I’ve had epilepsy for the past 18 years. When I was first diagnosed, they ran all the brain scans to try and figure out what was causing it, but could not find anything. The hypothosis was that there was a brain scar to small to pick up on any of the instruments and that there was nothing that could be done about it.
Recently, I had a sleep study done and found out that I do not get enough oxygen while I sleep, so now I’m hooked up to an oxygen machine as well as a CPAP when sleeping.
Which got me wondering: All my grand mal siezures save one have occured while I was sleeping or just after waking up, so could this lack of oxygen been a contributing factor?
(Another reason I suspect this is that my siezures have gotten more… um… not sure what word to use. When I was first diagnosed, I could go for months without my medication before having another. It steadily got to the point where today I cannot miss a single dose of my meds or I will have a grand mal… at the same time, I’ve steadily gained weight, which I understand is one of the contributing factors to not getting enough oxygen when I sleep.)
I’m pretty lucky in that my medication completely controls my epilepsy and I’ve been seizure-free for the past two years. It’s just always bothered me that I’ve never known why I’ve had had them in the first.
You’re right that it’s probably only one facet, as when I was working full-time I had complex-partial seiuzres on a regular basis, and that seemed to have no connection to sleep that I can tell.
Well, it’s pretty typical that the majority of seizure patients have normal EEGs (at least while not seizing) and normal brain scans.
Which is really sort of how you’d want it, mostly. I’d rather tell a patient that their scans & tests are normal, and their seizures are thus caused by an unknown but non-life-threatening thing, than tell them they’re caused by the expanding mass in their neocortex.
I hate hijacking but this is kind of on topic. I’ve never had a grand mal seizure (or any other kind of seizure that I know of), but recently several doctors have theorized that I might be having a neurological problem (I tend to space out and lose time to the point other people get creeped out by it). I had an EEG done and the results were announced normal.
Now, during the EEG something happened that never happened to me before in my life – during the strobe test I felt a very acrid smell of ozone/ionized air (like a UV lamp or lightning storm). I attributed it to the strobe, but then I noticed the strobe was LED, so I told the tech and she said she didn’t smell anything. Now, it was extremely vivid but I’m not discounting that it’s just a triggered association from childhood with lightning storms, since the EEG was declared “normal”. However, if I had a partial seizure when hooked up and recording, would it necessarily appear on the EEG? Should I make a follow up appointment with the neurologist and have him re-check that area of the recording? I am not sure if the tech conveyed this information to the doctor.
Ok, now back to the topic. If EEG’s should look normal when a person is not having a seizure, how are partial seizures even diagnosed properly? How do you tell them apart from psychiatric conditions?
My daughter was recently diagnosed with Absence Seizures (staring off into space for about 10 seconds at a time). She had the EEG done and had 2 events during the test, and the brain activity was noticeable on the graphs. Interestingly they had the scale set to see all activity and we could see normal bumps on the graph until the seizure hit and the lines went haywire. When the technician scaled down the graph to show the activity during the event, it was easy to see the rhythmic activity.
During our intake with the Pediatric Neurologist, he had asked if she cried immediately when born. We said no, that she needed some prompting and he looked smug like he had solved all of our problems (we’re not liking his bedside manner). We tried to ask him about this but he had moved on to other questions. I take it that he feels that the Epilepsy was caused due to the lack of oxygen immediately after birth.
Think of seizures as a spontaneous discharge of brain cells. That discharge is propagated to enough other cells to cause either a localized sign from a twitch to an odd smell, or spread over the whole brain so you jerk all over and all your higher cortical functions crap out along with the rest of your brain (a grand mal attack). These dysfunctional cells can have an external trigger (a flashing light, say) or an internal one such as a metabolic perturbation. In general the answer to “Is it possible that x is causing my seizures?” is “Yes, it’s possible,” because when the right stimulus fires off the wrong neuron, the seizure starts.
It is certainly possible that a low-oxygen state triggers your seizures–we see seizures in the Emergency Department all the time that are caused by low oxygen. However there are many other cyclical variations that occur when you sleep. If seizure control is an issue, some of these variations–oxygen levels, e.g.–can be tested for.
Q the M is right as always. You need a good physician and a structured approach to diagnosis and therapy.
Interesting I came across Skott’s post from 2007. WOW I’ve been fighting a seizure disorder since leaving hockey in 1973. Triggers are physical and mental stress; situations where my body is demanding more oxygen; needs fluctuate oxygen levels have been measured as low as 86% however tests fluctuate drastically. EEGs, MRIs normal!Yes oxygen levels have a drastic effect on seizures in my opinion. However finding a informed doctor who will take the time to sort out such complexities is the real challenge. i’m still looking.
I’d suggest looking for a neurologist at a teaching/academic hospital, particularly one whose specialty is seizures refractory to control with one or two medications. Such specialists are out there, and new drugs and new seizure control techniques are being employed by them.
I know two people who have seizures that seem to follow about 2 hours behind semi strenuous physical activity. Sex, fast walking for about 15 min, things like that. Both of these guys had brain injuries.
“Respiratory factors: impaired respiration and seizure induced pulmonary dysfunction as well as central apnea as a result of brain-stem respiratory centers suppression are known to play a role in some cases of SUDEP…”
So your risk of dying from epilepsy is known to increase with hypoxia. Stands to reason that hypoxia increases the frequency and severity of siezures, both raising the chance that its fatal.