Correlation between ADD and epilepsy in EEG in child

[milas]

I'm mother of a girl (soon will be 6 years old), which lately had certain health issues: vertigo, dimming of vision, weakness, headaches very rare, in case she gets scared of conditions above her lips go whiter (you can notice when fear manifests on her face), she is often stares, but she is ALWAYS present and aware even while staring (doesn't have Automatic behaviors (eyes freeze, ticks, shakes) during that time).
Starting 2-3 months ago, she had issues very occasionally. But on June 4th she had about 10 strikes, and another cca 10 strikes 2 days after (on June 6th). Till today she didn't had any new strikes. Even when strike happens - vertigo, dimming, fear from vertigo - she is always conscious and communicate what is happening to her - she don't turn off or ˝go away˝ at all.

After visiting physicians they found Iron deficiency she is taking Ferritine each day.
They sent us to neurologists which suspected she has an Focal Seizures. She had 3 EEGs: awake, sound/light stimulated EEG and Sleep-deprived sleep EEG. ONLY on Sleep-deprived sleep EEG she had epileptiform discharges recorded. We haven't been on head MRI, still waiting for it.

Neurologists are suggesting Valproic Acid usage in next 3 years.

Before we agree in medications on such long term, I wanted to be clear on what is happening to her, and read more about it. I found Iron deficiency can cause Attention deficit disorder ADD - I didn't mention this side of her, because we didn't know it has something to do with her issues. Very often I found her staring, dreaming, thinking about something. At this point she don't answer my questions immediately, but she is fully aware, not ˝away˝. In kindergarten - she is very intelligent and perfectionist, competitive with older kids in her group 5-7 year old kids. Whole group is doing Pre-school preparation - learning letters, graphomotoric, homework's... Younger kids like our were rejecting this tasks. I noticed it was too much for her, and I didn't push her to do that, but since she is competitive she wanted to keep going with older kids, even disappointed. Earlier, she knew many songs, poetry - but on last school event she got very short song, and had difficulties with recitation. She is showing difficulties when writing (no one from us is asking her to do that she want to do that by her self, and she is proud). She sleeps poorly sometimes, wakes very early, just lie awake, thinking about something. I think maybe something is bothering her in kindergarten with her friends, or she is simply fantasize/dreaming nature.

I believe she might have ADD from Iron deficiency, pressure...
Year ago we moved in another part of a city, maybe this info might have relevance.

Finally my question is about correlation with Iron deficiency, ADD and EEG (epileptiform discharges recorded in the sleep EEG in ADHD).

Is there any difference between EEG discharges in ADHD and in Epilepsy record, in sleep-deprived EEG?

I will mention to neurologist I think she might have ADD, and some of those symptoms such as staring and fears developed from that and low Iron levels, but I'm afraid he decided to treat her with medicament according to other symptoms.

But still, I think her staring has nothing to do with epilepsy - she is conscious all the time, complaining about what she feels at that same moment. Can this be classified as Epilepsy?

I'm sorry for extensive explanations, I wanted to be precise about everything.

 

[Nakamova]

Hi milas -- welcome to CWE!

You describe some moments when your daughter is staring and doesn't answer questions immediately. Those might be absence seizures, since they are very brief (only a few seconds). The vertigo and fear might be simple partial seizures. In those kinds of seizures the person is fully awake and aware, but experiences unusual sensations. They can take a lot of different forms. You can read about those here: http://www.epilepsy.com/learn/types-seizures/simple-partial-seizures

The fact that ONLY the sleep-deprived EEG produced abnormal brainwaves isn't unusual. Especially with partial seizures, that form of EEG is more likely to elicit those brainwaves than any other, and it's considered more reliable in that sense. Did the EEG analysis specify which kinds of brainwaves were abnormal and which part of the brain the epileptiform discharges appeared in? Those details can suggest ADD vs seizure disorder, and can also suggest one kind of seizure over another. Generally speaking, the brainwaves associated with ADD (excessive delta) are different than the brainwaves associated with seizure disorders (alpha and theta). However, with kids it can be very tricky to tell what's going on, and if you aren't comfortable with the neurologist's diagnosis and treatment plan, it's a good idea to get a second or even a third opinion. You might also look into neurofeedback -- a treatment that doesn't involve medication, and one that can be used for epilepsy and ADD.

You mentioned that your daughter doesn't always sleep well. Iron deficiency can cause sleep apnea as well as restless leg syndrome, both of which can lead to poor quality sleep. This in turn can lead to attention and memory problems, and/or make existing ones worse. If she is having seizures, then poor sleep can be a factor that triggers them. I think it's worth finding out what is affecting her sleep before tackling anything else.

Best,
Nakamova

 

[milas]

thank you

Hi Nakamova,
thank you for answering in such short term, and being attentive to all details I wrote!
My question goes to frequency of staring - I fond her staring very often.
20 times a day maybe, or more - is there a possibility she has 20 absence seizures or even more?
As for EEG brainwaves type - I still don't have all papers in my hands, they are in hospital, as soon as I get them, I'll send them in a post.
Thank you again!

 

[Nakamova]

Hi milas --

Yes, some kids can have many absence seizures per day.

