Neurobehavioral Extremes: Lethan Part Six
Probably the scariest things for a family after severe TBI, are the neurobehavioral extremes, wild mood swings and temper outbursts. While a teenager returning home to his parents is not nearly as dangerous a situation as when a man returns home to his wife, the nature and extent of these neurobehavioral extremes are rarely appreciated before discharge. It is something that if you haven’t lived through, you will probably not understand. Lethan touches on neurobehavioral extremes in the voice of his sister. Lethan first sets the stage:
Now some of you may have noticed that I haven’t spoken about my sister much yet and that’s because I mentioned her twice earlier in the story but I haven’t really focused on her version of the story because her story is so different. It doesn’t easily fit into the frame of mind story that we’ve been using. But I want to highlight her story here because my sister tells the story of a young woman who witnessed her brother’s accident and rehabilitation.
Then speaking as his sister about his neurobehavioral extremes:
I was halfway through my eighth grade year. He had just dropped me off at school when it happened and I witnessed the whirlwind of action and drama that surrounded the accident. I witnessed how hard both my parents worked. I hardly saw either of them for two months. And I witnessed the explosion of joy when he returned home from the hospital. That must mean he was better, right? Maybe now things could return to normal. Maybe even a better normal?
And I witnessed the difficulties with the return, the inconsistency of moods. I remember getting into fights with him, being afraid that I was going to be hit, the hand would raise, pause, and I witnessed the struggle between rage and reason on his face.
And he did hit me once; not hard but it hurt. And I wanted to help. I wanted to help bring my brother back home. I wanted to be part of the rehabilitative process but I never knew what I could do; what my job could be until one day I heard my brother and my father fighting downstairs and it was pretty loud so I remained upstairs. And when the screaming had stopped I ventured downstairs and I saw my father curled up on the couch. Crying. And my father soon saw me and pulled himself together and carried on but at that moment I knew my job.
I had be strong. Independent. I had to stay out of the way so that my parents could take care of my older brother. I didn’t understand it but I knew what I had to do.
And so my sister quietly displayed her strength, remaining true to her ideals and her belief despite this world of chaos around her, becoming an inspiration and a role model for her older brother,
Our future story of TJ will give a mother’s perspective on those wild temper outbursts and neurobehavioral extremes. What is the underlying cause of these outbursts the neurobehavioral extremes? Is it confusion and agitation? Is it pain? Is it resistance to the severe loss of independence? Lethan’s words:
Everything I could do all had to change. But I didn’t know what I wanted to do now. I didn’t even know what I could do now. I’m being given all these simple tests to do and when I do them right they all celebrate like I’m some 4-year-old. I’m NOT four. And what does it matter anyway; as soon as I get one thing finished, there are always ten more things to do. And I was tired. I wanted to rest. I was done.
Yet, in many ways these neurobehavioral extremes are childlike. Part of the problem is that there is little inhibition left to modulate the neurobehavioral extremes. Still, it is clear that it is more than the inability to control temper. Something is really “pissing them off”.
One factor is that everything after a severe TBI is so hard. Frustration, neurobehavioral extremes and impatience, synergistically combine. One analogy would be going through life as if stuck in a traffic jam, with total loss of patience and no capacity to avoid road rage.
While not well understood, it also likely that the cerebral cortex has become abnormally sensitive to stress and heightened neural signaling. In such cases, it may be that a type of seizure disorder is contributing to the loss of control. See the discussion of epilepsy spectrum disorder in the paper by Hines, et. al. at http:// subtlebraininjury.com/seizure.html and the pages thereafter.
Seizure disorders do not start and stop with grand mal and partial seizures. The same type of abnormal electrical signaling on the surface of the cerebral cortex, can also cause a whole host of abnormalities, including wild changes, called lability, in mood. More focus must be paid to this element of neurobehavioral abnormalities, particularly because medications that assist in controlling seizures may help in this area as well.
Epilepsy Spectrum Disorder symptoms include the following neurobehavioral extremes: a) “spells” or periods in which the patient reports losing track of time, staring, feeling as if they were in a trance; b) intense, unprecipitated episodic affective disturbances involving feelings of anxiety, depression, or rage which remit suddenly; c) episodic cognitive disturbances, including problems with speech articulation, confusion, feelings of jamais vu or deja vu, and paranoid ideation; f) episodic olfactory, gustatory, visual, haptic, and/or auditory hallucinations/illusions; and e) suicidal ideation and/or a history of previous suicide attempts. It is important to emphasize both the episodic nature of these symptoms within the context of normal functioning between episodes and the absence of clearly epileptiform findings in the patients’ EEG records.