August 6, 2009
ROYAL PAINS MEDICAL BLOG
By Dr. Irving Danesh

Hi, this is Doctor Irv and I hope you have had a healthy week.

In this week's episode of Royal Pains ("It's Like Jamais Vu All Over Again"), Hank has to diagnose a teenage girl with strange symptoms. She sees strange lights and has problems doing simple tasks that she has done hundreds of times before. Ultimately, Hank diagnoses her as having simple absence seizures.

A seizure is defined as physical findings or changes in behavior that happen after abnormal electrical activity occurs in the brain. There are many types of seizures depending on where the abnormal electrical activity occurs in the brain or what is going on in the body or environment at that time.

Some of the different types of seizures are:

1. Generalized tonic/clonic seizure
2. Partial or focal seizure
3. Petit mal or absence seizure
4. Fever seizure

Symptoms of seizures include everything from shaking and twitching to a state of staring and unawareness of the environment around the patient.

Generally, seizures are caused by brain tissue that has been damaged. The usual causes of damage are trauma, stroke or tumors. This damaged tissue can become an electrical short circuit that can initiate waves of abnormal brain activity.

Other causes of seizures can come from outside the brain. Certain drugs can cause the abnormal brain activity. Fevers that come on quickly in children can cause febrile seizures. Patients whose blood sugar drops to a certain low level can have a seizure. Patients who have a sudden drop in blood pressure, where blood can't flow to the brain, can experience a seizure. In come cases, a seizure can occur but the physician can't find a cause.

In this episode, Hank diagnoses Beth as having simple partial seizures, which come from one part of the brain. The International Classification of Epileptic Seizures (ICES) states that in simple partial seizures the patient stays alert and can remember what happened to him or her.

The ICES has divided simple partial seizures into 18 categories. Beth's type of seizure is classified as Psychic simple partial seizures. These come from the temporal or limbic region of the brain including the amygdala, hippocampus and parahypocampal gyrus. The patient usually has perceptual hallucinations or illusions. These hallucinations can be very complex. They can be visual or auditory. In some cases, the patient may experience déjà vu or a sense that he has already experienced a situation or sensation. In Beth's case, the patient knows that she has done something or experienced something many times, yet it feels like the first time. This is called jamais vu.

Patients usually experience fear when having the seizure but may experience happiness, sexual arousal or anger. The patients may also have a sense of depersonalization; unreality, forced thinking and other feelings.

Treatment of a simple partial seizure starts with drug treatment. Many current anti-epilepsy drugs work in these kinds of seizures and are usually chosen for individual patients on the basis of tolerance for the drug.

Sometimes surgery can play a part in the treatment. If a localized physical source in the brain is found, it may be removed to treat the patient. Usually epilepsy experts are consulted to make sure that this is the best treatment and that the surgery itself will not cause other problems from collateral damage to the brain.

Till next blog have a happy and healthy week,

Doctor Irv