Help me understand "epileptiform discharge"

In My Humble Opinion
1

No, it’s not THAT kind of discharge. :slight_smile:

To get this over with: Yes, you ANAD, I am being treated by a qualified Neurologist, blah, blah, blah.

Now that the kidding is over, my neurologist diagnosed me with “significant epileptiform discharge” in the left temporal lobe. I’m trying to understand what it is and how it affects my life.

He showed me the EEG and showed me the “jaggy spikes” that would occur every so often in the 3 traces of my left temporal lobe. These weren’t matched by the traces in the right temporal lobe, and he said that wasn’t “normal”. He currently has me ramping up on Keppra, an anti-seizure medicine.

My symptoms: I have passed out very briefly (2 - 5 seconds) twice in the last 4 years. There were no “seizure” symptoms however: no jerking, tongue biting, incontinence, etc. I just wasn’t there for a couple of seconds, and woke up very confused, and disoriented for another 5 - 10 seconds. I also occasionally have “head rushes”. These come on very quickly and feel like a rush of strong dizziness, leaving just as quickly. The whole head rush might last 2 - 3 seconds. The strongest head rushes might leave me feeling a little “off” for a minute or two after. I might have a mild head rush every 3 - 5 days.

I’m trying to understand what it means to have these “epileptiform discharges”. The Dr. said it wasn’t epilepsy. So what is it, then? Apparently it is some form of seizure, since he has me on anti-seizure medicine. Has anyone else been diagnosed with epileptiform discharge? What did it mean to you? What were your symptoms? Did anti-seizure medicine help?

I’ve looked around on the internet, but I’ve had a hard time finding any information that either wasn’t biased toward epilepsy, or biased toward this EEG result in children. Anyone have any links to information specifically about non-epilepsy epileptiform discharges? Anyone know of a good forum for this sort of thing?

I’m also interested in how this is going to affect my life. Does this commonly get worse over time? Or could I have had it my entire life, only discovering it now? (As a baby, I apparently did have a couple of seizures, which totally freaked out my parents. They happened when I was too young to remember them.) Anyone have experience with Keppra, and does it eliminate the problem, or just decrease it?

Sorry for the length. Thanks for any info.
J.

2

bump…

3

Well I can’t say much about you in particular and defer to your neurologist but I can say some things in general –

Seizures are electrical storms (discharges) in the brain. When they go over the parts of the brain that control muscles you get the jerking that are ususally thought of with the word seizure but they can also go over only other parts of the brain and cause odd sensations of thoughts or even personality changes. Temporal lobe seizures are famous for having odd sensations and those sorts of things as how they show up. Often people will be tired for a while afterwards, maybe half an hour or so, sometimes less, sometimes seconds, sometimes not at all. Seizures can stay localized (“partial seizures”) or spread all over the brain (“generalized seizures”).

Seizures that have an identifiable cause are called seizures caused by that cause. Seizures without an identifiable cause are referred to as eplilepsy.

Temporal lobe seizures can be of no identifiable cause but usually make us worry about something structural triggering it. Hence most people with temporal lobe seizures will get a brain MRI to make sure that there is no badness causing it.

Keppra reduces the freqeuncy of the events and the possibility of them spreading. One hopes that aftere a few years of seizure free on meds and a then normal EEG that many can get off the medicine.

I hope that helps.

4

I have no experience with it, nor can I offer any advice. The best I can do is an analogy of sorts that may help you visualize what’s going on better than the jaggy spikes on the chart.

Your neurons use electrical discharges to communicate. You could picture your brain as a thunderstorm spread over a vast forest. Lighting strikes pretty frequently, hitting trees all over the forest, whenever enough potential builds up for it to jump the gap. (In your brain, this happens when chemical concentrations change slightly, and make it easier for the charge to jump.)

In an epileptic grand mal (or tonic–clonic) seizure, lighting strikes every tree at once, sending incorrect and often conflicting signals all over the place. Afterwards, so much charge is used up that there’s very little lightning for a while–in other words, the person who just experienced the seizure is unconscious/sleeping.

Based on the term and your description, it sounds like your epileptiform discharges are similar to that, but they only affect one part of your brain–you get a bunch of lighting strikes all at once, but only on the trees on one particular hill. You’re not going to be doing anything on that hill while it’s happening, and probably not for a little while after, but it doesn’t do much damage elsewhere.

Your “hill” is your left temporal lobe, which is involved in a bunch of stuff, like vision, hearing, and maybe language comprehension and long-term memory formation. It doesn’t do muscle control, which is why you don’t get the symptoms you think of as “seizure symptoms”–the twitching and so forth. They’re still seizures, though, just a different kind.

