Brief Answer:
Hello there---so glad you've returned for a little more discussion

Detailed Answer:
Good afternoon and I'm glad you've returned....your case has crossed my mind a few times since last we chatted. Are you feeling any better of things in general? I hope so....now your questions....so let's review them.

I believe the BEST MEDICAL answer to your first question is "NOT LIKELY" as it pertains to seizures showing up on a "brain scan" but actually, I need you to clarify WHICH brain scan you are referring to? I understand that you really WANT this to show up on an MRI so I'm assuming that's what you're talking about but see below for a bit more explanation and then, choose the right clarification.

Seizures are electrical phenomenon in the brain which cause people to do everything from act funny, act forgetful, act goofy, to full out lose consciousness, jerk all the limbs, and in some unfortunate instances get severely injured. That's what seizures are from both an electrical as well as physical manifestation perspective.

Therefore, if by BRAIN SCAN you are referring to is an imaging study of the head to show architecture and topography such as x-ray, CT, or MRI then, the answer is NOT LIKELY since the only things one could see on such studies would be ANATOMIC or ARCHITECTURAL anomalies, bleeds, scars from strokes or penetrating wounds, etc. Seizures would not likely cause any of those things to happen.....even if neuronal circuits have been continuously or aberrantly stimulated as you say you had undiagnosed temporal lobe seizures for 4 years....even in that instances the physiological activity is nothing that an MRI or CT scan is designed to detect. But now read on young lady.

If on the other hand you were referring to a brain scan as being something such as an EEG (electroencephalogram) or even a PET scan which shows metabolic activity in different parts of the brain then, that's a different story and it is very possible that even if you've had seizures diagnosed in the past but have now been free that there could still be ABNORMAL ELECTRICAL or METABOLIC ACTIVITY that can be detected. In other words, if you're seizure free because you are on medication and have been very compliant but seizure activity is still present...even though physically you're controlled it could still show up on one of these tests I mentioned if it were of a degree that could be detected by the sensitivity of the machines.

If, however, the seizures that once were present, have since vanished....and that sometimes happens after a person is treated continuously then, such tests would be negative for abnormal electrical activity and they would also likely be negative for any detectable physical damage in the form of scarring or architectural changes such as atrophy (shrinkage), encephalomalacia (scarring), etc.

I'd like to also clarify one answer that a colleague gave to you about a week ago which is a good study to have done, MRI with seizure protocol.....that type of study also is not designed to detect DAMAGE so much as it can detect structural RISKS of things in the brain that can elevate the chances of having seizures and especially in the temporal lobes. What we look for in that case is something called MESIAL TEMPORAL SCLEROSIS. We don't find it often....but that's not exactly what you're wanting to find if I understand you correctly.

Well, again, it's nice that you're sent this question in and I am able to answer it for you...perhaps, I've explained myself a bit better this time around.

BTW, I am grateful for the very nice feedback you've given in the past so thanks a bunch. Are you a basketball fan at all? Of course, Atlanta's got an excellent team....anyways, didn't know if you were following the finals games in the NBA...but we're all XXXXXXX Cavaliers fans here....so tonight is the deciding battle between the Cavs and the Goldenstate Warriors....GO CAVS.

Looking forward to your response. Be well.

This query has utilized a total of 31 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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Brief Answer:
Speculation vs. facts

Detailed Answer:
I hear what you're saying and can appreciate that you feel something is organically wrong but I would like to point out (as hopefully the professional voice of reason between the 2 of us) that there is just far too much speculation and not enough facts. I'm sure you can appreciate that in medicine we can't treat complex things such as neurological disease without having a diagnosis backed up with some degree of diagnostic certainty. At the very least, we need to know that we've done all the tests possible to rule in or rule out an organic process before discussing treatment options. We cannot institute treatments especially controversial or dangerous things such as surgical or drug treatments on the basis of what patients feel without validating those symptoms by scientific means.

Therefore, talking about stem cells and other treatments are very premature and is at best speculative. What we really need which is a diagnosis.

By the same token, there's no need for you to be a "guinea pig" in a situation where standard and conventional approaches to diagnose you have not yet been tried.

Of course I think there is a good chance for you to feel better and more like your "old self" but if all we are going to do is talk about it and then, I'm afraid your chances at recovery are diminished. Makes sense, right? Let's get some things moving here and start a dialogue with your doctors. If you are not happy that your current provider is enough of a listener then, it's up to you to make a change. The best specialist that can help given your history of temporal lobe seizures and how you're feeling now would be an epileptologist....but then, you need to also have confidence in their abilities and desire to help and follow their lead both diagnostically and interventionally.

