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Suggest Treatment For Low BP And Seizure Reactions
Question: Hi please can you comment whether you feel based on the attached reports and symptoms that i require a further neuro /endocrine investigation. I have had several bouts of dangerously low bp last one 64/40 on high doses of neuro meds. Also had many focal type seizures reactions to meds. Please can you suggest what further blood tests/scans could be done to disgnose TBI/pitruitry dysfunction. So far all routine blood tests spparently "normal" but havd had frequent xcessive sweating in cold weather for a year, poor cognition and recently high bp . Could the low bp episodes have worsened the injury caused when knocked by car in 2006 and had post concussion and caused the pitruitry stalk deviation and endocrine problems? In your opinion is there enough medical evidence here to warrant further neurological investigations?please can you advise me on your conclusion from reports symptoms and photo and advise me on necessary blood tests/scans to determine problem thankyou
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I am sorry about the symptoms that you are feeling.
Looking at the files you have uploaded I see only an MRI report, which is from the year 2011. If I was to judge from the MRI alone I would have said that you do not have much to worry as apart from the deviation there is no other finding, everything else is perfectly normal, the pituitary parenchyma doesn't show any visible lesion.
However I see there that you have had a very high prolactin level. That calls for hormonal measurements at the time and also periodic follow up. Usual initial tests are cortisol, thyroid, prolactin, oestrogen, testosterone and growth hormone levels. Blood glucose, electrolytes, kidney and liver function, blood count are also advised, perhaps done already.
As for the possibility of low blood pressure causing damage I do not think you should worry about that, that happens only in extreme cases like cardiac arrest, those episodes are not enough to justify that. I do not think further neurological investigation is necessary based on the current information.
I remain at your disposal for further questions.
Read below.
Detailed Answer:
I read your question carefully and I am sorry about the symptoms that you are feeling.
Looking at the files you have uploaded I see only an MRI report, which is from the year 2011. If I was to judge from the MRI alone I would have said that you do not have much to worry as apart from the deviation there is no other finding, everything else is perfectly normal, the pituitary parenchyma doesn't show any visible lesion.
However I see there that you have had a very high prolactin level. That calls for hormonal measurements at the time and also periodic follow up. Usual initial tests are cortisol, thyroid, prolactin, oestrogen, testosterone and growth hormone levels. Blood glucose, electrolytes, kidney and liver function, blood count are also advised, perhaps done already.
As for the possibility of low blood pressure causing damage I do not think you should worry about that, that happens only in extreme cases like cardiac arrest, those episodes are not enough to justify that. I do not think further neurological investigation is necessary based on the current information.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Many thanks for your response i feel more reassured.
I have now attached the EEG report. At the time I was on higher doses of neuroleptic medication which was the culprit for the episodes of low bp and of 'seizure like' episodes where my head would tilt backwards looking up at the ceiling and my eyes would roll backwards. I must have had 50+ of these episodes without treatment over cause of a year or two and eventually i was put on Limotrojean medication, 200mg at the advise of a specialist mental health hospital. These episodes then stopped, as it was anti epileptic medication could it mean that I was having seizures as reaction to medication? They stopped this medication after a period and I have not had a fit like episode for over a year. When i did have them i was on high doses of meds. I have had 'premonitions' of a fit in last year but no actual fit. The specialist hospital reduced my Abilify in last 6 months or so to 10mg and velafaxine is 150mg but to be honest i do not feel i need these medications as im not physcotic or depressed. My main problem feels like a neurological one and some physcological effects of trauma which has lowered my self esteem but although i used to suffer high anxiety when younger these days its mild even when not on medication, if anything i feel too physiologically calm. I feel I may have neuroreceptor problems, connection problems, wiring in brain which is causing lower activity/abnormal brain wave rhythums but dont know if this medication is designed to help this or whether it could be hindering it? Can these connections/activity improve over time now on a low dose? I do not hear any voices, nor have i ever, the problem is low confidence/trauma from past events which I am getting physcology for and I am able to get on with life despite, (i work part time, keep ordered life etc,) my health concerns. My doctor is going to possibly lower the velafaxine medication to see if it aids faster brain processing/ lessens the fogginess and improves activity and hopefully then i wont be so tired and have more anxiety response. What are