression can lower the seizure threshold because of the anti-depressants. They can bring on seizures, so the psychiatrist and neurologist need to work together to find some meds that work for you.

Is your neuro an epileptologist, specializing in epilepsy?

Check out this site for Epilepsy/stress/ moods:

http://www.epilepsy.com/learn/impac...ood-and-behavior-101/stress-mood-and-seizures
 
Kgartner that is awful but good that they did manage to get something. It does have me a bit worried now about my video EEG though as I only have simple and complex partial seizures so I hope they can determine something.

Cint, I have seen of the link between epilepsy and mood disorders, however in my case the mid disorders were well established years before my first seizure. Interestingly enough though now I think back on it my neuro initially wanted me to stop the anti depressants entirely (with my psychs approval) and continued to pursue that until he changed his mind and decided it was probably PNES.

Also no he is not an epileptologist, his specialty is epilepsy but he deals with other neurological problems. I don't think there are any epileptologists in NZ. Because of the small population it's better if they make themselves available to treating other things as well.
 
Cint, I have seen of the link between epilepsy and mood disorders, however in my case the mid disorders were well established years before my first seizure. Interestingly enough though now I think back on it my neuro initially wanted me to stop the anti depressants entirely (with my psychs approval) and continued to pursue that until he changed his mind and decided it was probably PNES.

.

My seizures did not begin until I was 22 years old, and I too, had suffered depression for years before my seizures started as depression runs in my family. Like I said, the anti-depressants can lower the seizure threshold and the two docs need to work together.
 
My seizures did not begin until I was 22 years old, and I too, had suffered depression for years before my seizures started as depression runs in my family. Like I said, the anti-depressants can lower the seizure threshold and the two docs need to work together.

I was diagnosed at 25, and I have definately had counteractions with the two meds, I was stable on Tegretol for about a year then the seizures gradually started coming back, and once I switched to a higher dose it rendered my venlafaxine completely useless, almost instantly I started having panic attacks again and of course each medication throws the other out of balance.

They "kind of" work together, and by that I mean my neuro prescribes whatever the fuck he wants, and my psych adapts to whatever he has done. He seems very distrusting, when I was in hospital the neuro there worked closely with a psych there to make sure all my new meds were balanced, but when I had the follow up with my neuro he seemed like he didn't trust any of their opinions, hence trying to find another one, he may be the "best" for epilepsy, but he is so pigheaded he doesn't play well with other doctors.
 
Kgartner that is awful but good that they did manage to get something. It does have me a bit worried now about my video EEG though as I only have simple and complex partial seizures so I hope they can determine something.

I certainly didn't mean to make you worry! Hers show up as soon as they become a complex partial - it's just the auras/simple partials that don't show up. Just insist that they keep you in until you have a full typical seizure. And if you have someone who lives with you that can capture one of your seizures on video, that may be very helpful!
 
I certainly didn't mean to make you worry! Hers show up as soon as they become a complex partial - it's just the auras/simple partials that don't show up. Just insist that they keep you in until you have a full typical seizure. And if you have someone who lives with you that can capture one of your seizures on video, that may be very helpful!

Don't worry, I have been worried about that exact thing for weeks now, I just can't deal with what will happen if nothing shows up. My partner has got a video of one of my seizures, its just a pity he can't get time off work because the hospital prefers that someone who has seen your seizures can come with you so they can set off an alarm when I have a seizure so the technicians can make not of it on the EEG.
 
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