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Epilepsy and Narcolepsy EEG readings

Fri, 05/13/2016 - 14:36
Hi everyone, this is a long confusing story about my 7 year old son's journey. I'm just hoping that MAYBE one person out there has had a similar experience and has advice or even knows what we are talking about. Our team of doctors aren't sure what to do next and have mentioned Sleep Neurology at Mayo Clinic in the future. So, thanks for reading- sorry if you see this cross posted in another forum, there wasn't a great fit to put this in! My 7 year old has Epilepsy for sure, and probably Narcolepsy with Cataplexy. The cataplexy is easy to see and diagnose and it is very very super rare to have Cataplexy without Narcolepsy. His team of doctors and myself and my husband are trying to wrap our minds around how these two medical issues are mingling in our son's brain. The issue goes like this: Noah is almost always in a cycle of having generalized seizures that exacerbate the Narcolepsy/Cataplexy. He sleeps all day at school, collapses all the time or cannot hold up his head, and when he's awake he's so irritable and defiant. But once or twice a year things will settle and he'll be a COMPLETELY different boy: helpful, no memory issues, no naps needed, sleeps well at night. Then in a blink he's back to looking/feeling/acting off. After 2 years of trying to figure this out we are finally seeing a pattern on his EEGs. First EEG was a sleep deprived at age 5, this was the first time he was acting "off" and his EEG was abnormal but just focal in one spot. His MRI was clear but things were getting worse and he was having complex partial seizures. Once he was on a bigger dose of Carbamazepine and Keppra things settled but he was having memory issues and times when he was hallucinating and being tired and weak, a 48 hour EEG said no abnormalities while on Carb and Keppra. Right after this EEG he had his first seizure that was different and involved stiffening. For the next year he was better and manageable when he had his lapses of being sleepy/weak. But then in August of 2015 this became worse than ever. We had started to wean Carb and keep Keppra the same. By October he was non-functioning at school. The teacher called an emergency 504 meeting and the school nurse who rotated between a few schools in the area was assigned to stay at Noah's school full time for his unpredictable care. At this point he started seeing a Sleep specialist who is also a developmental Pediatrician. She witnessed Cataplexy and Noah falling asleep in the office, but we couldn't get a sleep study for several months. He was started on stimulants and weaned off of all seizure meds because the Neuro felt his issues might have been just Narcolepsy/Cataplexy all along and not seizures. Beginning of March 2016 Noah had a sleep study (which is an EEG) and he had been feeling GREAT, even off of stimulants. His EEG was clear, no abnormal brain waves, and his sleep was "unstable" but okay. 2 days later he was feeling bad again. I asked about his ongoing memory issues that were getting worse and worse and his Neuro had him do another sleep deprived EEG. If you sleep deprive him a little he gets really bad with irritability and muscle weakness and non-responsiveness. He had several seizures during that EEG and showed a lot of generalized sharp spike and wave discharges. His seizures during that EEG were ones where he would do a weird hollow laugh and his arm stiffened out to the side and his legs curled up to his chest and he started arching his back and rolling off the table. During sleep he had a ton of the same generalized discharges. So this time they put him on Depakote and since that EEG 2-3 weeks ago he's not felt well for one minute. He can barely participate in life. His sleep doctor found it very interesting that his EEG swings back and forth and if you sleep deprive him a little it sets everything off and we have a very hard time getting him back to baseline. It's very hard for us to tell when he is having absence seizures, but we think he has them a few times a day, or when he is post-ictal sleepy or just sleepy, or is post-ictal weak or is cataplexy weak. We've increased his stimulant to try and push him past this new Anti-Epileptic medication sedation (he never got used to the Carb or Keppra and he was on it for 2 years). But so far no luck- it's like he's not on stimulants at all even though he's sleeping through the night and for 11 hours a night even on school days. PLEASE, please if you have had any experience even sort of like ours I'd love to hear from you! Even if it was you, or a sibling, or your child. 2 years of watching my son have an awful quality of life is hard.

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