Post-ictal

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lindinig

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I know many on here talk about the period after a seizure, and I've been trying to find some references, but can't seem to figure out why my son seems to have a much longer recovery time than everyone else on this board.

He doesn't have tonic clonics, which I can actually see why the recovery time would be much longer, because the t/c lasts longer, and the whole body gets involved, so I can see why most people need to sleep for 2 days post-seizure.

My son only has absense seizures. They are so short, most people don't even recognize them. I think the longest might reach 20 seconds, but that is definitely reaching. So, from what I see, only the brain is affected by these seizures. I don't see any automatisms at all during these seizures. I think only once, he was wiggling his fingers. The rest of the time, he sits motionless, for the duration of the seizure. So why does his brain need 3-5 days to recover? I mean it's really bad! It's like his brain goes into a defense mode or something. He doesn't participate in conversation and when he does, he may say something that's completely off topic. He is always hungry, usually fixating on a particular food group, and can't get it out of his head. Last Saturday, he wanted bacon. He wanted it more than anything! After he had some, about an hour later, he wanted lunch. He kept coming out of his room asking what time it was, only because he wanted to see if it was lunch time so he could eat again!

He does these annoying things to his brother, like putting his feet on his brother's chair, or throwing things at him. He sticks things into his mouth. He put an entire rubber bracelet in his mouth, and was chewing it! Like so many others on this board, his short-term memory is gone, but it does eventually come back. That usually takes a good week to come back, even after the post-ictal phase is over. His concentration is definitely gone, so he misses school because he is incapable of doing any kind of work. He really acts loopy. Yesterday, he asked me 6 times what day it was. Then, he asked me another couple of times where his brother was. When I told him his brother was at school, he asked why he was at school. A few seconds later, he totally forgot what we were discussing.

Since I don't have seizures, it is really difficult to put myself in his shoes. I try very hard to understand what he is going through. When the post-ictal phase is over, he talks about it, but only a little. He equates it to a bad dream, because he will say, "did I really do that?" or "did this really happen, because I thought I was dreaming?".

The only conclusion I could come up with is that he is actually having clusters of seizures, and maybe we are only seeing 1, but he's having many. Because, how could 1 possibly affect his brain this much?

I did have another hunch though. When he was hospitalized last year before his diagnosis, he was first brought to the emergency room after a weekend of "zoning out". He was not loopy (though he was at his father's house, but when I talked to him on the phone, he didn't act loopy, and when I saw him in the emergency room, he acted fine, except for those brief moments of staring). He didn't get his epilepsy diagnosis until 2 days later. And, his neurologist said he was having seizures every few minutes (according to the EEG), and they were about 10 seconds in duration. He didn't start acting loopy until that first night they admitted him into the hospital (which was 2 days after the first witnessed seizure). So, could it be that his brain is trying to protect itself against damage? So that from now on, even though he only experiences 1 seizure, that it could just revert back to that loopy state?

I'm sorry if this post is so long. I have a lot on my mind, and I'm still trying to wrap my head around this. You'd think that since I've been dealing with this for over a year, that it would get easier, but it just gets more frustrating.
 
Hi lindinig,

Is your son on any medication? Some of the things you describe sound like they could be medication side effects. And some of the other things you describe (confusion, saying strange things) sound like actual seizures as opposed to post-ictal moodiness. If he's having memory problems to do the seizures, they may also be leading to behavioral problems.

You might want to check in with his doctor/neurologist, let him know what's been going on, and get another evaluation to see if your son's having more and different seizures.
 
He is on depakote ER, 1250 mg. He does not act this way until he has a seizure. For the past 10 weeks, he was fine. I can tell the medicine affects his memory a little, but not to the point of being disabling. When he has a seizure, we go through 3-5 days of this craziness. Then, as the days go on, everything starts to come back. The longer he goes between seizures, the better everything becomes.

