Seizure during an anxiety attack?

[Kgartner]

I apologize in advance - this is really long!

My 15-year old daughter had her first seizures in September (complex partial with secondary generalization), and has been on 1500mg Keppra daily since then. Aside from some odd things I have observed (most of which I think are medication related), we have not observed any seizure activity until last month. Mostly what we have been dealing with is a lot of anxiety (which she had before being diagnosed with epilepsy), some of which has been expressed in very dramatic anxiety attacks.

However, last month, the day after the start of the first menstrual period she had in several months, she had what we think were 2 simple-partials. We were eating dinner with the family when suddenly I noticed that she has kind of frozen in place, looking distressed. I ask if she’s OK. “I feel really weird,” she says, “like I’m about to black out.” She can talk normally, but is clearly having a distressing internal experience. “I feel scared. I feel like I’m about to lose control,” she told me. Physically she was very tense and still. After about 2 minutes it passed and she started to feel normal again, although she found it very scary. Afterwards she was quite anxious and said it felt like it did before she had a seizure in September. She had similar but less intense experience about 20 minutes later. When I ran this by the doctor he agreed that it was concerning, and that if something like that happened again he may want to increase her meds.

Well, the other day, also the day after her period started, she had a MAJOR anxiety attack – a really bad one. She was crying hysterically, shaking and hyperventilating. She’s under a lot of stress at school, plus doing auditions for summer ballet programs, so I think it all built up. I supported her through the anxiety attack, and it was getting better. As I was sitting next to her holding her, out of the blue she said to me that she was having trouble talking. I asked her if she has something she was trying to say and she shook her head, but that raised a red flag for me. I had to leave the room for a minute after that, and when I got back she asked me if she had just had a seizure because she felt really confused. I asked her what she was talking about – she said that suddenly she had just felt “different” and that it felt like a seizure. That’s all I’ve been able to get out of her! I’m going to try to get her to give me more details, but she seems to have real difficulty talking about it (she’s not a big talker in general).

I’m not quite sure what to tell the doctor about this one – I’m very confused by the whole thing, and not sure which of my observations were anxiety and which were (possibly) seizure. I also may have missed something when I was out of the room. However, she does NOT go around saying she has seizures – in fact the two events above are the only times she has ever said that to me. Is that enough to go back to the doctor with?

Has anyone ever had a simple partial seizure DURING an anxiety or panic attack? For her, something clearly felt “different” all of a sudden.

As far as I can tell her major anxiety symptoms also seem to come and go with her cycle – they peak right around the time of ovulation and the beginning of her cycle. So I think all of this is connected somehow.

So sorry for the novel I just wrote LOL. I don’t seem to be able to make it shorter! Thanks in advance if you have any thoughts.

 

[Nakamova]

If she was having trouble speaking, that makes it fairly likely that she was having a complex partial seizure, and you should definitely mention it to her doctor. In addition, there's a good chance that at least some of her episodes of anxiety actually ARE simple partial seizures. One characteristic form they can take is an unexplained sense of fear or dread. It can have a strong physical component -- that "pit of the stomach" feeling, or nausea or increased heart rate.

The anxiety attack where she was crying and hyperventilating could have been a seizure or could have triggered one. Hyperventilation is a known seizure trigger, along with stress in general. The good news is that the Keppra may be preventing her episodes from generalizing, limiting them to partials. However, there's also a chance that the Keppra is making her more emotional and anxious (esp. hard for a teenager), so it may not be the ideal med for her.

I recommend you do get in touch with her neurologist to let him/her know of your concerns. If there is a hormonal element (catamenial epilepsy), the doc may be able recommend treatments (such as certain kinds of birth control) that can help to counteract the estrogen spikes.

In the meantime, whatever your daughter can do to minimize stress would be ideal. You know the drill -- balanced diet, good sleep, etc. Any chance she could take up meditation? It doesn't have to be anything extensive -- just taking 5 minutes once or twice a day to be still and focus on her breathing.

 

[Kgartner]

Nakamova - thank you for your thoughtful and helpful reply! Since I can't get more details out of her I think I will just send the description of the event that I wrote above to her doctor. It's helpful to get some validation for what I am thinking - for some reason I always feel nervous that he is just going to dismiss my concerns. I would be very interested to hear what he suggests for seizures that seem to have a hormonal component.

I don't think that her "regular" anxiety attacks are actually seizures because they last too long (20-30 minutes) and her cognition and perception seem normal. I have wondered if the Keppra is making her anxiety worse, and I've discussed possibly switching to lamictal with her doctor. But it makes me really nervous to make a change, and lamictal has side effects that concern me as well (particularly increased insomnia, which she already deals with). But right now the anxiety she is dealing with is the worst part. Honestly we could probably live with a couple of brief partials around the time of her period if the anxiety would just abate!

As for reducing stress and getting enough sleep - that's really tough for a 10th grader at a magnet HS who dances 12 1/2 hours a week! My husband and I have started seeing a family therapist who specializes in "mindfulness" with the hope that my daughter will be willing to see her at some point (unfortunately she had a negative experience with a therapist in the past that has kind of turned her off). I'm sure that meditation could be very helpful for her if she was willing to give it a try!

 

[Nakamova]

For me, the Lamictal insomnia was short-lived -- after a few months that side effect went away, and I sleep very solidly. So it may be worth a try if the Keppra ultimately proves problematic.

