New here! Son diagnosed with temporal lobe epilepsy (at night)

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hdufort

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Hi! I am new here. My 6-years old son was recently diagnosed with temporal lobe epilepsy. I’ll give the details below.

My son has had very poor sleep quality since he’s 1 years old (before that age it’s difficult to tell). He would wake up screaming or moaning multiple times every night, and he also moves his legs a lot during sleep. At first we were coping with that, and assuming it was a normal problem due to moving him in his own bedroom.

But it kept going, every night. We first mentioned this problem to a doctor when my son was 2 1/2 years old. The doctor bluntly told us that we should have more authority and leave him crying, for the whole night if necessary, to "break" his attachment. So we tried this for weeks, without any success. Friends and family started commenting on how poor our parenting skills are.

So the sleep problems kept going and going, and we were becoming very exhausted. He would start screaming/moaning and kicking every hour, from 11pm to 5am sometimes. Going to bed was a stressful experience, we knew what would happen during the night and couldn’t help.

Then we had a new family doctor. She noticed how exhausted we were, and started working on our son’s case. The first hypothesis were acid reflux (since the sleep problems started 4-5 hours after meal) so we tried antiacid medication, with limited success. Then she wondered if my son’s pedaling and feet rubbing movements were related to joint pain, e.g. rheumatoid arthritis; we tried anti-inflammatory drugs, without much success.

My son’s health was degrading as well, due to the lack of efficient sleep -- he wasn’t participating to activities at the daycare and was very irritable as well. The educator started isolating him, which created self-esteem problems (which took lots of efforts to correct afterwards). We also consulted a psychologist, who freaked out when we showed her a recording of my son’s sleep problems (she expected the usual "kid doesn’t want to go to bed" story). She told us she couldn’t do anything.

At some point, I started reading about sleep problems on the Internet and built several decision grids to understand what could cause such sleep disturbences: RLS, sleep apnea, temporal lobe epilepsy, PLMD, etc. My doctor didn’t take this very seriously, and told me that I think too much. Events would later prove her wrong.

We kept having random medical appointments to rheumatologists, ENT doctors, etc. until they figured out something totally unrelated to his sleep problems: he’s 100% deaf in one ear! This finding was devastating to us, but it also motivated all the specialists to figure out what was wrong. We met with geneticists, and had multiple blood tests, CT scans and MRI to find some clues. They found nothing specific, except some minor white matter anomalies in the brain.

Then we had to wait several months for our sleep clinic appointments. We tried combining melatonin, antiacids and blowing air in his bedroom (the fan’s noise seemed to help). Shortly before his fifth birthday, my son’s sleep started to improve (well superficially). He didn’t scream or moan as much, although he started grinding his teeth a lot during the night. He required a 12-hours night of sleep, and was still very tired in the morning. Hopefully he started school in a better shape because of the improvement in his sleep, and we started recovering (we are self-employed and lost 25% of our revenue and some clients, due to lack of sleep). We finally had our first 2 sleep clinic appointments, first for checking his oxygen level during sleep (which was normal), then to check his sleep patterns during 1 hour and then flashing strobe lights. Everything was normal.

There was a 1-year delay for the last sleep clinic appointment, but in the mean-time we had several appointments with a pediatrician who’s also the province’s leading expert in child sleep. She started working on the case and also investigated our son’s possible asperger’s or anxiety disorder. We finally had the "complete" sleep clinic test last month, a complete night with EEG and camera monitoring. The results were very surprising, I’d even say they were disturbing.

Our son is a "sleep oddity". He has not one, but FIVE sleep disorders.
- RLS (Restless Legs Syndrome), in which the legs tend to jump and move, which caused micro-awakenings (41 per night)
- Obstructive sleep apnea, in which he stops breathing for a few seconds (or chokes) because his throat or airways are blocked (14 per night)
- Central sleep apnea, in which the central brain misreads the blood oxygen saturation and shuts down respiration (7 per night)
- Temporal Lobe Epilepsy, which causes the yelling, moaning, hand clasping and confuse awakenings at night (7 per night)
- Acid reflux, which causes incomfort and reduces sleep quality

So this is where we are -- we need to manage all these problems at once with prescription meds and food supplements. For the epilepsy the doctor’s starting him on a small dose of valproic acid. For RLS, iron+vitamin C supplements. For obstructive sleep apnea, we have appointments to see if the pharynx is too soft, or if the adenoids are blocking the way, or if he’s having sinusitis. For central sleep apnea I don’t remember the medication name, but it’s "on hold" -- my wife is freaking out.

