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HomeAnswersNeurologyseizureAre there epilepsies that do not cause physical seizures?

Is there any epilepsy that does not cause physical seizures?

Is there any epilepsy that does not cause physical seizures?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Hitesh Kumar

Medically reviewed by

iCliniq medical review team

Published At January 19, 2017
Reviewed AtAugust 3, 2023

Patient's Query

Hello doctor,

I have been suffering from a wide array of mental symptoms for around nine years. Some years ago, I went to see a neurologist. He took an electroencephalography (EEG), and found "epileptiform activity", I think in temporal lobes. So he said I have epilepsy and prescribed Valproate. He said my depersonalisation and anxiety were caused by my epilepsy. However, I never had a physical seizure nor an absence and neither have my family noticed any. Also, my symptoms did not improve after one year of Valproate. To make matters worse, some months after quitting Valproate, I developed a psychosis. I have also tried other antiepileptics as part of my treatment following this episode. These include Gabapentin, Carbamazepine and Phenytoin. My symptoms have not improved. Generally, I am feeling malaise and psychotic-like thought patterns after sunset, with anxiety, social anxiety, etc. Could all of this be caused by some underlying neurological problem? Why did the EEG show epileptiform activity? If I do have epilepsy, in spite of not having seizures, why have not the antiepileptics done any good? Are there epilepsies that do not cause physical seizures and also one is not aware of absences because they are very short? Can this type of epilepsy also cause psychiatric symptoms? What would be the best medication for my case? I took a single photon emission computed tomography (SPECT)/positron emission tomography (PET) which showed reduced blood flow to the right frontotemporal lobe. The magnetic resonance imaging (MRI) scans were normal. I also have enlarged liver, rapid heartbeat with palpitations, Epstein-Barr virus infection, history of high eosinophils, history of allergies or bronchitis, history of folliculitis, childhood meningitis and chronic diarrhea (10 years, diagnosed as irritable bowel syndrome (IBS)). Recent results showed elevated gamma-glutamyl transferase (GGT), low blood chloride, elevated morning cortisol and adrenocorticotropic hormone (ACTH). After the psychotic episode results showed low blood potassium. Currently, I am taking Aripiprazole, Phenytoin, Gabapentin, Amoxapine and high dose of vitamin B3 and B6.

Answered by Dr. Hitesh Kumar

Hi,

Welcome to icliniq.com. EEG (electroencephalogram)is not a diagnostic tool in itself. EEG can show abnormality in a normal person and also can be normal in epilepsy patients. Few EEG changes can be seen in normal and abnormal conditions. As you mentioned that your symptom is psychotic like, these can be either psychosis or seizure too. It has to be correlated clinically. For that, I need to know your symptoms in detail. I suggest getting video EEG during the symptom. The medicines Valproate and Carbamazepine have been used in psychosis also. Gabapentin and Phenytoin are not much effective for psychosis. You need to consult a neurologist and psychiatrist again with a good detailed clinical history. You may need to get a long-term video EEG to look for any EEG changes during your symptom.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Hitesh Kumar
Dr. Hitesh Kumar

Neurology

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