Seizure Symptoms After TBI: TJ Part Twenty
Along with some of TJ’s interests we also discussed whether or not he had any seizure symptoms after TBI. We touch on how his mood swings could possibly be seizure symptoms after TBI.
Progress in rehabilitation has a lot to do with motivation. Yet, one of the areas often impacted after brain injury is motivation, especially if the injury is to the lower frontal lobes. I find therapies focused on areas of “high interest” like music or sports particularly promising because interest tends to leverage motivation. I probed this with Michelle:
Is there anything that he is more interested in that he, that might be, increase his motivation in terms of some of these things? The gym, for example, is something he likes.
Well, he’s, yeah, he’s very motivated in going to the gym. The problem with TJ is – one of the issues that I find… How am I going to explain this?
Okay, we have moods, we have highs and lows, which he has dramatic high and low, okay? But he basically keeps on an even keel, so if you said to TJ, we’re going to Disneyworld tomorrow, any other person or, I mean, I’ll just use Disneyworld because we know we all get excited about going to Disneyworld. So he would get, somebody would get excited. TJ doesn’t get excited. It’s the same as if you just said we’re going to sit by the pool for an hour.
They would use the word flat affect to describe what could be seizure symptoms after TBI?
Except when there are outbursts.
So you have a very flat affect, and fairly poor insight and then all of a sudden you have these catastrophic changes in mood?
When we started you said that those changes in mood could be set off by something as simple as good morning?
Is it possible that there isn’t any logical explanation for those outbursts other than some type of seizure symptoms after TBI?
It could be because sometimes I just don’t understand why he’s not understanding what I said. Why does that turn and trigger something? Because it’s like, what, how are you – and I’ll ask him that, you know, what did you hear me say that, why did you ask that way?
Well, you’ve been married long enough to know that there’s a certain resistance –
Disconnect between a man and a woman. Yeah.
That there’s a certain word that said at the wrong moment that will cause a flare-up in a marriage.
Men, being married you go through certain things even before you get married, and one of the things I remember from the marriage counseling prior to getting married was that they had us do a technique where it was like I would say something and how did you hear it, being a man, how did you hear that, repeat it back to me. I know that they hear things differently than how we say it, and we do the same exact thing.
That isn’t the kind of issue with what set him off?
The only thing I’ve done with TJ is what I call the vertical blind theory: When he starts outbursts, as much as I want to, I want to scream, I want to strangle him, I want to pull my hair out. It’s just, I mean, it’s like stop, stop, stop, and you want to yell that ….
I shut the blinds, he’s there, he’s still screaming, he’s still outbursting right in front of me, he’s safe, he’s there, I’m not going to let anything bad happen to him, but I cannot react back.
And that is difficult.
Will his outbursts stop as fast as they start?
Yes, and about three seconds later, well, I wouldn’t say three seconds, probably about three to four minutes later he does not remember like what he did.
Have you ever explained the nature of those outbursts to someone who’s actually looking at the seizure symptoms after TBI question to ask them if that is in fact a seizure?
Oh, yeah, we’re with his neuropsychologist, this is we’re trying to – yes.
In the context of the anger outburst?
And that’s why the latest thing that we’ve done is the sleep apnea machine. That is our latest progression of where we’re at and we’re hoping that with that, because the seizures are apparent. You can’t, if he didn’t lean forward like this and rest this arm on his leg you would’ve seen him tremor.
They have been declining, those tremors.
He’s been on the sleep apnea machine, and he was forgetting to wear it or he would say he would take it off during the night, but I really don’t even think that. I think it was that he wouldn’t even put it on.
Do you think he’s getting more sleep now?
I do. We, we had them come out and give him a new mask, so it’s more comfortable.
As part of the sleep study, has he had a portable EEG (also called an ambulatory EEG)?
I think they did that during, he went and slept overnight.
That would’ve been while he was at the facility.
Yes. Yes, at the faculty.
Have they ever sent him home with an EEG?
It’s something that it might be worth considering in terms of trying to figure out if his outbursts are seizure symptoms after TBI related. How many outbursts a day?
TJ’s father offered: “It depends on how much you talk to him.”
Yeah, it depends on… The more you interact with him, the more outbursts he’s going to have. And when he does outburst the one thing that happens is the tremors get even worse. I mean, he just starts.
If you monitored him for 24 to 48 hours straight, you would see some evidence of the outburst?
Yeah, you did, you try, and as cruel as this is going to sound, but you try not to have too much conversation with him. I mean, it’s not like I don’t talk to him at all, but we try to limit it because that is going to, it’s going to trigger an outburst.
One explanation for these outbursts from TJ would be subtle type of seizure and they could be seizure symptoms after TBI. Pointing towards such an explanation is:
- The lack of a objective stimulus to set off these outburst,
- TJ’s amnesia for events during the outbursts, and
- The rapid acceleration and deceleration of his temper.
In an excellent paper on what is called therein “Epilepsy Spectrum Disorder” (“ESD”), this type of seizure symptoms after TBI is marked by
a) “spells” or periods in which the patient reports losing track of time, staring, feeling as if they were in a trance;
b) b) intense, unprecipitated episodic affective disturbances involving feelings of anxiety, depression, or rage which remit suddenly;” 
This seems to describe what is occurring in TJ, yet the increase of such outburst with human interaction, might point to some behavioral reaction, versus the ESD.
While EEG technology is unbelievably obsolete in today’s high tech world, the frequency of TJ’s outburst make it worth attempting, regardless. An ambulatory EEG sent home with him, where he kept it on continuously for 24 to 48 hours, could possibly identify seizure symptoms after TBI.
 Applied Neuropsychology, 1995, published by Munksgaard, “Characteristics and Mechanisms of epilepsy spectrum disorder: an explanatory model”, M.E. Hines, C.S. Kubu, R.J. Roberts and N.R. Varney, pages 1-6. This paper can be read at http:// subtlebraininjury.com/seizure.html