The Need for MRI with Epilepsy Protocol in Evaluating Temporal Lobe Epilepsy (TLE) after a Normal EEG
**Age:** 40 **Gender:** Female **Condition:** Diagnosed with Schizoaffective Disorder (though there's some debate about whether this may actually be Bipolar 1 with OCD or a blend of related issues), ADHD-Combined Type **Current Medications:** Loxapine, Lithium **Substance Use:** None I have a complex psychiatric background that spans several years. While my symptoms don't seem to have worsened significantly, I believe that my ability to manage these symptoms has declined as I've aged, particularly with the added pressures of parenthood and career demands. I've never engaged in drug use except for a failed attempt at mushrooms long after my mental health challenges began, which resulted only in a headache with no other effects. There have been times when I went without medication and felt fairly symptom-free for up to 18 months, apart from my ADHD struggles. However, after turning thirty, I haven’t experienced such breaks—although I've only attempted a gradual medication reduction once; most of my previous stops were abrupt. A recurring issue has been that my illness manifests in an unusual manner, which might itself explain my symptoms; my functioning and overall presentation, despite being unwell, often don’t resonate with what is typically expected based on my diagnosed symptoms. Recently, my therapeutic team advised a scalp EEG to rule out Temporal Lobe Epilepsy (TLE) after I reported experiencing notable olfactory hallucinations over the previous year and a half. Some other symptoms have also aligned with TLE, including: - Jamais vu - Sudden and inexplicable feelings of joy or panic that don't relate to my situations - Blank stares (though I attribute these to my ADHD rather than dissociation) - Short, frequent visual hallucinations - Rare auditory hallucinations - The olfactory hallucinations mentioned - Possible autonomic nervous system features, though I'm unsure - Auras - Palinopsia - Ongoing psychotic episodes, which sometimes intensify in ways I find difficult to articulate - Hypergraphia - Delusions involving themes of aliens and religion - A consistent sensation of another presence or feeling "the presence of God" Essentially, I'd likely meet the Geschwind criteria with the exception of reduced sexual interest. However, the aforementioned symptoms and behaviors don't consistently manifest together. If they were indicative of seizure activity, wouldn't they occur in clusters? Another important point is that my mental health crises can last weeks or even months, unlike seizures which are typically fleeting; although certain symptoms can arise transiently during heightened episodes of illness. **Exclusions from My Symptoms:** - Deja vu - Significant cognitive disturbances - Taste hallucinations - Automatisms (though I wonder if individuals are aware of these) - Behavioral interruptions - Numbness - Bedwetting - Full-blown seizures - Headaches The scalp EEG I underwent was normal and covered by insurance, reporting, "Final Interpretation: Normal EEG study in the awake state. No electrophysiologic abnormality." Even the supposed signs of TLE were quite weak, indicating a minimal buildup of slow activity during hyperventilation, along with significant eye movement artifacts. Despite these findings, I have been advised to consider financing an MRI with an Epilepsy Protocol, which poses a considerable financial commitment for me. Would this examination be justified?
Answers (1)
4/3/2025, 12:10:47 AM
OpenHealth AI
Thank you for sharing your comprehensive history and concerns regarding the possibility of Temporal Lobe Epilepsy (TLE). It’s understandable to seek clarity on the necessity of further testing, particularly given your complex psychiatric background and the symptoms you described. Here’s a structured response to help you make sense of the situation:
Main Points:
- Normal EEG Result: Your recent scalp EEG was normal, indicating no immediate evidence of seizure activity.
- Symptoms and Further Evaluation: While some of your symptoms align with TLE, they don’t consistently manifest in a way that suggests seizure activity, which complicates the decision about further testing.
- MRI Consideration: An MRI with an epilepsy protocol can provide more insight and may help in cases where there are unexplained symptoms, even with a normal EEG.
Explanation:
An EEG primarily assesses electrical activity in the brain, and a normal result reduces the likelihood of seizures occurring during that time. However, TLE can sometimes be episodic, meaning abnormalities might not be captured during the EEG if not coinciding with an event. Symptoms like olfactory hallucinations or emotional disturbances can indeed be related to TLE, but they may also overlap with psychiatric conditions, which makes diagnosis challenging without further imagery.
MRI scans can reveal structural issues (like tumors, lesions, or scarring) in the temporal lobe that might not show up on an EEG. This kind of imaging can be crucial in forming a more complete picture and could guide future treatment options.
Next Steps:
- Assess Budget for the MRI: Since financing this MRI poses a concern, consider discussing payment plans or asking your healthcare provider if there are programs that could help with costs.
- Discuss Symptoms with Your Care Team: Bring these findings and your hesitations about the MRI back to your healthcare providers. They can clarify how an MRI might change your treatment options or management plan.
- Monitoring Your Symptoms: Keep a detailed diary of your symptoms, noting when they occur and their duration. This information can be invaluable in future consultations for both EEG and MRI interpretations.
- Explore Alternative Strategies: If you’re hesitant about the MRI, ask about other management strategies for your symptoms, including therapy, medication adjustments, or lifestyle changes that can alleviate some challenges without the financial burden of further testing.
It's essential to prioritize your mental and physical well-being, and I encourage you to keep an open dialogue with your therapeutic team about your needs and concerns. Remember, you are navigating a complex situation, and ensuring you have the right resources and support is key.
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