Our family doctor will receive the report tomorrow, and I’m pretty sure she’ll call us!

I’ll have several questions about Temporal lobe epilepsy. Thanks in advance for your kind help.

Hugo
 
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hdufort

That is a lot of stress to be under. I hope all goes well for you keep us up to date.
 
Thanks! I had a major depression this summer, due to lack of sleep, stress and other events. Things will get better now. We have answers!

Our son will start taking valproic acid tonight, but the dose is really small. I don’t understand why they started him on such a small dose (1 ml).
 
Warm welcome to CWE hdufort :)

I am mother to Son aged 27 with epilepsy

Sorry to hear the diagnose, utterly overwhelming to say the least :( I am sure not only your wife is freaking out...

Did they do thorough vitamin and mineral check to confirm deficiencies? Are there any food allergies? I’d of thought magnesium would have been on the cards, no mention of this?
 
hdufort

I don’t understand why they started him on such a small dose (1 ml).

Ever person has a different way and ability to absorb drugs, the bigger the body usually the bigger the dose, your child is growing and the body has to get used to the drugs you cannot just hand it to him. It will be hard to take or he may have no problem with taking it. No matter the age you have to take things slowly with the body. No body is the same, remember it may help your situation but you have to watch for side effects and reactions as well, its not straight forward.
 
Valproic acid is what my Son takes...

Do not under estimate these meds; be overly watchful of your bambino at start of this medication and continue to monitor if increase (you know your child best).

Keep diary of every seizure or anything out of ordinary, it’s been a major blessing for my Son and we pull out often to review and helps identity triggers and patterns. And you have instant record when you visit docs.
 
Hi hdufort, welcome to CWE!

If you haven't already, you might want to have your son try supplementing with magnesium as well. An iron deficiency can cause RLS, but low magnesium, folic acid and B vitamins can also cause it. Magnesium in particular can potentially help with symptoms related to muscle tension (like teeth grinding and leg cramps).

I hope the valproate helps, and his sleep improves.

Best,
Nakamova
 
Hi! Thanks for your comments. Here are a few answers and some more comments.

ABOUT MY WIFE’S REACTION:
My wife freaked out because the doctor prescribed benzodiazepines to try to control central sleep apnea. She’s a pharmacist’s daughter, and has associated these medications with their psychiatric customers.

My son never had any daytime seizure that we could observe, or at least if he did we didn’t notice. I understand that temporal lobe epilepsy can cause very subtle seizures, not the "rolling on the floor" events that we see in movies. If he has complex partial seizures, then it’s difficult for untrained people to understand what’s going on (i.e. he wouldn’t collapse on the floor or start shaking).

In fact, my son’s teacher was really worried that she would have to manage tonic-clonic seizures (she didn’t use these words, she really said "rolling on the floor"!) and she even made a comment about the fact that his IQ seems to be fairly high. Which shows just how much misconceptions and stigma there is in our society about epilepsy in general.

ABOUT HIS SEIZURES:
Some complementary information: My son’s night time seizures start in either temporal lobe, then spread to the other temporal lobe, to the central nervous system, and to some limited areas of the frontal lobe. They do not spread to the entire brain. There are no convulsion, just slow body movements such as clenching one fist or vocalizing. Sometimes he also has chewing movements during his sleep. Rarely he would sit in his bed a speak some confused sentences. If his eyes are open, he usually doesn’s "see" normally and he never interacts normally with us during these episodes. He’s usually unable to pronounce words correctly even when he tries. Although it looks a bit like night terrors, sleep experts told us that it’s absolutely not related.

ABOUT FOOD ALLERGIES AND OTHER TESTS:
We had blood tests and a biopsy to check for gluten intolerence (coeliac disease). He also passed a test for lactose intolerence. And we went to the allergologist and he had the "prick test" for the most common allergens. Everything was negative. He was also tested for vitamin B12 deficiency, and most minerals as well. He just had so many blood tests over the last 4 years, we’re lucky he takes it very well!

ABOUT VITAMINS:
We’ll check about the other vitamins. Two years before we received the diagnosis, I tried a cocktail of vitamins because I thought that maybe my son had RLS. We stopped after two months because we observed no improvements. We didn’t know, at the time, that we would have to treat 5 sleep disorders at the same time. You know... in TV series such as House, the mystery patient always suffers from a single disease. And of course as parents we don’t have access to biochemistry labs to test our hypothesis!