I hope the neuro is responsive to your concerns. It's his job to help you and your daughter interpret what's going on when she feels "off."

 

[lindsayschu2]

Geez Namakova you are incredibly tolerant. I'd never consider a few months of insomnia as 'short-lived' ;-)

 

[MAB]

Nakamova - thank you for your thoughtful and helpful reply! Since I can't get more details out of her I think I will just send the description of the event that I wrote above to her doctor. It's helpful to get some validation for what I am thinking - for some reason I always feel nervous that he is just going to dismiss my concerns. I would be very interested to hear what he suggests for seizures that seem to have a hormonal component.

I don't think that her "regular" anxiety attacks are actually seizures because they last too long (20-30 minutes) and her cognition and perception seem normal. I have wondered if the Keppra is making her anxiety worse, and I've discussed possibly switching to lamictal with her doctor. But it makes me really nervous to make a change, and lamictal has side effects that concern me as well (particularly increased insomnia, which she already deals with). But right now the anxiety she is dealing with is the worst part. Honestly we could probably live with a couple of brief partials around the time of her period if the anxiety would just abate!

As for reducing stress and getting enough sleep - that's really tough for a 10th grader at a magnet HS who dances 12 1/2 hours a week! My husband and I have started seeing a family therapist who specializes in "mindfulness" with the hope that my daughter will be willing to see her at some point (unfortunately she had a negative experience with a therapist in the past that has kind of turned her off). I'm sure that meditation could be very helpful for her if she was willing to give it a try!

I don't think lamictial has made my insomnia any worse than it was to start with. I do take a larger dose (100mg) early in the morning and a smaller dose (50mg) at 3PM.

After having 100's, maybe a thousand simple partials over the last 3 1/2 years, I didn't think it was any big deal when I had a mild, short partial in November but it seemed to alarm my doctor. I wad only DX'ed in October.

 

[Kgartner]

She had an existing anxiety disorder when she was diagnosed with epilepsy, and I am concerned that the Keppra really is making it worse. The fact that she already had anxiety makes it harder to tell what's due to the effect of the medication and what's just "her" - but from what I understand it also means that it's more likely that Keppra will have these effects. So while I am nervous about making a switch for lots of reasons, I'm really beginning to think it's worth a try.

Her life would be so much better if she didn't struggle with anxiety all the time. While these major anxiety attacks with hysterical crying and hyperventilating etc. "only" happen once a month or so, she deals with pretty strong anxiety symptoms several times a week. I gather that lamictal could work to "stabilize" some of these mood issues. She's incredibly strong, and coping pretty well, but if a change could really make things better for her that would be great (as long as we still get good seizure control of course . . . ).

 

[Nakamova]

Geez Nakamova you are incredibly tolerant. I'd never consider a few months of insomnia as 'short-lived'.

Well, the insomnia was accompanied by a hyper-focused perkiness during the day -- the kind that leads you to organize your sock drawer alphabetically and by color... So while the restless sleep was no fun, the daytime productivity was great!

Kgartner, I do think the Lamictal may be worth a try. As you may know it's considered to be a mood-stabilizer, and to have few or zero cognitive side effects. Of course everyone reacts differently, and med transitions can be stressful, but worth discussing with the neuro.

 

[MAB]

I like the lamictal. My mood is certainly more stable. I was worried my hair would fall out and that I would gain weight. My hair hasn't fallen out yet and I am actually losing weight, so I'm happy. I even manage to get my butt out of bed in the morning and hit the gym several days a week.

 

[kirsten]

In the old days when they did holter scans they'd try their best to induce seizures by limiting sleep, limiting food, and making you as stressed out as possible. If all else failed, they'd artificially create an anxiety attack using adrenaline and hyperventilation, so yes, an anxiety attack is particularly good at inducing seizures. Ideally, absolute control means no abnormal circumstances cause seizures but I've always found that to be too ambitious. Lifestyle management is a core part of managing my seizures, and stress management is a huge part of that.

 

[Kgartner]

In the old days when they did holter scans they'd try their best to induce seizures by limiting sleep, limiting food, and making you as stressed out as possible. If all else failed, they'd artificially create an anxiety attack using adrenaline and hyperventilation, so yes, an anxiety attack is particularly good at inducing seizures.

Wow, I had no idea. To me that means that keeping her anxiety at bay could be an important part of her seizure control. Thanks.

 

[kirsten]

If she has temporil lobe epilepsy, unusual mood changes can also be seizures. I will never forget the drastic mood change I had ten years ago. After having arrived home, I felt viciously depressed and suicidal. On my way to the bedroom, in the time it took to walk from one room to another, it swung immediately and for the rest of the night, I was completely on top of the world, as if I'd just bought a Gucci suit and was on my way to New York to fetch my Pulitzer prize. The next day, I was back to normal.

 

[Kgartner]

We don't know where they are localized. The doctor originally told me that they were likely originating in her frontal lobe (based on my description of her seizure), but after I described the partial seizure she had in December which was largely a strong feeling of fear he mentioned TLE. She's only had one fairly short EEG, about 18 hours after her first seizures, and it was normal. So we only have the clinical presentation to go on.

 

[kirsten]

They can tell a lot from clinical presentation. Before I told my new neurologist about my focus, he asked me about 100 questions about symptoms and told me I had temporal lobe epilepsy radiating into the occipital lobe, which is precisely what my holter scan picked up.