I have been diagnosed with hypomania. It is an interesting diagnosis, not easily achieved. I am impressed by the diagnostic work the medical professionals involved went through.
But what kinds of tests did I get? How did those tests eliminate (mostly) physiological brain issues like epilepsy? It was an interesting process
First it was a seizure
My initial incident on December 15 looked, to the medical professionals, like a seizure. They treated it as such with fairly “blunt object” anti-seizure meds as well as Ativan and haloperidol. This all calmed me down- unsurprisingly if you know much about the drugs.
Then the hunt for a neurological (physical) cause began in earnest. The tests included:
- MRI (Brain / head): looking for brain lesions
- Numerous blood and urine test: looking for oddities in the blood that could prove a particular infection or diagnostic path to investigate e.g.: ammonia buildup in the blood which can cause seizures
- CT scan (Brain /head) with contrast: also looking for brain lesions
- note that I already knew I had such lesions. I also knew that such lesions really prove nothing as they are common to people of a certain age. They are generally considered ‘idiopathic’ i.e.: unknown cause so long as they are clean of cancer and show no scarring. My brain holes meet all these requirements and even appear in exactly the right place for temporal lobe epilepsy i.e.: the temporal lobe
- Lumbar puncture: looking for infectious matter beyond the blood/brain barrier by drawing fluid from the spine . Lumbar punctures used to be called “spinal taps”, so I can no claim affiliate membership in the Band. In my case they scanned for many things including evidence of encephalitis
The only ‘solid’ evidence found in my testing was the temporal lobe lesion which I already knew about. It could be part of TLE, or it could be nothing. Epilepsy requires (apparently) brain lesions, but brain lesions don’t directly cause epilepsy. Regardless, treating the problem as epilepsy seemed to be the best course for the start of things.
“Proving” hypomania
A couple of psychiatrists were brought in to consult on my case as the doctors started to sense that the evidence wasn’t all adding up for TLE. The psychiatrists asserted that TLE didn’t have the right indicators for my behaviour, particularly that my original incident didn’t sound quite like a seizure. To them it sounded much more like a manic episode instead of an epileptic seisure.
The psychiatrists proposed hypomania, but it is really hard to ‘prove’ a psychiatric diagnosis when nice physiological ones are right there in front of you as an option. A brain with a hole in it is provable and somewhat ‘obvious’: a brain which simply isn’t functioning within normal parameters is not so obvious.
To prove my hypomania diagnosis the doctors admitted me to the psychiatric ward. Under close supervision they began titrating down my anti-seizure meds while switching over to anti-mania meds. The main seizure med they reduced for me was Keppra aka Levetiracetam. I did well on the reduced dose of Keppra, so they kept on reducing it until they and Irene felt safe with me going home- that was January 5th.
I’ve been off Keppra entirely for about two weeks now. So what does eliminating Keppra prove? Well, nothing with regards to my condition’s diagnosis is a certainty. In fact, the meds I’m still on – notably divalproex – have a milder anti-seizure effect. But the fact that I’m doing better without Keppra is a good sign that mania is more likely than a seizure-related malady like epilepsy.
For hard evidence I guess I have to look to the EEG I had last week. A lack of clear seizure markers in that test should put a theoretical nail in the proverbial coffin of temporal lobe epilepsy (TLE) for me. Basically, the neurologists will be back to having some idiopathic holes in my temporal lobe with no epileptic element, which kind of closes that chapter.
I see the results for my EEG on my personal health portal have these two promising (to me) sentences.
There are no epileptiform abnormalities.
No signs nor symptoms during the recording.
I’m no doctor, but that sounds like “no epilepsy found” to me. I’m pretty sure that is the last “hard” evidence I’m going to get that TLE is out of the diagnostic picture. I’ll get more feedback from a visit I have booked tomorrow with my psychiatrist.