In the beginning, I actually thought he was still having seizures, yet his EEG's during this period have been clean. He was post-ictal during a neurologist appt once. I didn't know he was post-ictal, because he seemed kind of normal, yet a little tired, when I picked him up from school. He slept the whole way to his appt. When we got in the waiting room, he sat right next to me. When he's post-ictal, he wants to hug me a lot, or hold my hand. He was putting his head on my shoulder in the waiting room, but because he was talking fine, and we were having a normal conversation, I thought nothing of it. My kids tend to be attention-seeking, and regress a little when they go to the doctor, so that's what I thought he was doing. The neurologist came out and got us. We went back to his office, and he preceded to do the neurologic exam, like asking questions to test his cognitive ability. Then he did the muscle-tone test, and he said Jon looked really great, even though he had a seizure the previous day. Meanwhile, I was so frustrated with him, because he was rolling around on the table, kicking the wall, and not immediately answering the doctor's questions, only smiling at him. I repeatedly told him to act his age. I feel so bad about it now, because he was definitely post-ictal in the office, and I kept him home from school the following day because it was apparent to me once we got home from that appointment, that there was no way he would be able to hold it together for 6 1/2 hours and be able to meet the demands of school.

This neurologist and his previous neurologist have said that if he was having seizures, he would not be able to carry on a conversation, or do what was asked. I have seen this in the past, that he is more spacey, rather than defiant. When he was in the hospital, he just didn't talk at all. The fact that he actually starts conversations tells me that he's probably not having seizures (or maybe not as many). He's not as talkative as he normally is during this state, but he's not a mute either.

On the flip side, I have seen him act 10 times worse than this when on Keppra, and when he had just a touch too much depakote in his system, so his meds can also make him behave this way. He has been on this dose of depakote for the past 10 weeks, reduced from 1500 mg. which his blood tests showed was too high. We had a blood test 2 weeks after he went down to 1250 and it showed normal. He seems pretty much back to normal today too, and we did not alter his medicine. On other times, when the medicine was the culprit, he didn't return back to normal until we cut out the offending medicine.
 
The lack of a clean EEG doesn't necessarily rule out the possibility that he's having seizures. (And it is possible to have a conversation while having a seizure.)

But if it's not the case that either seizures or meds are directly causing the post-ictal behavior you've observed, then it's important to find out if something else is responsible, or if your son's developing something along the lines of ADD/ADHD (which is statistically higher in kids with epilepsy). So a trip to the doctor's could help rule something out or something in.
 
Hi Nakamova,

I wish I could totally understand what he's going through, so I could help him more. There is so much information to absorb, and even that won't exactly fit his case. I've learned more by being a member of this forum than through all the reading I do, and my 100's of questions I ask his neurologist.

So, maybe that's it. I have to talk to his nfb practicioners tonight. We went to his nfb session yesterday, and the provider said he saw a 3 hz spikewave for a second, just while he was watching the monitor. The way he mentioned it was very non-challant. It wasn't until later last night that it dawned on me that my son could be having a series of really small seizures during this supposive "post-ictal" time. I have to get there a few minutes early tonight, as they are going to go over his sessions to date, and hopefully they will go over his QEEG too.

He did tell me that he saw a lot of "slowing" on his EEG during Thursday's session. His initial look at the QEEG that was done last week showed a series of 1hz spikes of 1 second, followed by a series of slowing of about 1-2 seconds. These were roughly 5 minutes apart. He attributed that slowing to his medicine controlling the seizure, but his neurologist saw "slowing" following a spike wave on his EEG pre-medicine, and attributed that to the seizure. And we wonder why I'm so confused! He said the spikes, even though they were only 1hz, were abnormal, and consistent with an epileptic brain.

Ironically, after the appointment yesterday, my son stopped "acting strange". He was more conversational, started joking around with me more. His attention and memory were still impaired, but he was starting to act more normal.

He called me from school about an hour ago, and was acting "totally normal". I just hope he's able to concentrate more now than yesterday. :banana:
 
I hope the nfb folks can give you more insight. It's interesting (and promising) that yesterday's session seemed to help. Fingers-crossed that it continues to make a difference.
 
Yes I thought it was very interesting that he was mentally "with it" after we left than before we went in. Yesterday's visit was only his 4th. I really like this place. It's a husband-wife team. The wife is a trained psychologist and her husband is a scientist and a very smart guy! They seem to have a lot of experience with the really tough cases like intractable epilepsy. The husband wrote a program that combs through a patient's file, looking for 3 hz spikewaves. He said he needed to do this for one epilepsy client (a teenager) who would not be able to get his license if any 3hz spikewaves were found on his EEG.
 
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