your thoughts re this? It may lessen the sweating too as she said it can be a side effect from that medication. I have a question regarding the EEG, why does it show Theta waves (sleep waves) when i was awake? Why is there an abnormal alpha wave? Why was there no response from taking deep breaths and photic stimulation? To me that implies my brain is in stand-by mode not working (ie semi comatose state)? If you conclude the same what would cause this malfunction? Could lack of oxygen/blood flow problem cause it or the medications? What is the best scan to determine the cause of problem and if its a blood flow problem? I hope to hear from you soon. If you could write a brief summary/report conclusion based on this report, MRI and symptoms and an advised plan of action I would be very grateful. In terms of medication which may aid brain function/neuro receptor response what do you suggest? Would Ritilin or other similar medication to increase dopamine and stimulate brain function be worth a try? What do you suggest i do about the excess sweating if it doesnt improve with the medication reduction? Is there any physical medication i could try to help reduce sweating or would it be worth seeking opinion from an endocrinologist/dermatologist? Another point i should mention is that the optician said i had ''sluggish pupil dilation''. Hope to hear from you soon with a response to EEG report and my questions. If I can obtain MRI images from my dad would you be able to do a brief report on them for me/suggestions? Many many thanks for your help really value
Are there any brain supplements i could take to help brain activity/function/repair im currently taking beetroot for circulation and magnesium
I have now attached the EEG report. At the time I was on higher doses of neuroleptic medication which was the culprit for the episodes of low bp and of 'seizure like' episodes where my head would tilt backwards looking up at the ceiling and my eyes would roll backwards. I must have had 50+ of these episodes without treatment over cause of a year or two and eventually i was put on Limotrojean medication, 200mg at the advise of a specialist mental health hospital. These episodes then stopped, as it was anti epileptic medication could it mean that I was having seizures as reaction to medication? They stopped this medication after a period and I have not had a fit like episode for over a year. When i did have them i was on high doses of meds. I have had 'premonitions' of a fit in last year but no actual fit. The specialist hospital reduced my Abilify in last 6 months or so to 10mg and velafaxine is 150mg but to be honest i do not feel i need these medications as im not physcotic or depressed. My main problem feels like a neurological one and some physcological effects of trauma which has lowered my self esteem but although i used to suffer high anxiety when younger these days its mild even when not on medication, if anything i feel too physiologically calm. I feel I may have neuroreceptor problems, connection problems, wiring in brain which is causing lower activity/abnormal brain wave rhythums but dont know if this medication is designed to help this or whether it could be hindering it? Can these connections/activity improve over time now on a low dose? I do not hear any voices, nor have i ever, the problem is low confidence/trauma from past events which I am getting physcology for and I am able to get on with life despite, (i work part time, keep ordered life etc,) my health concerns. My doctor is going to possibly lower the velafaxine medication to see if it aids faster brain processing/ lessens the fogginess and improves activity and hopefully then i wont be so tired and have more anxiety response. What are your thoughts re this? It may lessen the sweating too as she said it can be a side effect from that medication. I have a question regarding the EEG, why does it show Theta waves (sleep waves) when i was awake? Why is there an abnormal alpha wave? Why was there no response from taking deep breaths and photic stimulation? To me that implies my brain is in stand-by mode not working (ie semi comatose state)? If you conclude the same what would cause this malfunction? Could lack of oxygen/blood flow problem cause it or the medications? What is the best scan to determine the cause of problem and if its a blood flow problem? I hope to hear from you soon. If you could write a brief summary/report conclusion based on this report, MRI and symptoms and an advised plan of action I would be very grateful. In terms of medication which may aid brain function/neuro receptor response what do you suggest? Would Ritilin or other similar medication to increase dopamine and stimulate brain function be worth a try? What do you suggest i do about the excess sweating if it doesnt improve with the medication reduction? Is there any physical medication i could try to help reduce sweating or would it be worth seeking opinion from an endocrinologist/dermatologist? Another point i should mention is that the optician said i had ''sluggish pupil dilation''. Hope to hear from you soon with a response to EEG report and my questions. If I can obtain MRI images from my dad would you be able to do a brief report on them for me/suggestions? Many many thanks for your help really value
Are there any brain supplements i could take to help brain activity/function/repair im currently taking beetroot for circulation and magnesium
Brief Answer:
Read below.
