Daughter with Migraines, seizures, conversion disorder?

Health Professional

Full Question:

I have been reading your site for the last year and a half and have found it helpful. My daughter is 16 and was diagnosed with complicated migraine (has both hemiplegic and basilar symptoms).

They seem to be triggered by glucose and severe upper respiratory colds. About 1 year ago she started to have unconsciousness for 30-60 minutes, and then seizure approximately 1-3 minutes during the unconsciousness, the head pain usually follows if there is any at all. The clusters seem to happen in the fall and the spring for a duration of a week or so. She has had an EEG that showed an awake state (alpha rhythm) during the entire EEG with no change, but she was unconscious and unresponsive to painful stimuli and photic stimulation.   I know you can have seizure induced by migraine, but can it be non-epileptic or can the seizure be deep enough in the brain that the EEG could not pick it up? She is being followed by a Neurologist, but because this disorder is not common they are questioning conversion disorder.

Thank you, Diana.

Full Answer:

Dear Diana;

This is a very difficult issue to understand and perhaps resolve. 50-60% of EEG monitoring in an EEG lab are negative when a person is worked up for a possible seizure disorder. Thus conversion disorder often arises as a "diagnosis" EEG abnormalities do not have to be seen at the time of a seizure-like episode but a board-certified EEG reader (only 6% of all neurologists) should be able to detect even minor abnormalities or irregularities in the record. Abnormal events, even from very deep structures, are directly part of an ongoing EEG recording from the surface of the scalp. Repeat EEGs can show abnormalities where previous ones didn't. We have had patients with suspected seizure-like episodes show EEG changes on the 3rd, 4th or 5th EEG but not on previous ones. High-grade EEGs, 20-30 or more channels of data, may pick up more minor abnormalities than older units with fewer electrodes placed. You have to know the reader, the quality of the recording done by the technologist and the machine. EEGs aren't created equal.

Good luck,
John Claude Krusz and Teri Robert

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