this week's news and more temporal lobe epilepsy information

Well, the official MRI results are in and there was no finding on the MRI which is good news.  We had our visit with the neurologist today to discuss our current problem which is Calvin's behavior. Even though he is seizure free, he is still completely out of control emotionally. Since he has epilepsy in his temporal and frontal lobes his behavior/mood are directly related to his epilepsy. We went to the dr. to discuss our current situation and what course of treatment he'd recommend. At this point it is not possible for us to blindly walk into a psyciatrist's office looking for medicines and as epilepsy is our first disease we thought we should start there first.

Our dr says though some  will deny the relationship between emotional/behavior/mood problems being directly associated with epilepsy with temporal and frontal lobe epilepsy it is impossible to deny.  Before seeking psyciatric medications we want to be sure that the epilepsy is controlled.  To that end, we are increasing the dose of his current epileptic medication over a few weeks. Then, we will go in for a 48 hour EEG to see what kinds of epileptic activity we are still getting. Calvin's first EEG last summer had a lot of epileptic activity.  A seizure is an over active neuron pathway and seizures can happen without being seen from the outside. We only see a seizure if it involves movement of a body part we can see. With Calvin we suspect he is having sub- clinical seizures contributing to his wild behavior and mood swings.

Some reading on Temporal lobe epilepsy:

1. Partial Seizures (SPS) involve small areas of the temporal lobe such as the amygdala or the hippocampus. The term "simple" means that consciousness is not altered. In temporal lobe epilepsy SPS usually only cause sensations. These sensations may be mnestic such as déjà vu (a feeling of familiarity), jamais vu (a feeling of unfamiliarity), a specific single or set of memories, or amnesia. The sensations may be auditory such as a sound or tune, gustatory such as a taste, or olfactory such as a smell that is not physically present. Sensations can also be visual, involve feelings on the skin or in the internal organs. The latter feelings may seem to move over the body. Dysphoric or euphoric feelings, fear, anger, and other sensations can also occur during SPS. Often, it is hard for persons with SPS of TLE to describe the feeling. SPS are often called "auras" by lay persons who mistake them for a warning sign of a subsequent seizure. In fact, they are actual seizures in and of themselves. Persons experiencing only SPS may not recognize what they are or seek medical advice about them. SPS may or may not progress to the seizure types listed below.
2. Simple Partial Seziures
3. Complex Generalized Clonic Tonic Seizures

(calvin has had #'s 1 and 2. I underlined the part that he seems to have problems with. Possible sub clinical seizures or auras causing major rage.)

Personality

The effect of temporal lobe epilepsy on personality is a historical observation dating back to the 1800’s. Historical psychologists such as Sigmund Freud stated, “We know that epilepsy produces these remarkable changes in the personality."[1] Personality change in temporal lobe epilepsy is seen as a chronic syndrome. It is classified as a chronic syndrome when symptoms from a particular disorder persist for a minimum of 3 months. Personality and behavioral changes can be a result of the seizures from temporal lobe epilepsy. Norman Geschwind [2] suggested that a reason for this personality change could be the location in the brain where the syndrome takes place. Geschwind article stated, “It’s the location of the lesions producing temporal lobe epilepsy. These lesions are characteristically on the surface of the temporal lobe.[3]” Furthermore, “These lesions lie directly in structures with pathways into the parts of the brain that are involved in emotional behavior."[4]”Emotional behavior in this regards can be seen as actions that contributes to an individual’s personality who has temporal lobe epilepsy.

These quotes are from wikipedia but Dave and I have both done a lot of searching in the literature to read these papers and they are summarized well here.

The temporal lobe is home to the amygdala - the part of the brain considered to process emotions and espeically anger and agression. Also, present is the hippocampus which is also part of the lymbic system and involved with creating memories.    I recently finished a college course on the biology of human behavior and spent a lot of hours learning about the different parts of the brain. As I listened to the lectures I could see very clearly how Calivn's problems are very attributable to the part of the brain where his epilepsy and damage are located. It was very informative but sort of sad to hear.

Anyway, if the EEG shows a lot of active epilepsy still going on I assume the dr. will add a second medicine or increase his current medicine to help control the epilepsy. If not, we will assume the epilepsy is mostly controlled and look to another medication for help and probably consult with a neuropsychiatrist.  Apparently the is one really good on town but I believe we'll have to pay out of pocket to see him.

The EEG will be a Mon-Wed. Calvin will get to miss school and sit in the hospital for 3 days watching TV, playing video games and eating hospital food. He is actually super excited!  Of course the girls are way jealous!  Luckily Dave has some flexibility in his schedule so he can go with Calvin on this little adventure in May.