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What Do These EEG Findings Indicate?
Question: My teen daughter has been having fainting with seizure activity in the morning while on or 1-3 days after her menstrual has ended. We have seen a cardiologist and electrophysiologist who have both stated that she is having seizures due to lack of oxygen to the brain caused by orthostatic hypotension, because her blood pressure drops over 20 upon standing. However, the neurologist is saying she has epilepsy because the EEG shows a hyperventilation induced polyspike and wave 3-4HZ. They started her on lamictal. Prior to the abnormal EEG, we found that she was low on ferritin and vitamin D. Since supplementing iron and D3, she has not had another issue and that was 3 months prior to starting the AED. Which specialist is correct?
Brief Answer:
Continue Antiepileptics
Detailed Answer:
Hello,
I have gone through your question and understand your concern.
EEG finding of 3 hz polyspikes with hyperventilation at this age is highly suggestive of juvenile myoclonic epilepsy.
In JME, early morning seizures, myoclonic jerks and episodes of absence seizures like unawareness of surrounding for brief periods occurs.
JME seizures are highly sensitive to sleep deprivation.
As all seizures can be precipitated by anemia, fever, hypoxia, the girl sustained such episodes aggravated by anemia and hypotension.
You can get a repeat EEG done.
Antiepileptics should be continued with preference of valproate and levetiracetam.
Treatment of anemia and vitamin D deficiency should be done.
You can upload eeg too.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Continue Antiepileptics
Detailed Answer:
Hello,
I have gone through your question and understand your concern.
EEG finding of 3 hz polyspikes with hyperventilation at this age is highly suggestive of juvenile myoclonic epilepsy.
In JME, early morning seizures, myoclonic jerks and episodes of absence seizures like unawareness of surrounding for brief periods occurs.
JME seizures are highly sensitive to sleep deprivation.
As all seizures can be precipitated by anemia, fever, hypoxia, the girl sustained such episodes aggravated by anemia and hypotension.
You can get a repeat EEG done.
Antiepileptics should be continued with preference of valproate and levetiracetam.
Treatment of anemia and vitamin D deficiency should be done.
You can upload eeg too.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Yogesh D
I have uploaded the Report for your review. She has never had any jerks or absence seizures, that were visible. They mentioned JME has a possibility but cant confirm due tomthe lack of myclonic jerks. They have prescribed lamictal, gradually working up to 400 mg per day. Thus far, i have noticed that she has lack of appetite with them.
Brief Answer:
Continue treatment
Detailed Answer:
Hello,
I have gone through the reports.
The spike wave complex of 3-4 hz at this age is most likely Juvenile myoclonic epilepsy.
Sometimes myoclonus or absence seizures are not apparent.
Lamictal can be reduced if seizures well controlled after a static period of around 6 months.
Loss of appetite is associated with drug usage.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Continue treatment
Detailed Answer:
Hello,
I have gone through the reports.
The spike wave complex of 3-4 hz at this age is most likely Juvenile myoclonic epilepsy.
Sometimes myoclonus or absence seizures are not apparent.
Lamictal can be reduced if seizures well controlled after a static period of around 6 months.
Loss of appetite is associated with drug usage.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Prasad
Can a teen grow out of this? What is her prognosis if it is JME?
Brief Answer:
Continue treatment at present
Detailed Answer:
Hello,
JME at present requires prolonged treatment mostly life long.
The seizures are well controlled in most cases with low doses of antiepileptics like valproate, levetiracetam or lamotrigine.
If in doubt regarding JME or idiopathic epilepsy, drug can be gradually tapered after asymptomatic period of atleast 3 years.
Wishing good health.
Regards
Dr N Kumar
Neurologist
Continue treatment at present
Detailed Answer:
Hello,
JME at present requires prolonged treatment mostly life long.
The seizures are well controlled in most cases with low doses of antiepileptics like valproate, levetiracetam or lamotrigine.
If in doubt regarding JME or idiopathic epilepsy, drug can be gradually tapered after asymptomatic period of atleast 3 years.
Wishing good health.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Prasad
Since my daughters always happen on her menstrual. I have scheduled an appointment with an endocrinologist. Can a sex hormonne imbalance cause an abnormal EEG?
Brief Answer:
Yes, sex hormone can cause seizures
Detailed Answer:
Hello,
Seizure in relation to menstruation is called as catamenial epilepsy. The management differs slightly.
Use of acetazolamide, OCPs and hormones like progesterone in addition to other conventional AED can be used in such case.
Diagnosis is established based on regular record of menstrual cycle and seizures.
Visiting to an endocrinologist can be helpful.
Yes, Sex hormone imbalance is associated with seizures.
Regards
Dr n Kumar
Neurologist
Yes, sex hormone can cause seizures
Detailed Answer:
Hello,
Seizure in relation to menstruation is called as catamenial epilepsy. The management differs slightly.
Use of acetazolamide, OCPs and hormones like progesterone in addition to other conventional AED can be used in such case.
Diagnosis is established based on regular record of menstrual cycle and seizures.
Visiting to an endocrinologist can be helpful.
Yes, Sex hormone imbalance is associated with seizures.
Regards
Dr n Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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