I don’t think anyone knows exactly how Keppra (levetiracetam) works, but it’s known to affect calcium channels in neurons–which are involved in determining how hard it is for an electrical charge to pass from one neuron to another. It may make it harder for all those “lightning strikes” to happen at once, so the goal is presumably to reduce the number of seizures–hopefully to zero.

I hope this is helpful. (Also: what DSeid said.)

5

Hi jharvey,

Medically, epilepsy is a condition defined by recurrent seizures. That’ why your neurologist has not diagnosed you with epilepsy. From what you described in your post, the diagnoses of epileptiform discharges fits the bill. Simply put, your brain is giving out uncontrolled discharges (probably interictal activity perhaps, I can’t tell without looking at your EEG).

So basically epileptiform discharges are when your brain is being bombarded with "unexpected/spontaneous"electrical discharges. These discharges inhibit the normal function of your brain and can very well result in loss of consciousness (like passing out) for a brief moments until the abnormal discharges in your brain subside.

You won’t find anything on the internet for epileptiform discharges, you would have to look through the Google Scholars section to find any relevant information. Even then, you wouldn’t be able to access the journal without their ridiculous $30 fees (per journal!).

Give me an idea of your science background, maybe I can send you some information related to your condition.

If you don’t have too much of a science background, maybe I can help translate all the science jargon into layman’s terms for you if you really need it. Let me know, I’d be happy to help because I’m currently writing a paper on the initiation of seizures so I am filled with more information then I would prefer. Oh and I should mentioned I’m not a medical doctor (yet), I’m just a student so just take everything I say as a buddy over lunch.

Sincerely,

MC
Toronto Western Hospital
Fundamental Neurobiology

6

My science background: I have no formal medical background per se, but I feel a little bit comfortable with looking it up on the web. I often check out drug and disease descriptions on the net as my doctor mentions them. I have advanced degrees in computer science so I’m versed in logical and scientific thinking.

I’ve been on Keppra now for over 6 months, and recently got a little better understanding of its purpose from my neurologist. I thought it was supposed to eliminate or at least decrease the epileptiform discharges appearing in my EEG, but apparently that is not correct. My neurologist didn’t expect my EEG to be improved by Keppra. Instead, Keppra (he said) was meant to prevent this discharge from spreading to other parts of my brain and causing a seizure.

J.

7

What I want to know is, if one is having “epileptiform discharges” or partial seizures or anything similar, is one at risk of having one’s drivers license yanked?

8

It depends on what state you live in. Here in PA, I believe you have to be seizure-free for so many months before you’re eligible to drive.

9

Dear Mr. Mike,

She fainted twice - once in April 2013 and once few days back. She remained unconsious for 4-5 minutes in both occasions. In the recent occurance a small amount of ‘twitching of hands’ was noticed. On both occasions her breathing was very heavy, eyes were open and retina going upwards before going unconsious. First occurance happened while she was asleep and second time after waking up from sleep.

We met a neurologist recently and he did an EEG. Report mentions ‘Abnormal awake EEG record generalised epliptiform discharges. Clinical corelation is recommended’ . After obtaining the EEG report he prescribed one drug ‘Depakine Chrono 500’. Dosage 0.5 tablet daily. On reading the leaflet along with the drug, it appears there are many side effects.

I seek your advise on what to be done, what are the precautions to be taken and how it will affect my daughter in future. I am very much worried about my daughter.

10

This is just myown personal experience with the symptoms you are describing.
In the 8th grade I was having these sensations where I would totally blank out of the moment and then come back minutes later not even knowing anything had happened but noticed everyone staring at me. I was also having 20 to 30 episodes of deja vu daily. I would sometimes be aware of events transpiring around me but suddenly being unable to speak and/or being unable to read and this was really freaking me out. Finally one year later I had a grand mal seizure in the middle of the night and woke up in the ER. They ran an EEG and told me I was having these discharges in my left temporal lobe but could not find the reason why. I was put on Tegretol and Dilantin all to no avail whatsoever. Went back to the specialist at Texas Tech in Lubbock and after further testing was informed I had an astrocytoma near the hippocampus or memory center of my brain.
I am by no means trying to scare you or try to diagnose, I was just relieved to find out that although it was malignant they could remove it and I have never had another seizure. In Texas, I wasn’t permitted a driver’s license until I was free from seizures for one year with a doctor’s note verifying this fact YMMV. I realize this is an old thread but wanted to be of help if possible.

FWIW and a hijack I am now fighting lymphoma and I am in remission after 6 months of chemo and I told God if He gives me prostate cancer next I better get a winning lottery ticket with it, because I give up.
I pray that your diagnosis and subsequent prognosis is a good one.
Sorry in advance if this was in no way helpful at all.
-Grey