Monday, November 3, 2014

The more I know.. the less I understand.

I was so full of hope in my last post. I thought we'd spend a few nights at NYU, capture a seizure on an EEG, and get Josie in the trial for epidiolex.

Well, that wasn't quite the turnout. Actually, we are more confused now than we were before going to NYU for the week.

So, Josie was admitted on a Tuesday. It was the only time I actually hoped for her to have a seizure. We needed it to be captured and it had been a few days since her last one, so chances were good that she would have one.

Well, she sure did put on a perfect performance on Wednesday night.

I noticed that her usual restless activity changed by the sound of her breathing. Rich and I recently realized that it's the sound of her breathing that lets us know it's starting to happen. She started to stiffen and went on to have a 12 minute seizure. A few minutes in, we gave her the Medazalin spray. It's the new rescue med that Dr. Davinsky prescribed. She continued to stiffen on and off, and after about five minutes she stayed stiff for at least 10 seconds. So we went for the Diastat.

Before this event, I had discussed with the doctor on-call and our nurse that in the event of a seizure, I have the rescue meds.

That was the plan.

I administered the Diastat and about one minute later, our nurse come running back in to the room and was about to give Josie another dose of Diastat in her butt.

I stopped her.

I don't even want to think what would have happened if I didn't catch this. We have strict instructions not to use Diastat twice in a 24-hour period. Medazalin can be used multiple times. It's a nasal spray that supposedly works faster and shouldn't have the prolonged knock-out affect after.

Anyway, the seizure ended after 12 minutes and Josie went right to sleep as usual. I felt like we just finished a race and we were standing on a podium with our giant trophy. After five EEGs in the past, we finally got the full-blown seizure on camera and on the EEG. Now, they will have the data they need.

Victory!

The next morning, our trophy was stripped away. The neurologist at the hospital those few days, Dr. Miles, who works with Dr. Davinsky, came into the room and told me that he has been watching the video and while he sees the event he said, "the EEG is not showing a correlation with it being a seizure."

Excuse me?

How is that possible? We gave two sets of rescue meds (Medazalin and Diastat). We used oxygen. She stayed stiff for 10 seconds twice along with at least 20 other quick "tonic" stiffening. The entire team of nurses and doctors saw it.

He went on to describe the "event" he saw. He kept talking about Josie's arms flailing around, but he wasn't mentioning the stiffening. I asked to sit with him and watch the video with him to point out each time she stiffened and to show him when she stayed stiff. So we sat in the viewing room and we watched. What an interesting experience to watch myself handle a seizure. I seemed calm.

When I showed him exactly what we consider a seizure from the face she makes, to her arms stiff across her body, and her legs straightening out. He saw it. He flagged each stiffening event for Dr. Davinsky to see and he saw the two prolonged events. But, he showed me how when looking at those black lines that show brainwave activity, they didn't change much along with these events.

The next day Dr. Davinsky told me he also reviewed the film and if he were to guess he would say these are seizures even though the EEG isn't correlating. The video shows a pretty obvious seizure event.

Dr. Miles said if he had to guess, he would say they are not. He said maybe it's very bad reflux and has something to do with her lying down. This was actually the diagnosis we got after the very first EEG we did, two years ago, in which she didn't have a seizure during so I never knew how we could rule it out and call it reflux. Dr. Miles said he's seen kids stiffen and arch their bodies from reflux. I just don't know. I would say 80% of her seizures happen lying down, but there have been many sitting up.

So what now?

Dr. Davinsky asked us to stay a few more nights to try and capture another. Ever win a race and then you're told to start over? Disqualified. Well, we stayed two more nights and even lowered her meds to try and bring another one on, but as it goes, she rarely has a seizure a day or so after a big one, she didn't have another. By Saturday morning we were more than ready to go home.

Separately, both doctors thought there could be something going on with her breathing while she sleeps. I've been concerned about this. They recommended we do a sleep study at the NY Sleep Center. We did this, which I'll get to in a moment.

First, I want to talk about the Ketogenic diet we started while in the hospital. Here's a recent article about it in which the dietician we are working with explains the potential benefits for epilepsy patients. It's pretty amazing how this has been working for so many people for so long.

Jose is tolerating the formula called Ketocal very well. It's actually delicious. Well, it's about 90% fat and it's vanilla flavored, how can it be bad? I won't lie, I thought about putting it in my coffee. It's been three weeks since she started and her ketone levels have been good every day. They say it can take at least a month to know if it's working. She's still having a seizure every two to three days, so it's not working yet, but I will say the last few seizures have been milder than others. I also don't know if that's because the Medazalin is working before it turns into a grand mal seizure. We shall see.

So, back to the sleep study. Well, that was an experience. Poor Josie had to have 26 probes put on her head again for another EEG. And that's not it folks, she had to wear a thin plastic tube across her face and in her nose, two belts around her waist, and EKG wires.

I asked if we can arrive at 6:30 pm instead of 7:30 so that they can get everything all set and she can be ready to sleep by her normal bedtime - 7:30. We did show up at 6:30, but they were not done with all the technical finagling until 10:30pm! And then the techs came into the room every five minutes. Finally, a tech said to me, "There are three techs watching her. She is hooked up to every machine to monitor her. You should sleep." He told me to turn off my cell phone since it could interfere and just go to sleep. I was in a big bed with Josie and I thought I'd never actually be able to sleep.

The next time I looked at my watch it was 9:30 am! We both slept.

The results of the sleep study showed that Josie has mild obstructive apnea. That doesn't surprise me. They saw that she was restless and her brain was active all night. We are seeing an ENT this Friday and we will also see the sleep neurologist as well.

I feel like Sherlock Holmes. I got copies of the DVDs and reports of both this last EEG where she had the seizure that didn't correlate and of the EEG from April where our neurologist saw enough seizure activity to start her on anti-seizure meds. I'm having both neurology teams review both EEGs. Will Dr. Davinsky see the seizure that Dr. Maytal diagnosed as a seizure? What will Dr. Maytal think of the non-correlating event?

In speaking with Dr. Davinsky's Nurse Practitioner yesterday, she said they'd like us to try again to capture another seizure on an EEG.

I just have to sit back and breathe - deeply - for a moment before I can think about putting Josie through this again so soon.

In the mean time, I've asked Dr. D. if we can ween her off one of her medications as it's clear none of them are working and this one, Keppra, is the one that we think is causing her restlessness at night.

So that is where we are right now. So much to figure out. Many more doctors to see. Perhaps more hospital stays. But we will figure it out!


To be continued....

2 comments:

  1. What a coincidence! The results from Tay's sleep study are coming back. Although the analysis in not yet complete, the neurologist called back and said he has sleep apnea. This isn't something that I have ever noticed. I thought that maybe the discomfort with the head wraps and nose tube thingy caused this reading. We have also been referred to an ENT to follow up. I wonder if this is common among all of the kiddos.

    I hope a CPAP machine isn't the recommended course of action. I am not that familiar with them, but I hear they are loud and uncomfortable to sleep with. Tay will not be pleased...

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  2. I know this frustration well. I know my child and finally said to the neuro at the time, no more EEG 's. I know he's having seizures and I don't have to prove it to you. We moved on to our present neuro. Let me tell you something as an RN. Trying a new drug on your child to prevent seizures is like throwing jello at the wall to see if it sticks. " Well, the blue jello didn't stick, maybe the red jello will" . One day they will understand that when the brain is formed COMPLETELY DIFFERENT from the brains they used to develop these meds, and EEGs, YOU CANT COMPARE SEIZURES OF A FOXG1 child to any other seizures!!!!

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