What role does stress play in brain-related problems?

Hello doctor,

I am 37 years old. I had a prenatal stroke that caused neonatal seizures. While my brain continued to develop, I still had three small ‘dead’ spots in my frontal lobe and one large ‘dead’ area in my occipital lobe, as shown by MRIs. I am also significantly hard of hearing, which my last neurologist believed was due to the stroke affecting my auditory nerves. I take Lamotrigine to control my epilepsy and I have not had a seizure in 16 years.

When I was 29, I was diagnosed with REM behavior disorder (RBD). In normal cases, RBD often leads to neurodegenerative disorders, such as Parkinson’s, Lewy body dementia, and multiple system atrophy. However, very little is known about early-onset RBD. Since then, I have experienced some symptoms that, in older adults, would likely be diagnosed as one of these disorders (occasional visual hallucinations of a cat, brief auditory hallucinations, tremors in my hands and face, occasional memory lapses, typing incorrect words, and continued struggles with RBD).

However, because of my age, doctors have understandably been hesitant to diagnose me with a chronic condition. I also do not have any gait issues or confusion. Nevertheless, last month, I had trouble controlling the movements of my right hand. My handwriting became sloppy because I struggled to use a pen, I dropped things more often, tying my shoelaces was difficult, and I could barely sign ASL with that hand. However, these symptoms as well as the tremors, nightmares, and hallucinations have almost completely subsided during my vacation this past week.

The last time I saw my neurologist, she suggested that high stress could exacerbate my symptoms. Basically, despite being 37, I am a patient with brain damage caused by a stroke, so I may have symptoms similar to those of older individuals who have had strokes.

The recent issues with tying my shoelaces and holding a pen seemed to come on suddenly, but all other symptoms have been ongoing. I have had severe nightmares since I was young, so it is possible I had RBD much longer than diagnosed. My sleep schedule is often irregular, and I sometimes struggle to fall asleep even with melatonin. My sleep gets much worse when I am stressed or have too many responsibilities. Although my mother now has 'chemo brain,' the only other case of dementia in my family is my mother's half-sister.

I cannot see my new neurologist for a couple of months, so I wanted to ask: Is it possible that these symptoms are completely unrelated to neurodegeneration and more likely caused by stress, with the symptoms being more noticeable because of my previous stroke and brain damage? In other words, if I significantly reduce the stress in my life, as I did on vacation, are these symptoms likely to minimize or become dormant?

Kindly help.

Hi doctor,

Thank you for the reply.

I have attached the most recent vitamin D level from last year, which was measured while I was taking 2000 IU (international units). After this, the dosage was increased to 4,000 IU. When it was first diagnosed eight years ago, my level was 10. Vitamin D and iron supplements seem to control both the deficiency and anemia.

The RBD was diagnosed after a comprehensive overnight sleep study conducted by a doctor specializing in RBD. He reported that I had ‘no sleep architecture.’ This result, along with severe nightmares, talking in my sleep, extensive movement during sleep, and a history of sleepwalking, led to the diagnosis. It is mostly managed with melatonin, but I can tell a difference when I am overly stressed.

I have had EEGs in the past, including those intentionally designed to provoke a seizure, and they have always been clear. My seizures immediately following birth, as well as one when I was an infant, were classified as status epilepticus. The few seizures I had as a teenager and young adult (approximately five in total) were diagnosed as grand mal or tonic-clonic, with one being a reaction to Ambien (Zolpidem).

Brain atrophy was not mentioned, but ‘volume loss’ was noted in the MRI seven years ago. Please see the attached report.

I am diagnosed with bipolar disorder, but I feel it is well-controlled by both Lamotrigine and regular psychotherapy. Recent therapeutic questionnaires and tests have not indicated depression. I would say that the amount of stress I have been under recently has had a negative effect on my mood, but I do not feel that I have symptoms of depression. My roommate has observed visual hallucinations (which are only of the cat) and other issues stated earlier, but there are no noticeable behavioral changes.

Recent blood tests, including a CBC (complete blood count), were all normal.