Hello,

The odd sensations she describes would be generically referred to as NEUROPATHIC SENSATIONS and I do not believe these are in relation to her epileptic condition.

If she is confirmed to have an epileptic condition by way of EEG studies and clinical judgment being treated with topiramate as monotherapy then, the neuropathic sensations may be investigated by way of testing her for metabolic causes of neuropathy.

For example, has she had thyroid studies such as TSH and FT4, Vitamin B12 and Vitamin D assays, electrolytes to include Magnesium and Calcium levels, and glycemic indices checked for diabetes or prediabetic considerations?

If any of these fall outside the limits of normal for someone her age then, perhaps specific treatments to normalize chemistries would lead to improvement of symptoms.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Dariush Saghafi, Neurologist

Hello,

Generally, patients with vague or difficult symptoms to explain that could be classified as neuropathic in some way should be evaluated for metabolic deficiencies.

In a previous response to your question I detailed the chemistries I would check. However, if these are negative then, what she's describing as a reflection of stress or anxiety should be considered in the differential.

It could be that education and counseling using RELAXATION TECHNIQUES to include directed visual imagery, biofeedback, and deep breathing exercises can lessen the intensity of these symptoms if not due to metabolic derangements of any sort.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Dariush Saghafi, Neurologist

Hello,

People with seizure disorders that are under very good control as in your daughter's case typically do not have such symptoms during what is known as the interictal phases (between seizures).

They usually do not report sharp, stinging, or electric sensations in the limbs.

As I've outlined in 2 other responses to this question there are a series of lab tests that could be performed to rule out metabolic abnormalities.

However if negative then, the likelihood an organic cause could be the explanation to her symptoms becomes less and the chance of there being psychological underpinnings to what she refers become greater.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Dariush Saghafi, Neurologist

Hello,

I've responded in detail to this question in other similar or identical queries placed.

However, another possible set of possibilities to explain electrical sensations in the limbs may come from degenerative arthritic processes that could be found in something such as STILL'S DISEASE (juvenile onset rheumatoid arthritis).

If she were to undergo a series of PLAIN FILMS (not CT scan since this puts out 200x more radiation than an X-ray) of the cervical and lumbar spines in an effort to localize any bony prominences or calcified prominences that could be causing the electrical sensations.

Bubbles under the skin are more frequently referred by patients who are undergoing stressful periods or having episodes of generalized anxiety.

She may benefit from having a Global Assessment of Functioning (GAF) Score determined which will indicate current levels of anxiety which may also help explain potential reasons for her yearly episode of seizure.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Dariush Saghafi, Neurologist

Hello,

What you're describing could be symptoms of some type of neuropathy which is a 15-year-old with 1 yearly seizure who is on daily topiramate could be due to a side effect of the medication itself through the more common side effects we hear about are tingling sensations in fingers, toes, lips, or nose. At least where neuropathic symptoms are concerned.

These symptoms are also manifest by stress and anxiety in the case where no organic cause can be revealed.

I'd be curious to know exactly how the diagnosis of epilepsy was "CONFIRMED" if she only has 1 yearly event and for how many years has this been occurring.

It may be worthwhile looking at a couple of confirmatory diagnostic tests to see if she really does have an underlying epileptiform disorder which is that cyclical since epilepsy doesn't typically behave this way.

For example, has she had an MRI scan with gadolinium and fine cuts through the TEMPORAL LOBES looking for mesial temporal sclerosis? Has she had a prolonged SLEEP DEPRIVED, 60 min. EEG?

Has she had a 72 hr. ambulatory EEG which can be worn home then, returned to the diagnostic center for processing of the information?

If the seizure occurs once yearly is there a particular season, month, or anniversary around a very stressful event that occurred such as an accident, death of a close friend or family member, or any other factor that could precipitate the event so that she may actually be videotaped on the given day she has her episode?

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Dariush Saghafi, Neurologist