One other thing to ask the doctor about is supplementing with B12 in addition to iron. If your daughter's iron deficiency is related to absorption issues, then she could also be deficient in B12, which is very important for brain health. A B12 deficiency can cause weakness/dizziness, vision problems and attention and mood issues, so it could be contributing to your daughter's symptoms.

 

[milas]

Yes, that is a case - she is using B vitamins and C vitamin along with Fe, for better absorption.
Luckily, we got scheduled MRI for tomorrow morning, sleep-deprivated sleep MRI of head (not sure what exactly they will look at, but I hope it will be thoroughly!). I'm heading now with her to hospital, to spend night there.

 

[Nakamova]

Hope all goes well there.

 

[milas]

Thank you for concern,
We were making MRI scan, waiting for results.

But I finally got 3 EEG's she made (I. and II. are similar), I tried to translate them correctly (we are from Serbia, I'm sorry for mistakes, I'm not too familiar with terminology).
Does this finding may differentiate seizure and ADHD?
Does the fact that a child is left-handed have any impact on the reading of the EEG?
Can you tell me what these mean (especially III)?



I
In passive EEG OA is pronounced well, medium voltage, a well regulated amplitude, dominating waves of 6Hz subdominant waves of 5.7Hz. On the primary activity in the frontal regions with superimposed beta activity. Visual blockage well-defined.
During the HV OA without significant changes. Present is difference in voltage on left and right side, at the expense of the left.

The conclusion: EEG Theta type. In today's finding no signs of specific electrocortical cerebral dysfunction.


II
In passive EEG OA is pronounced well, medium voltage, a well regulated amplitude, dominating waves of 6Hz subdominant waves of 5.7Hz. On the primary activity in the frontal regions with superimposed beta activity. Visual blockage well-defined.
All the while recording present more voltage steep waves of 3-4Hz in CPTO regions on both sides simultaneously. During the HV and IFS OA without significant changes.

The conclusion: EEG Theta type.nIn today's finding no signs of specific electrocortical cerebral dysfunction. All the while recording present more voltage steep waves of 3-4Hz in CPTO regions on both sides simultaneously.


III
EEG was performed after sleep deprivation, OA is pronounced well, medium voltage, a well regulated amplitude, irregular mixed, dominating waves of 8 Hz subdominant waves of 7.9 Hz.
The primary activity in the frontal regions with superimposed beta activity. Visual blockage moderately developed. During HV OA without significant changes. During the recording of sleep, present spike waves on both sides synchronous synchronous and asynchronous pronounced on the left side. All the while recording present voltage asymmetry at the expense of the left.

The conclusion: EEG indicates the actual present epileptic activity in the form of a spike waves on both sides synchronous and asynchronous prominent on the left.


Thank you!

 

[Nakamova]

Hi Milas --

The best person to interpret and explain the EEG is the neurologist, since there may be specific details not in the summary above that lead them to one evaluation vs. another. But here's a general take:

1. Being right- or left-handed doesn't affect the EEG.

2. The first two EEG's don't point to anything being wrong. Beta and Theta waves are both normal during awake hours. Beta waves are associated with alertness and focus, theta with relaxation and daydreaming. Too little beta and/or too much theta would suggest ADD/ADHD, but there's no mention of those being abnormal in the EEG. (You could ask the neuro to confirm this).

3. The third EEG records spike waves during the sleeping portion, which are considered a sign of epilepsy.

Interestingly enough, no abnormal brainwaves were produced during the hyperventilation (HV) section of any of the EEGs -- if there were, that would be a strong indication of absence seizures. The lack of them doesn't rule out absence epilepsy, but their presence would help rule it in.

Hope this helps!

 

[milas]

Thank you for answering,
Does theta result mean she is a daydreamer ?

Neurologist was circumspect when deciding she needs therapy. I believe facts about her health we provided were crucial in making this decision. My dilemma is if she didn't had iron deficiency at that moment, maybe she wouldn't have vertigo, fear, weakness... (when all of this happened iron was 3.9 from minimal 11!). Or that was a trigger for starting illness? I understand it is delicate to come up with diagnosis that will change her life. I also can't gamble with her health.


if anyone else on this forum can comment this, I'd appreciate it!!

 

[AngelaVA]

My daughter showed many signs that could have been interpreted as ADHD but decreased dramatically once she started on medication. My thought is that for a child having seizures the world becomes very disjointed and incongruous at times. They get a little behind on learning to focus on things because of their seizures. Also I may be wrong about this but from what i observe I think sometimes there is some seizure activity in the brain that doesn't get to the point of manifesting seizure symptoms at that particular moment, but it still makes the person feel a little fuzzy or "off".

There is so much judgment in our current culture about parents who allow their child to take medication. A few quacks aside doctors hate prescribing medication to children, that's why they did all the EEG's instead of just writing a prescription right off the bat. I had a lot of people advising me not to medication who had to take back their words when they saw the positive change for my child. Taking medication for a time doesn't mean taking it forever. If it's not working out, you can stop, change meds ect. I think that there is a really good chance it could dramatically improve your child's quality of life and her enjoyment of her childhood though.


Sent from my iPhone using Tapatalk

 

[milas]

AngelaVa, thank you for your opinion, I appreciate it!