Diagnosed with seizures-Negative EEG

[LovebugLPN]

I saw a patient in her early 30s who was under observation for frequent falls and periods of "blacking out". She had many tests including an EEG, MRI with dye, CT Scan with dye, and labs. All came back negative and she was sent home with no real diagnosis. Another EEG was performed (24 hour) and also came back negative. She was still diagnosed with seizures and will lose her driving license for many months. I thought that a diagnosis of seizures was only possible with positive documentation after an EEG. Has anyone else ever heard of this happening? I am just extemely curious to hear from anyone else about this. Going by symptoms and signs these definetely sound like seizures due to the fact that she has reported having them since she was young and having a "feeling" before one happens. If you went by symptoms only everyone (doctors included) thought these were seizures but again no proof besides.

[vashtee, RN]

My daughter has a history of seizures, but was taken off of her depakote because it was causing menstrual problems. Because she is a teenager, her neurologist felt it was likely she would outgrow her disorder (not uncommon). After she had been off the meds for 6 months or so, she felt like she was "losing time" (her way of describing absence seizures. She had 2 EEGs, both were negative, but her doctor put her back on a low dose of Lamictal.

I guess just because they can't reproduce a seizure on demand doesn't mean they aren't having them.

[LovebugLPN]

I guess what I really don't understand is how can someone lose a driving license for something that has no proof? It was also suggested she may be having atypical migraines and that the meds that were used to treat these migraines are also the meds used to treat seizures so either way they would work for her. I guess I just feel bad watching her lose her license for a diagnosis that has no proof.

[santhony44, MSN, RN, NP]

I've seen people who have seizures who have "normal" EEGs except when the seizure was actually taking place. Most people with seizures have negative MRI's, CT's, and so forth, as well.

I worked in an epliepsy monitoring unit for 5 years. Sometimes it took a week or longer of monitoring patients constantly to get a seizure on EEG; that included doing things like tapering them off meds, sleep depriving them, and so forth. Some of them never did have one.

We also had quite a few patients who proved to have cardiac issues, so sometimes cardiac testing for these patients can be a really good idea, too.

[vashtee, RN]

I guess what I really don't understand is how can someone lose a driving license for something that has no proof? It was also suggested she may be having atypical migraines and that the meds that were used to treat these migraines are also the meds used to treat seizures so either way they would work for her. I guess I just feel bad watching her lose her license for a diagnosis that has no proof.

I know it seems harsh, but I would feel worse if she had a seizure while driving and hurt herself or someone else.

BTW - the license restriction is only temporary. Still inconvenient, I know.

[santhony44, MSN, RN, NP]

I guess what I really don't understand is how can someone lose a driving license for something that has no proof? It was also suggested she may be having atypical migraines and that the meds that were used to treat these migraines are also the meds used to treat seizures so either way they would work for her. I guess I just feel bad watching her lose her license for a diagnosis that has no proof.

Wouldn't you feel worse seeing her, or someone else, lose their life? There's a reason people who have seizures aren't supposed to drive.

[LovebugLPN]

I know you guys are right about this issue and these things are without a doubt very true. I just felt bad watching her and realizing that her life in a way was being lost. She has no family except for her son, lives in a very remote area with no public transportation, and after this diagnosis her husband wants to leave her. She is a nurse and unable to work without transportation (which, again, she does not have). I guess I just got too involved but for some reason my heart is breaking for her. But again her heart would be more broken if something happened to someone else due to her not being able to function properly while driving.

[morte, LPN, LVN]

might well be a migraine....in some quarters they are considered to be related to seizures anyway.....but cardiac issues should be ruled out, before she loses that whole year.....

[LovebugLPN]

might well be a migraine....in some quarters they are considered to be related to seizures anyway.....but cardiac issues should be ruled out, before she loses that whole year.....

She was given an EKG and labs were drawn what else could have been done?

[morte, LPN, LVN]

i would think a 24 hour holter monitor.....not a cardiac RN here.....perhaps some one of those could advance a few thoughts?

[LiverpoolJane]

I have come across a few pts with siezures but EEG was NAD, but I work in renal and the cause in most cases it was metabolic. One female pt had the Docs scratching their heads and I done a little research and found an article on codeine causing seizures and on investigation it transpires this pt is self medicating huge doses of the stuff. It may be worth exploring more obscure causes other than neurological.

[Penelope_Pitstop, BSN, RN]

i know that on the form i've seen sent to the dmv, it does not necessitate a diagnosis of seizures. it makes mention of blackouts, however. i wish i could remember exactly how it was worded.

jess