Detailed Answer:
Thank you for the additional information.
Antipsychotics like Olanzapine and Abilify can lower have side effects, at high doses they do explain low blood pressure. They also lower seizure threshold so the episodes being seizures can not be excluded. Could explain current slowing and fogginess as well.
As for the rest of the issues you describe, they do not sound like neurological issues, more like psychiatric one. Both neurology and psychiatry deal with the brain, but neurology is more focused towards identifiable lesions like stroke, multiple sclerosis, tumors, dementia, etc, while when it comes to issues at a microscopic level, alterations of the balance of the many neurotransmitters in the brain, it is more a focus of psychiatry. Conditions like anxiety, self esteem issues may be due to such neurotransmitter changes, medication like venlafaxine and abilify try to correct these imbalances by changing certain neurotransmitter levels or action. You may have a predisposition towards these issues which you may always have, but with the psychotherapy which you are having you may be able to need less medication and possibly even gradually interrupt it, depending on evolution.
As for the EEG results there is not much to be read about them, nothing worrying. Minor disturbances in wave pattern may be expected in someone who is taking neuroleptics and variations may be present among individuals. Important thing is that there is no epileptiform brain activity. As for hyperventilation and photic stimulation they are actually used to induce epileptiform changes to evidence seizures, so actually not having them is not a bad thing at all. So as I said there is nothing to worry about in that EEG.
As for the sweating may have many causes, may be endocrine (high thyroid function), but also related to the medication you are taking so if hormone levels are normal lowering dosages may help.
I wouldn't take Ritalin, at least not for the moment, while it is being considered lowering antidepressant, it would confuse judgement. Perhaps may be considered at a later time if other medication dosage is fixed and symptoms persist.
I would gladly look your MRI if you can upload it.
Additional supplements you may take could include Gingko Biloba products.
Read below.
Detailed Answer:
Thank you for the additional information.
Antipsychotics like Olanzapine and Abilify can lower have side effects, at high doses they do explain low blood pressure. They also lower seizure threshold so the episodes being seizures can not be excluded. Could explain current slowing and fogginess as well.
As for the rest of the issues you describe, they do not sound like neurological issues, more like psychiatric one. Both neurology and psychiatry deal with the brain, but neurology is more focused towards identifiable lesions like stroke, multiple sclerosis, tumors, dementia, etc, while when it comes to issues at a microscopic level, alterations of the balance of the many neurotransmitters in the brain, it is more a focus of psychiatry. Conditions like anxiety, self esteem issues may be due to such neurotransmitter changes, medication like venlafaxine and abilify try to correct these imbalances by changing certain neurotransmitter levels or action. You may have a predisposition towards these issues which you may always have, but with the psychotherapy which you are having you may be able to need less medication and possibly even gradually interrupt it, depending on evolution.
As for the EEG results there is not much to be read about them, nothing worrying. Minor disturbances in wave pattern may be expected in someone who is taking neuroleptics and variations may be present among individuals. Important thing is that there is no epileptiform brain activity. As for hyperventilation and photic stimulation they are actually used to induce epileptiform changes to evidence seizures, so actually not having them is not a bad thing at all. So as I said there is nothing to worry about in that EEG.
