[Info] When seizures look like psychiatric disease

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I found this article on www.epilepsy.com

“CRAZY? THINK AGAIN…” WHEN SEIZURES LOOK LIKE PSYCHIATRIC DISEASE

Many people in the community have seen or heard of a "grand mal" seizure, otherwise known a generalized tonic-clonic seizure. These are the types of seizures that are obvious and usually portrayed in films and on television. People who have epilepsy, as well as their friends and family members, understand that not all seizures are as dramatic as grand mal seizures or the ones portrayed in the media. Many seizures are much more minor things, such as staring spells or lip smacking. These slight physical changes may be the only outward manifestation of the seizure. Even less commonly recognized and diagnosed as seizures are some rare types of seizures where patients may have only psychological or psychiatric symptoms, at least at first.

One type of epilepsy – frontal lobe epilepsy – is notorious for causing strange behaviors that frequently go misdiagnosed as psychiatric disease. Patients can have unexplained behaviors that cannot be explained by a prior psychiatric history or family history of psychiatric problems. They may even be diagnosed with pseudoseizures, or psychiatric non-epileptic attacks, because the behavior caused by the seizure is not typical seizure behavior. For example: one of our patients was sent for evaluation because she began to have episodes of inappropriate behavior at work: giggling, dancing, and speaking gibberish. Another patient sent to us had been having the obsessive-compulsive behavior of checking their blood glucose. Yet another who has chronic headaches began to have episodes of crying out in agonizing pain. Upon monitoring in our epilepsy monitoring unit, we found that all of them had seizures which were causing the abnormal behavior.

An additional type of rare seizure becomes more prevalent in the summertime (or year-round in the subtropics of Florida), when mosquitoes abound. It is not an uncommon occurrence for some of our patients to be eventually diagnosed with a viral infection of the brain, called encephalitis. Many of the patients we have seen have personality changes or memory problems for two to three weeks, but have not seen a Neurologist because it is not initially clear that the brain has a problem. They may not even have symptoms of a viral illness (flu-like symptoms such as a headache, fever, or body aches). When they are eventually evaluated for their memory problems or personality changes, they would have brain imaging (MRI) and brain wave testing (EEG); these are usually abnormal with encephalitis. The MRI may confirm that they have abnormalities in the temporal lobe of the brain, which can affect memory. EEG may show what is known as "subclinical seizures" (seizures that are not obvious but that can cause personality changes and memory problems). When a spinal tap is done, it can reveal laboratory findings of encephalitis. Sometimes, we are able to find the virus responsible (for example, West Nile Virus) – but many times, at the end of the day, we are unable to identify the virus responsible.

The lesson is that there is a sudden onset of personality changes, or changes over two to three weeks in a person who does not have a history of abnormal behavior or psychiatric illness, and especially in a patient with no family history of psychiatric illness, the cause of the personality change should be further investigated by a Neurologist. The workup for this would generally be an MRI and an EEG to identify seizures that are not the typical types of seizures, and sometimes a spinal tap to attempt to identify any signs of an infectious cause (encephalitis).

 

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This is a very important article. I really wish that I could find out more about this topic.

My son had his first seizure when we woke him out of a deep sleep. He didn't have any more seizures, and we thought it was a one-time thing.

Several months later, my son started behaving very oddly and was showing symptoms of OCD.

The standard thing you do when you have OCD is go to a psychiatrist. The psychiatrist prescribes medicine and possibly therapy, but you are not tested for epilepsy. A lot of people with OCD do not get better.

I had a very strong feeling the seizure was somehow related to my son's OCD. Our infant had just been diagnosed with epilesy, so we were already seeing a neurologist. That made it easy for us to make an appointment for our older son.

We told the doctor about the OCD and seizure. He did an EEG and found it to be abnormal. The doctor said that untreated epilesy can lead to OCD and other problems. He believed that the OCD would go away once we treated the epilepsy.

If you are reading this and are not familiar with OCD, let me tell you that it is utterly debilitating and Hell on Earth to live with someone who has this condition.

In any case, my son has been having more seizures lately, but the OCD issue is 98% resolved thanks to God first and then to the medications he is taking. I can totally see how someone could really get misled into the wrong diagnosis and live for many years with a potentially treatable condition simply because people do not usually visit a neurologist or have EEGs done when presenting with symptoms of mental illness.

If anyone has further information about this topic, I would be grateful to read it.