I have three questions for you:

1- What are the chances that his night time seizure are strictly limited to sleep patterns (NREM stage 4)? How high is the possibility that he’s also having daytime triggers?

2- Are there links between epilepsy and central sleep apnea? Is it possible that treating the temporal lobe epilepsy will have an effect with the central sleep apnea? The EEG didn’t show any seizure during apnea events, if I recall.

3- Anyone here with sleep-induced temporal lobe epilepsy or night seizures?
 
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There appears to be a connection between apnea and seizures, but it isn't well-understood:
http://www.ncbi.nlm.nih.gov/pubmed/15157411

Below is a link to threads from the CWE archives that discuss it:
http://www.coping-with-epilepsy.com/forums/tags/sleep apnea.html

I know many CWE members have nocturnal seizures and will respond, but in the meantime, you might also want to check out these CWE threads about nocturnal seizures:
http://www.coping-with-epilepsy.com/forums/f23/night-time-seizures-5237/
http://www.coping-with-epilepsy.com/forums/f42/sleep-seizures-11-yr-old-daughter-scared-16952/
http://www.coping-with-epilepsy.com/forums/f23/finally-got-answer-nocturnal-seizures-11045/
 
Your story broke my heart... I can only imagine how stressful and worrying that must have been for you. I hope you find solutions quickly, so you, your wife and your son can return to some sort of norm!

As a teacher myself, I hope your son's teacher is empathetic and is able to cater to his needs. I hope also that he or she can give him a boost of confidence, which he sounds like he needs after his encounter with the daycare educator, who sounded like a butthead!

Thinking of you guys!
 
Big (((hugs)))! The two of you are being great parents! You have never given up on trying to find out what is causing your son to have his difficulties. I can't imagine your family members ever saying you were not good parents! This has been such a long road for the three of you. I hope that your son starts to get some benefits from the new courses of medication soon. Please keep us up to date
 
First night with valproic acid. My son seems to have slept well, and he was able to get out of bed when his alarm clock music started. Which is a good sign. I will have to use the night camera to film a 1-hour sample and see how good are the improvements. Over a few weeks course we’ll see if his sleep is of constant quality.

@scaredycat,
His current teacher seems to have misconceptions about epilepsy (like most people do) but she really likes him. And he has good grades and good behavior in class (despite being exhausted most of the times). He sometimes fails to finish school work when it requires lots of concentration but he has a good attitude. We have a parents-teacher meeting next week so we’ll have plenty of time to discuss the issues. Also with RLS he’s uncomfortable sitting for a long time, so we’ll discuss strategies with the teacher. And of course there are the special needs related to his unilateral deafness (where he should be located in class, what to do when the environment is noisy, etc.).
 
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Hdufort,

I could have written a similar story about my daughter. Misdiagnosed for months as having Parasomnias, even after an EEG and 2 sleep studies. Until she had a Tonic Clonic in her sleep, when she was sick with Sinusitis. I had to change to another Dr in a different city because no one would listen to me. She has never had a daytime seizure either. We are now on meds and doing alot better but it was a long road and I can relate to your wife. I was devastated. Could not eat, sleep and would cry often. We are all coping much better since the diagnosis and med change. Please feel free to ask any questions I can help with. Welcome to CWE!!
 
Hi hdufort
So sorry to hear what you have been through with your son.

I have had nocturnal events all my life which I now know to be sleep seizures caused by temporal lobe epilepsy. It is interesting that I wet the bed til age 10, and slept walked nearly every night from a young age, but in early adulthood started having what I thought were night terrors. The only reason epilepsy has now been diagnosed is I started at age 40 having some daytime symptoms, such as vertigo and headaches and visual issues, and also some bed wetting incidents. My neurologist thinks the daytime symptoms are partly after effects of the nightime seizures and some partial seizures but I was not aware of them. I think there are probably many people with night time seizures only. Since being on the valproate I have slept like a baby. The first night I said to my husband, That is the best sleep I've had in, well, EVER!

By the way, I am deaf in one ear too and still did very well in school and at university. I did often have a sense of confusion and not quite knowing what was going on sometimes but watched other people for clues. As you said, your son is intelligent and he will work things out.
Just thought you might like some info from someone who has experienced some of what your son is going through. Hope that helps.
 
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