Brief Answer:
Don't see why they can't be BREC

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am a neurologist in XXXXXXX OH.

Given the information you've provided and after having read a colleague's opinion that did not agree with BREC I would have to take different point of view and state that based upon what you've described and what is known so far I don't see WHY IT COULDN'T BE BREC.

Please bear in mind that I am not a pediatric neurologist or epileptologist but from my recollection of when I did pediatric rounds and later reading on this MOST COMMON childhood epileptic disorder we know of in the literature the 4 most frequent manifestations in BREC are:


1. facial sensory and motor symptoms
2. oropharyngolaryngeal manifestations (the clicking and sounds he makes)
3. speech arrest (in his case I think I'd give him the slurring as a variant of arrest)
4. hypersalivation (Drooling)

So from where I sit...I think you're almost describing a classic textbook example of the most common epileptic disorder in childhood. The fact that the EEG is negative means nothing. EEG's are MOSTLY negative for abnormalities when you want them to be POSITIVE for something.

It's the old, take the car to the mechanic routine for that noise in the brakes that's been going on incessantly for the past 2 weeks....which then, disappears as soon as you pull in the dealer's bay.....drives 'ya nuts!

EEG's are only about 30% sensitive...on a lucky day...maybe a bit higher....but essentially, you don't start hitting the jackpot until at least 2 if not 3 studies and this would be in someone who has fulminant disease going on.

Have you considered videotaping him while he is asleep and perhaps doing some of these things? From a further workup point of view if I were his neurologist I may suggest he do a video EEG monitor either in the hospital or if there is a company that can come home and set it up for a weekend. That way he doesn't have to miss school.

Also, one could consider interictal PET scanning or functional MRI.

It seems to be that these symptoms are benign enough as you're describing them and I do think I would put BREC up there on the differential list failrly high if not in 1st, 2nd, and 3rd place based on what you're saying such that I believe they will subside with time....Because that is typical for BREC patients.

Good question on whether damage will occur. The truth of the matter is we have now changed our opinions on partial seizures and their once thought to be benign nature to a position of at least recognizing the potential for harm. I believe that whenever the brain seizes, whether it is generalized or just a tiniy area causing focal symptoms that some neurons must be suffering....to me that kind of like sliding a table across a beautifully fiinished polished hardwood floor, 'ya with me on this example....goofy to be sure but see if it makes sense.

You've got this table on this beautifully polished brand new expensive CHERRY HARDWOOD FLOOR....(I'm asking taking an example from my own house and my DIVINE CHILDREN!! HA).....so there's a coffee table which at times needs to be lifted from one place to another in the room.....of course, when my wife and I do it we LIFT the table and carry it and set it down....when the kids do it.....they PUSH the stupid things across the floor....they try lifting but it really becomes pushing after 2 feet....right? So you tell them...don't do that because it's going to SCRATCH the floor.....but they don't listen..of course not...so they keep pushing and pushing until one day...for as lightly and as careful as they've tried to be...we notice....the scratch marks back and forth in the floor....the scratch marks on the table.....damage to the floor by obviously by BRAIN DAMAGED KIDS----as XXXXXXX Cosby might say......

So, is the damage to the floor SIGNIFICANT? Probably not...is it even noticeable? Probably not unless you really look hard at certain angles....but does it accumulate over time and begin to look like something you'd rather not have? Yeah....it does if they keep dragging the dang table around and you don't do something about it!!

I think partial seizures can be thought of in similar terms.

Does that crazy example make sense? Bottom line is that I believe these seizures should be treated with the LOWEST DOSE POSSIBLE of the most appropriate medication DEPENDING ON EXACTLY WHAT THE SEIZURE TYPE IS. I understand that chronic use of antiepileptic medications has its downsides on maturing and growing minds as well as skeletons, etc. But again, BREC is self limited so you're not destined to be using medication for very long and I think there are decent agents now which are less offensive to the brain and liver itself instead of the most commonly used carbamazepine.

But again, here we go....WE NEED TO KNOW THE SEIZURE TYPE....

Anyways, I think that these should be investigated, at least videotaped and taken in to a good pediatric epileptologist to see. I even think this little guy deserves a video EEG for a few days at home preferably but if necessary in the hospital so we get a good record of what he's doing as it relates to EEG activity.

Finally, I think the lowest dose possible of the LEAST OFFENSIVE antiepileptic appropriate to the seizure type needs to be used in order to control these events. I think you'll see that if you can bring this thing under decent control he will change. He will get brighter, be more active, do better in school, and just overall look and act better and more mature.....

Please consider sending future questions on any medical topic you feel I may be able to help with directly to my attention on this network by calling up:

http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474

and addressing the question directly to my attention (DARIUSH SAGHAFI, MD).

I also give live webcam conference private consults and would be happy to see your son if you'd live to communicate in that way. Or we can also do straight texting or audio if you don't have the webcam hooked up. You can find me on that network at :

www.healthtap.com/drsaghafi

If that is of interest to you please let me know and we can arrange an appointment to meet there as well.

If this information has been of value to you please consider a little written feedback and a STAR RATING. If you could also CLOSE THE QUERY that would be also appreciated assuming you have no further questions or comments for me.

This query required 58 minutes of physician specific time to review, research, and document in final draft form for envoy.

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