Dr. Hitesh Kumar
Neurology
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Patient's Query
Hi doctor,
I had an electroencephalogram (EEG) done and the results were abnormal. I have attached the reports. What do the results mean? Can I be treated? If yes, then how? I take Aripiprazole, Fluoxetine, and Oxybutynin. I am diagnosed with depression, anxiety, and urinary incontinence. When I was a child (2 or 3 years old), I had encephalitis. When I exercise for a long period of time, I feel like I partially lose consciousness. I have urinary incontinence since 21 years of age.
Hello,
Welcome to icliniq.com. I would like to know some details about your symptoms: 1. What exactly happens in the episode of partial loss of consciousness. Is it the feeling of surroundings rotating around you? Is it the feeling of you rotating yourself? Is it the feeling of impending doom with increased heart beat and rapid breathing? Do you feel any blurring of vision during the episode? Do you feel any blackening in front of eyes during the episode? 2. Do you remain fully conscious and aware of surroundings during the episode? 3. Are you able to see the surroundings and hear the surrounding sounds that time? 4. Have there been urine incontinence or tongue biting during the episode of partial loss of consciousness?5. Has anyone seen the changes in your body during the episode? 6. How long does one episode last? 7. How is your day to day mood? 8. How is your sleep? 9. How is your magnetic resonance imaging (MRI) of the brain report? Some abnormal electroencephalogram (EEG) changes can be seen in normal individual, and it can be normal in a sick person. So, it always has to be clinically correlated. I would like to see the EEG graphs. I suggest you send the EEG scans here as an attachment.
Patient's Query
Thank you doctor,
I do not have a feeling of my surrounding rotating or a feeling of me rotating. I do not feel impending doom with increased heartbeat and rapid breathing. I do not feel blurring of vision, but I do feel a bit of blackening in front of my eyes like I am not as visually aware of my surroundings as normal. During the episode, I feel less aware of my surroundings, and I feel a bit less conscious. However, I can still talk. During that time, I can hear the surrounding noises, but I feel like I cannot see the surroundings completely. People around me see that I am resting to try to recover and talking less. I think that an episode lasts 2 to 5 minutes. My day to day mood is lower and more depressed than average. I sleep a lot; about 12 hours when I can. It may be due to the antipsychotic medication I take, but nine hours when I have to wake up early. I do not wake up during the night, and sometimes I have difficulty falling asleep. I had an magnetic resonance imaging (MRI) of my brain, and the results were normal because the doctors did not tell me of any abnormalities. I am sorry, but I do not have the electroencephalogram (EEG) graphs anymore. The EEG is actually old, and I was told that it is not valid anymore. However, I wanted to ask what you think about the results. I do not have the MRI scans with me right now, but I can upload them later when I get access to them. What does it mean that EEG changes have to be clinically coordinated? Thank you.
Hello,
Welcome back to icliniq.com. Electroencephalogram (EEG) has to be clinically correlated means that EEG abnormality in alone does not make any diagnosis, except few specific pattern. An EEG can be normal in a known epilepsy patient, and it can be abnormal in completely normal person. EEG abnormality can be due to many reasons, like medicines, lack of sleep, or otherwise too, which may be specific or nonspecific. So any abnormality in EEG is significant only if that is relevant with the clinical details, which is called as clinical correlation. Your clinical description is not suggestive of seizure or epilepsy. But it is not appropriate to comment on EEG without seeing the graphs. If you are so anxious, you can repeat the EEG now. Maybe, the current EEG will be completely normal, and then your anxiety will reduce drastically.
Patient's Query
Hi doctor,
Thank you for explaining. I now understand what it means that electroencephalogram (EEG) has to be clinically correlated. I may have another EEG done. Do you think the episodes of feeling less conscious normal? Does everyone experiences this when they exercise too much? My psychiatrist told me she thinks those episodes are anxiety, and I went to a psychologist who said she thinks it is dissociation. Also, I found that antipsychotic medication helps with this problem and makes it easier for me to exercise. If I do not sleep enough, I feel less conscious too.
Hello,
Welcome back to icliniq.com. Feeling of being less alert may be due to exhaustion from heavy exercise. But that is not completely normal and not everybody experience such feeling after heavy exercise. As you saying that you can hear surrounding voices clearly, you are not unconsciousness at that time. But not able to see things clearly during that time, looks a little odd. These symptoms can be related to severe anxiety during that time. Also, you noticed an improvement by the antipsychotic medications. But I would like to rule out some cardiac issues, which may get precipitated by exercise, that is, HOCM (hypertrophic obstructive cardiomyopathy) before labeling it to be psychological or anxiety related. I suggest you get the following tests done: 1. 2D echocardiography. 2. 24-hour Holter monitoring. 3. Bilateral carotids and vertebral arteries Doppler.
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