explanation of VEEG

[dowma]

I recently had my second VEEG ( the first showed decreased theta waves but no sz).  I have been diagnosed with "neuro autoimmune disease".  I know this isnt a typical diagnosis but thats what i was told.  I am currently on monthly IVIG had 5 months so far.  My second VEEG showed presence of left temporal sharply contoured rhythmic theta.  Apparently I had one seizure show while awake, which I dont recall.  I actually spoke to nurse during episode.  EEG: showed bi-temp sharply contoured theta, begins and ends abruptly.  I just started lamicatal 25mg yesterday and have been on keppra 375mg for the last 4 wks.  My doctor wants to ween me off keppra due to irritability and slowly increase my lamictal.  Can you explain the VEEG report?  I am not considered to have epilepsy.  PET scan showed decreased metabolic activity in the left parietal lobe.  MRI showed two small foci of flair signal alteration in the right frontal, subcorticqal white matter.  MEG showed rare right hemispheric cortical hyperexcitability involving the right mesial temporal lobe, right posterior temporal lobe and right frontal operculum.  I've also had labs which were all negative and 2 spinal taps normal.   Neuropsych. showed focal difficulty with memory functioning.  specific difficulties seen in ability to recall stored verbal, semantic knowledge as well as in ability to encode new verbal information into long-term memory stores.  Can you explain this?  thanks for all your help.  MB

[Abhijeet Deshmukh, MD]

Hello.

We can not tell for sure if the IVIG will help the parietal lobe functioning directly. Since your neurologist is suspecting an autoimmune pathology, we should expect the immunoglobulins to improve the parietal functions.

If the autoimmune disease is demyelinating, the IVIG will help.

Regards

[dowma]

Thank you for all your input, you have been very helpful.  Is the IVIG supposed to help with these changes in the PET scan? MB

[Abhijeet Deshmukh, MD]

Hi.

The PET scan finding is significant as far as your cognitive status is concerned. You have certain executive functioning problems coming up, which include memory. This has to do with the parietal lobe. Parietal lobe is the most important lobe for cognition. The nerve cells in the parietal cortex are not taking up adequate glucose. There could be a structural change. A repeat PET scan may not show any changes unless certain remedial measures are taken.

Regards

[dowma]

No, I've been very healthy until all this started about 2 yrs ago.  I'm 42 with no other medical history prior to this.  I've not been any medications prior to starting the sz meds.
Thanks for the explanation I guess I just have  to be patient and see what happens.  I will have  an ambulatory EEG in a month and I'm assuming he will want to repeat the PET scan at some point.  what is the significance of the findings from PET?  (decreased metabolic acitivity in the left parietal lobe)?
thanks, MB

[Abhijeet Deshmukh, MD]

Hi.

The frontal lobe has the motor cortex. If the nerve fibers coming from that area are affected, you get the pronator drift. Right frontal lobe controls the left side of the body. Hence, your pronator drift on the left becomes significant. The lesions shown on the MRI are in the white matter. Lesions in white matter affect the nerve fibers coming from the cortex. It is possible that the nerve fibers coming from the motor cortex are affected.

There is no doubt that the VEEG and MEG reports suggest focal temporal lobe seizures. The question is what causes the seizures. If MS has been ruled out, what else? I am not able to provide you with a diagnosis at present. But I hope we can have a better understanding of the condition.

You have mixed motor and sensory features. Two-point discrimination is a sensory dysfunction. The nerve fibers are arranged close to the nerves coming from the motor area. Since you have these on one side, I suspect the lesions shown in the MRI are the cause.

You could think of small vessel problem. Do you have hypertension? Did you have any transient ischemic attacks (TIAs) in the recent past?

Regards

[dowma]

thanks for the information.  I also have paresthesia in both legs and arms as well as vibratory sensations.  I get this sensation of fullness in the back of my head that makes me feel "foggy".  My biggest issue is my memory, I have difficulty retaining what i read and with verbal memory. I also experience extreme fatigue.  they have already r/o MS with testing.
I tend to thrash around alot when I sleep, have a sensation of always feeling hot even though its winter(usually at night).   I used to be a great sleeper but not lately I wake frequently.  
My most recent episode that sent me for the second VEEG was 3 days of feeling as if my vision was affected as if thing were moving from side to side with associated nausea.  On exam I am hyper-reflexic and have difficulty with pin-piont discrimination and heal to toe walking. I beleive I have pronator drift on the left. EMG was also negative.
I wasn't dx with having sz until the VEEG was done (3 days) apparently only one episode showed which i don't recall lasting 4min. 49 seconds.
I've had multiple MRI's of the brain which remained the same just small white matter foci 2-3. It wasn't until the PET scan MEG and VEEG that all this turned up.  The doctor seems to think I am having multiple events during the day and night which I am not aware of so I agree he says they are partial sz.
on VEEG report: spontaneous activity says: there are frequent medium amplitude left temporal sharply contoured rhythmic theta that also evolves at times occuring at 5 Hertz lasting up to 4 presnt during sleep. Clinical correlation: mild bitemporal, left worse than right cerebral dysfunction.
He thinks that this "inflammation" is now whats causing the sz's. Which is why I'm recieving IVIG still.  Just not comfortable with this blanket diagnosis of this neuro auto immune disease.  I am comfortable with my doctor but cant help but question the diagnosis, maybe he just doesn't know?

[Abhijeet Deshmukh, MD]

Hello.

Temporal lobe seizures are partial seizures and are usually not associated with loss of consciousness. You probably have focal seizures, mostly absence seizures. Can you describe any specific movements during such an episode? Or was it only the VEEG that was showing the activity and you had nothing?

Your temporal lobe pathology is part of some bigger problem. It will help if you can mention any other symptoms you have.

Regards