As for the sweating may have many causes, may be endocrine (high thyroid function), but also related to the medication you are taking so if hormone levels are normal lowering dosages may help.
I wouldn't take Ritalin, at least not for the moment, while it is being considered lowering antidepressant, it would confuse judgement. Perhaps may be considered at a later time if other medication dosage is fixed and symptoms persist.
I would gladly look your MRI if you can upload it.
Additional supplements you may take could include Gingko Biloba products.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can seizure episodes damage the brain or the neuro connections/activity if you have had 50+ untreated over a couple of years? If so as I expect can that damage be reversed over time? Why do seizures happen is it because the neuro connections are trying to re-connect/adjusting due to medication and as a result not communicating properly? I agree I may need a low dose of medication but im on way too much its evident in the fact that i was on 30mg Abilify prior to going to london, they reduced it to 10mg and i got loads better but i think i should be on 5mg or less but in the words of my CPN my brain may ''slow down even more then'' but its sedative so i would have thought it would be the reverse, maybe not initially but over time as chemistry re-adjusted etc. Ill just have to continue taking it, making improvements more cardio, eat well, cognitive tasks etc and try that supplement you mentioned, hopefully once she reduces the Velafaxine if do ok as anticipate i will she will reduce it further and further to minimal dose of both. I wont try or suggest Ritilin or other similar med until ive tried lower dose of current meds. At least im not on a med that lowers Dopamine, Abilify regulates it to right level as feel my dopamine is too low if anything. Can I ask is there a test for Dopamine in blood? Thankyou so much for your help i feel more reassured and clearer. I will however try and get hold of MRI images for you to give your opinion on. thankyou :)
is there such a thing as brain stimulation in neuro ward?
is there such a thing as brain stimulation in neuro ward?
Brief Answer:
Read below.
Detailed Answer:
Seizure are thought to potentially play a role in higher mental functions decline. However it is more the case for generalized seizures, convulsions, and for patients who have frequent seizures for many years. There is not a specific number of years/seizures, but most studies showing such a cognitive damage have been in patients suffering for many years (over 10 years) with frequent seizures, in which structural changes happen. So I do not think the damage if any is significant in your case.
As for how antipsychotics can lower seizure threshold (make one more prone to seizures) is by neurotransmitter levels changes such as depletion in GABA or dopaminergic-cholinergic balance disruption.
There is no test for dopamine in the blood, and it would be useless anyway. When we speak about dopamine changes we refer to its presence in the brain synapses, connections between brain cells in different brain areas, it is there where the action takes place, where it is produced by some cells acting on others, not in the blood.
As for brain stimulation, yes there is, but it is not in the sense that you might thinking of, hasn't much to do with your case. It refers to inserting electrodes to stimulate very specific areas in patients with conditions such as Parkinson's disease. It is not used to enhance mental performance if that is what you have in mind.
I hope to have been of help.
Read below.
Detailed Answer:
Seizure are thought to potentially play a role in higher mental functions decline. However it is more the case for generalized seizures, convulsions, and for patients who have frequent seizures for many years. There is not a specific number of years/seizures, but most studies showing such a cognitive damage have been in patients suffering for many years (over 10 years) with frequent seizures, in which structural changes happen. So I do not think the damage if any is significant in your case.
As for how antipsychotics can lower seizure threshold (make one more prone to seizures) is by neurotransmitter levels changes such as depletion in GABA or dopaminergic-cholinergic balance disruption.
There is no test for dopamine in the blood, and it would be useless anyway. When we speak about dopamine changes we refer to its presence in the brain synapses, connections between brain cells in different brain areas, it is there where the action takes place, where it is produced by some cells acting on others, not in the blood.
As for brain stimulation, yes there is, but it is not in the sense that you might thinking of, hasn't much to do with your case. It refers to inserting electrodes to stimulate very specific areas in patients with conditions such as Parkinson's disease. It is not used to enhance mental performance if that is what you have in mind.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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