What is happening to my son?

[LizM66]

My 16 year old son has been having some unusual episodes over the last 4 months which have lead to hospitalisation but no diagnosis of what is happening to him.  Symptoms include headaches, pain in his side, passing out (possibly seizures or vaso vagal syncope), vagueness when coming to and general weakness, pale, sweaty/clammy.  Sometimes disoriented (doesn't know day, time etc).  Incontinence is becoming more frequent (2 - 3 times a day) without being aware that it has or is happening.  Often becomes agitated after episodes and then sleeps for approximately 1-2 hours. EEG is normal.  Doctor has suggested Psuedo seizures but the incontinence worries me because this does not seem a normal part of psuedo seizures.  

Had epilepsy as a child (4 - 9 years old), Meningitis age 2, Osteomyelitis (right wrist) age 4

[Dr. Kokil Mathur]

Hi
Thanks for the post! How is your son now?

Past history of epilepsy should be kept in mind. Was your son on any medications when the EEG was done? Sometimes certain medications hamper the result. Also “If the doctor thinks that a person has epilepsy but the EEG is normal, the technologist running the EEG test may have the person look at a flashing light (photic stimulation), breathe fast and deeply (hyperventilation), or sleep during the test. These techniques sometimes show epileptic EEG patterns that did not show up at first. If epilepsy is suspected after an initial EEG, the doctor may repeat the EEG more than once.
An EEG done during a seizure will almost always show abnormal electrical patterns. This makes an EEG useful when a doctor thinks that a person is having psychogenic seizures (pseudoseizures), which have no physical cause but can be caused by stress, emotional trauma, or mental illness. Psychogenic seizures do not cause abnormal electrical activity in the brain and will not show abnormal EEG results.
Other tests that may also be done include:
Video EEG. Video EEG records seizures on videotape and on computer so that the doctor can see what happens just before, during, and right after a seizure. This test can be very helpful in finding the specific area of the brain that the seizures may be coming from. It is also helpful in diagnosing psychogenic seizures, which may look like real seizures but do not affect the electrical activity in the brain. Video EEG may be used short-term or long-term:
Short-term monitoring is done on an outpatient basis and may last up to 6 hours.
Long-term monitoring is done in the hospital and may last 3 to 7 days.
Brain mapping. Brain mapping is a fairly new method that is very similar to EEG. With electrodes placed on the person's scalp to transmit the brain's electrical activity, a computer makes a color-coded map of signals from the brain. It is sometimes done to find a specific problem area in the brain that has already shown up on a regular EEG. Doctors are still not certain how brain mapping could be best used.
Ambulatory EEG monitoring. In ambulatory EEG monitoring, the person is able to move around, and the test allows for long periods of time in recording of electrical activity in the brain. Fewer electrodes are attached to the person, and the person carries a small, portable recording unit. The recording may last for a full day or more, and the person is allowed to leave the hospital. Ambulatory EEG monitoring is not as accurate as a regular EEG.”
An attempt should be made to rule out epilepsy all together. Once this is done and it is confirmed that it is not epilepsy, then only pseudoepilepsy be thought of. Incontinence as you rightly said is a feature of epilepsy, and rare in pseudoepilepsy. Hence it is important to rule out epilepsy completely.

Hope this helps. Please let me know if there is any thing else and do keep me posted. Take

[Bhupinder Kaur, MD]

Hello,

How are you?
Without physical examination and investigations,diagnosis is difficult but various possibilities are there for your son’s symptoms.

For syncope/fainting to occur, either the reticular activating system in the brain needs to lose its blood supply, or both hemispheres of the brain need to be deprived of blood, oxygen, or glucose.One of the possibility is of encephalitis.It is an acute inflammation of the brain. It can be caused by a bacterial infection (primary encephalitis) or may be a complication of a current infectious disease like syphilis (secondary encephalitis).

Sometimes, there are partial or complete blockages in the arteries that supply the brain with blood.  These blockages can cause a temporary loss of blood flow (called transient ischemic attack, or TIA for short), or permanent loss of blood flow (called stroke; also called cerebrovascular accident).This can lead to impaired blood flow through these arteries and so such symptoms.Stroke is an important possibility because it is often associated with incontinence.Other important possibility is of space occupying lesions likie tumors or aneurysm.

I sincerely advise you to consult a neurologist because confirmatory diagnosis can only be made only after a detailed neurological examination and CT/MRI head.

Hope this helps.Take care and pls do keep me posted on how your son is doing or if you have any additional queries.Kind regards.