Seizures often misdiagnosed as epilepsy, actually stress: Study
People sometimes joke about being so stressed out that they're about to burst an aneurysm. Unfortunately, for the estimated six million Americans whose brains harbor an aneurysm – a dangerously weakened portion of a blood vessel – that's not so far from the truth.
In a study published recently in the journal “Stroke,” scientists pinpointed eight everyday activities can cause a brain aneurysm to rupture and bleed – an often-deadly event known as a subarachnoid hemorrhage.
Click to see all eight triggers – and keep clicking to find out what you should know about protecting yourself against brain aneurysms. istockphoto
(CBS News) Seizures are the only visible symptom of epilepsy – but that doesn't mean all seizures indicate epilepsy, a new study shows.
Many patients are admitted to hospitals for seizures that look epilepsy but are actually triggered by stress and poor coping skills, researchers found.
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These seizures, called psychogenic non-epileptic seizures (PNES), are often found in patients such as returning war veterans, mothers in child custody battles, and overworked professionals.
For the study, published online in the journal Seizure, researchers from the Johns Hopkins Hospital looked at 40 patients with PNES, 20 with epilepsy, and 40 healthy volunteers.
Participants reported their stressful life events over the past five years and the amount of stress these events induced.
Each group reported roughly the same amount of stressful events, but the PNES group reported much higher levels of experienced stress associated with the events.
The results suggest people with PNES don't actually experience more stressful events than people with epilepsy or healthy people, or have actual neurological problems, researchers say – but they seem to lack effective coping mechanisms to deal with stress.
“These patients behave as if they have an organic brain disease, but they don't,” study author Dr.
Jason Brandt, professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine, said in a university written statement.
“And it turns out that their life stresses weren't all that high, but they're very sensitive to stress and they don't deal with it well.”
According to researchers, people with PNES are less ly to plan a course of action during stressful life events, using denial to ward off anxiety instead. Patients with PNES also tend to have other problematic behaviors and unstable relationships.
How common is PNES? A 2005 study published in the journal Neurology found that 54 percent of patients were misdiagnosed with epilepsy (through misreading of EEGS). Dr.
Gregory Krauss, study author and a neurology professor at Johns Hopkins, said he is surprised by how many patients have been referred to his epilepsy unit without actually having epilepsy.
Krauss says that as many as half of his patients in recent months have had pseudo-seizures.
Misdiagnosis of seizures as epilepsy is also costly, leading to unnecessary doctor visits, medications and hospitalizations in specialty units. The study highlights the need to focus more on cognitive-behavioral therapy that helps patients strengthen their coping skills.
“There's a lot of stress out there in our modern society, and this research highlights that many people don't have the skills to cope with that,” said Krauss.
First published on April 13, 2012 / 11:31 AM
© 2012 CBS Interactive Inc. All Rights Reserved.
Innovative surgery grants teen two years seizure free, new perspective
Shawnee High School freshman Morgan Kelly participated an epilepsy awareness video following her laser ablation surgery at Johns Hopkins Hospital to tell her journey to through the surgery and what it’s done for her (Krystal Nurse/The Sun).
Then-10-year-old Morgan Kelly experienced her first seizure four years ago and come January, she’s ready to celebrate two years seizure free thanks to an innovative surgery.
Morgan was a normal active fifth-grader when, during a soccer game, the ball rolled toward her and she had walked in the opposite direction, zoned out.
“All I could remember was my coach yelling my name and I couldn’t move,” Morgan explained. “I was in fifth grade and it was pretty scary because I had no idea what was happening to me.”
Morgan’s mom, Cindy, said her daughter didn’t have any other medical conditions or head injuries prior that would trigger a seizure.
“It took some testing and different hospitals and doctors visits to actually find out that she would have non-convulsive seizures,” Cindy said. “She would stare for a little bit and check out, then not know what happened.”
Following multiple visits to different doctors, specialists and hospitals after being diagnosed with epilepsy, Morgan landed at Robert Wood Johnson where a doctor recommended her to Johns Hopkins Medicine in Baltimore, Md., for a laser ablation surgery, which was fairly new at the time.
Epilepsy is a neurological disorder that causes seizures and comes in different forms, according to the Epilepsy Foundation. An estimated 3.4 million Americans have epilepsy and experience different types of seizures (non-convulsive, Grand Mal, etc.).
Morgan’s seizures became more severe over time and weren’t helped with medication, which led to the surgery recommendation at the Maryland hospital.
“She was basically socially isolated because she was in and school so much, so it was hard to keep up with activities and friendships,” Cindy said. “It was really controlling her life. We were hoping that even if the surgery could cut down the severity of the seizures, then that’d be great.”
Morgan underwent surgery on Jan. 5, 2018 and, since then, has been relieved of her seizures. Doctors inserted a laser scope in Morgan’s temporal lobe through the back of her head, and destroyed the seizure-causing area with heat.
Since the surgery, Morgan has been pulled off two of her three medications and hasn’t experienced a seizure. The duo said a follow-up doctor’s appointment will tell them if Morgan can stop her last medication.
