What Causes Seizure Like Episode After A Dental Procedure?

Question: Hi, my name's XXXXXXX and I'd like to ask you for help with the diagnosis of my symptoms.

About a year ago I started having some sort of 'seizures' (I'll call them seizures but I don't know what they actually are). The first time they happened was after I had my wisdom teeth taken out about 1 year ago. (I also have orthodontic braces on my teeth). The episodes usually come in the morning (but sometimes they wake me up during night) and happen 3-5 times a day on that day. I get such 'seizure' days in about once in six weeks, always 2-3 days after an orthodontic appointment. During the seizure, I feel a strange sense of pleasure coming from my stomach, then I get something like a dream while awake. It's a sequence combined of memories (things that actually happened) but there are also things which don't exist in the real world. It's extremely fast and lasts for about 10 seconds. There's so many things that happen in the episode that I rarely remember the content afterwards. As the dream approaches the end, I start feeling nausea, but I never actually vomit. After the episode I'm extremely tired. These episodes come completely out of the blue with no possible trigger I'm aware of. (they happen in different times of the day in different places).

I've been feeling extremely tired for the last two years and it's been getting worse and worse. It's a strange type of fatigue - my body works OK, I can even do exercise as usual but it's like there's some sort of fog on my eyes (but no distorted vision). I have difficulty concentrating, remembering things (including my friend's and family's names occasionally). I have difficulty finding words to say in a sentence. I feel some sort of pressure at the back of my eyes and it makes my eyes hurt and makes me blink a lot. The fatigue is the worst after sleeping in the morning, after eating lunch in the afternoon; and it's least bad at about 9pm for an hour when I almost suddenly 'wake up' for a while and most of the symptoms remit by 50%. So the fatigue is mainly psychological rather than physical, it feels like I'm heavily drunk or after a lot of mental work. The fatigue has a regular daily cycle and is independent of what I do during the day. Sometime it's so bad I can't even get out of bed until the evening. Strangely, sometimes it helps to drink a glass of wine.

I'm getting occasional twitches all over my body, especially in fingers. I have difficulty reading as can't coordinate my eyes properly - they jump over words at wrong intervals so I either misread words for something else or I omit them. My handwriting is also quite strange as my hands are stiff. In addition, I have all body tremor, but especially prominent in my hands. It’s greatest when I use my muscles with low to moderate strength, when I rotate my wrists or when I’m holding something such as fork and knife. I constantly feel all body internal resting tremor, which is, however, not visible. I get most tremor when using my muscles.

I saw a neurologist a month ago, who ran the following blood tests: basic bloodwork (red, white cells, lymphocytes, basophil, and many others), liver function test, Serum electrolytes, Thyroid function test, urine microscopy, vit B12, serum ACE, folate, Serum C protein, Complement C3 C4, erythrocyte sedimentation rate

ALL TESTS CAME OK WITHIN RANGE

In addition, the neurologist did a physical examination:

“on neurological examination, there was no neck stiffness. Fundoscopy did not reveal any signs of papilledema. His pupils were wide but light reactive. His visual fields were full to confrontation. He had full external ocular movements without nystagmus. His visual acuity was normal. There was no facial asymmetry. The lower cranial nerve exam was normal. On the limb exam there was no weakness, no evidence of ataxia, reflexes were symmetrical, plantar response was flexion, sensory was normal, Romberg was negative, gait was normal. In summary, I think the recurrent episodes can be clinical presentation of temporal seizures. "

I also had a MRI of brain done, and NOTHING WAS FOUND.

I further saw an otorhinolaryngologist, who did one sleep study and FOUND (no fluctuation of oxygen during sleep or heart rate).

What do you think could be happening to me and what would you suggest that I should do?

I don't take or have ever taken any drugs, except alcohol and caffeine in small amounts and very occasionally. No history of any illness or epilepsy. No family history of any illness.


Thanks for your help.
XXXXXXX

Thank you so much for such a detailed answer!

I have one follow-up question. My neurologist said that the episodes are probably temporal lobe epilepsy.

What probability in your opinion is there that these are anxiety-related episodes and not temporal lobe epilepsy? In that case, what are they?

Thank you again,
XXXXXXX

Thanks again!

So if nothing is found on PET and EEG recording and anti-epilepsy medications don't help then it's most likely anxiety disorder, am I right?

If the anti-epilepsy medications, on the other hand, do alleviate my symptoms such as fatigue, then it is epilepsy.

Thank you!

One more observation that may contribute to diagnosis - I've noticed that if I sleep fewer than 6 hours, although my body feels tired, I feel much better (sharper and less heavy in the head). Strange indeed.

One more question. I've read about the Chronic Fatigue Syndrome, which some doctors believe might be caused by a hidden infection (or so I have read). Is there a chance that I could have that instead of anxiety/epilepsy and if so, would you recommend a virus/bacterial screen (and what kind of)?

Thanks so much. You've been the most helpful from all the doctors I've spoken too. I'll make sure to give you the best possible rating and review.