Therefore, if you were my patient in XXXXXXX OH (home of the Rock 'n Roll Hall of Fame....and the currently battling Cavaliers for the NBA championship tonight, the XXXXXXX Orchestra, and the World Headquarters for DUCK TAPE) I would put you through the following paces:

1. Neuropsychometrics need to be done. You may think this sounds as if I am trying to make this a "mental" condition and that's not true at all. Neuropsychometric analysis is sometimes more sensitive than imaging studies can be in terms of localizing and describing functional brain problems (as well as detecting damage) compared to MRI or PET scans. Therefore, a good NEUROPSYCHOLOGICAL battery should be performed by a tester who is very aware of the picture of temporal lobe seizures and what that can look like once seizures have been suppressed.

2. EEG performed (possibly sleep deprived) for baseline data which can then, be superimposed upon the imaging study of your doctor's choice.

3. Imaging study that rounds out the workup

a. FUNCTIONAL MRI (fMRI)
b. PET scan (depending upon what the EEG shows).

This query has utilized a total of 83 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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Brief Answer:
Enrolling in stem cell trials

Detailed Answer:
Thank you for your clarifications. I would very much like to see you get all the things done that you could use in order to figure things out but there are simply some requests out of mine or any other physician on this network's control. Making a referral to an experimental or investigatory protocol for stem cell transplantation would be one of those things. In order for this to happen the requirement is that the physician referring you be your PRIMARY care provider and I am not he/she. They are going to request prior medical records, prescriptions, specialist consultation notes, etc. All that information is at either your primary doctor's office or at the neurologist who diagnosed and treated you before. You could certainly ask your doctor if they would be willing to make such a referral.

I'm not aware of any trials that are going on for stem cell transplantation to accomplish the clinical effect you're looking for but I'm happy to point you in a direction that you may be able to further investigate to see if you could be enrolled in such a program since I clearly can detect your passion and desire to get better and would not want to see you miss an opportunity you think has merit and ultimately could help.

Again, my own professional opinion and approach to resolving the problem as you've described and outlined in detail-- if this were happening to myself or someone in my family-- would be to get a firm diagnosis by way of testing. If you've had the MRI and EEG then, that's great (that's half the battle). I would then, submit myself or my patient to EITHER a neuropsychological consultation or for a PET SCAN of the brain. Though getting both would be optimal if cost were a factor then, I would choose one or the other...depending on which was less. My guess is that the neuropsychological testing would be cheaper...but I don't know for sure. Sometimes if you tell a facility that you're paying out of pocket they'll work out a very economical deal. For example, I can tell you that for my patients who have no insurance I can send them to get MRI studies done of the brain for $350.00. That's a fraction of the cost they XXXXXXX for patients with insurance coverage which is sometimes upwards of $4000-$5000.

So, I would think that PET scanning would be the same and a neuropsychologist would similarly likely work with an indigent or less than optimally covered insurance patient in the same way by only requiring a minimum consultation fee for their services. You just have to let them know up front what your financial constraints are.

And then, after I had obtained the results of EITHER the neuropsych testing or the PET scan I would sit down with an epileptologist or neurologist and ask what my options are depending on what was found. I understand that neither the MRI nor EEG showed anything of a significant abnormality in your case.

Again, to reiterate; my approach toward all patients for neurological assessment is to think ORGANIC first and then, if I cannot offer anything in terms of medication or intervention (physical rehabilitation, exercise therapy, cognitive rehabilitation, etc) then, refer back to the primary doctor or to another specialist for further workup or analysis.

But in the interest of giving you something that you could look further into or present to your primary doctor- let me provide you with the following link:

http://rarediseases.org/

and their phone number of: 800-999-6673

If you start with them they may be able to help direct you to more specific physicians, programs, or even research protocols to accomplish what you're trying to do. They even have patient advocacy and patient assistance programs which may include paying for expensive procedures and/or medications for medical conditions in folks who cannot afford them and are felt to be deserving.

This query has utilized a total of 115 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Your charitable comments are much appreciated about our interaction if you have no further questions.

All the very best.

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Brief Answer:
Get better Soon

Detailed Answer:
I am hoping that some of the information will help you feel better soon. All the best.

Your feedback and brief comments are greatly appreciated on our current transaction.

Regards and All the Best.

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