The family was approached by Johns Hopkins in 2018 to document Morgan’s journey with epilepsy and the good that came the laser ablation surgery. The video detailing her experiences was published in August 2018.
“For me, it was scary and I couldn’t imagine anyone else who had epilepsy, (who) was younger than me,” Morgan admitted.
She later stated she was fearful what would happen to younger kids when they grow up and still had epilepsy especially with how the seizures can cause the changes Morgan experienced. The video helps her explain along the way how the surgery positively affected her life and the leaps science has made for this to be possible.
Morgan had resumed playing soccer in 2018, however, she stopped by the recommendation of her doctor. As a freshman at Shawnee High School this year, she became active again and joined the Renegades’ freshman volleyball team. The low-contact sport allowed her to build new friendships and gain a sense of oneness with her team.
“I started as a team and finished as one, which felt really good to be a part of something,” Morgan said. “I missed that feeling and enjoyed it when I got to have it again.”
The experience has made Cindy an advocate for Morgan to seek other professional advice before landing at Johns Hopkins. She also developed a deep sense of compassion for those who have “hidden health ailments” such as Asperger’s or depression, or are even just going through a tough point in their lives.
“We might not have the same disease or situation, but we all learned along the way as far as being a health advocate or how social things affect us,” Cindy said. “There’s so many things that I would love to be able to talk to support groups or caregiver groups about, and just help people to let them know they’re not alone.”
After experiencing her neurological disorder, Morgan has hopes of studying the brain and people’s behavior throughout high school and into college – and to try-out again for the volleyball team.
“Socially, it was hard for her because she was a really active kid and it took a lot her,” Cindy explained, “but that all being said, there’s opportunity to get life back and get it under control somehow, whether it’d be medications or surgery.”
“It was definitely the scariest time in my life, probably, and there were times when I’d say ‘I’m done’ and want to give up fighting this to see what happens,” Morgan said. “But my family would push me and since I didn’t give up on that, I’m almost two years seizure-free.
“I give them credit for that.”
Establishing an Adult Epilepsy Diet Center: Experience, efficacy and challenges
Volume 58, May 2016, Pages 61-68
Over 250 medical centers worldwide offer ketogenic diets to children with epilepsy; however, access to these therapies has been extremely limited for adults until recent years. We examine our 5-year experience creating and implementing a dedicated Adult Epilepsy Diet Center designed to provide adults with epilepsy access to ketogenic diets.
Outpatients seen at the Johns Hopkins Adult Epilepsy Diet Center from August 2010 thru September 2015 age 18 years and older were enrolled in a prospective open-label observational study. Patients that also enrolled in ongoing clinical diet trials were excluded from this study.
Participant demographics, diet type, urine and/or serum ketones, laboratory studies, seizure frequency, diet duration, reason for discontinuing diet therapy, and side effects were recorded.
A subgroup analysis of participants that met International League Against Epilepsy (ILAE) criteria for drug-resistant epilepsy (DRE) and were treated de novo with a Modified Atkins Diet (MAD) was performed to compare outcomes with the current literature regarding efficacy of other antiseizure treatments for DRE.
Two hundred and twenty-nine adults attended the Adult Epilepsy Diet Center, and 168 met inclusion criteria. Two-thirds (n = 113, 67%) were women with an age range of 18–86 years at the initial visit.
Thirty-five participants (21%, n = 133) were already on a therapeutic diet while 79% (n = 133) were naïve to diet therapy at the time of the initial visit.
Diet-naïve participants were typically prescribed MAD (n = 130, 98%), unless unable to intake adequate oral nutrition, in which case they were prescribed KD (n = 1) or a combination of oral MAD and ketogenic formula (n = 2). Twenty-nine of 130 (22%) participants prescribed MAD elected not to start or were lost to follow-up, and 101 (78%) began MAD.
A subgroup analysis was performed on one hundred and six participants naïve to diet therapy that met International League Against Epilepsy criteria for DRE, were able to tolerate oral nutrition, and were prescribed a MAD.
Relative to the number of enrolled participants who had reliable follow-up results for a given duration (including those that ultimately elected not to start or were later lost to follow-up), at 3 months, 36% of these participants responded (≥ 50% seizure reduction) to diet therapy, and 16% were seizure-free.
At 1 year, 30% responded, and 13% were seizure-free. At 4 years, 21% responded, and 7% were seizure-free.
Hyperlipidemia was the most common side effect (occurring in 39% of screened participants, including those on a therapeutic diet prior to the initial visit). Weight loss was also common (occurring in 19% of all participants treated with a ketogenic diet therapy) yet was often an intended effect.
This study, the largest series of adults with epilepsy treated with ketogenic diet therapies to date, provides evidence that ketogenic diets may be feasible, effective, and safe long-term in adults, although long-term adherence was limited and further adequately controlled studies are necessary to determine the efficacy of ketogenic diets in the treatment of adults with epilepsy.
AEDCAdult Epilepsy Diet CenterView Abstract