Brief Answer:
Pinpointing areas of abnormality in a brain

Detailed Answer:
Untreated temporal lobe epileptiform activity (i.e. seizures) are probably some of the most COMMONLY missed types of seizures for exactly what you mentioned; both patients as well as doctors attributes patient's behaviors or actions to other psychologically or psychiatrically based phenomenon and for that reason a person may go a very long time without a proper diagnosis taking medication for other problems that truly don't exist.

Let's look, however, at the statement you made: "The seizures have stopped. I know I am not now having seizures; however I know my brain is damaged based on the way I feel."

I need to point out this detail- If you'd been having untreated temporal lobe seizures for 4 then, that would suggest a very discrete event in the past when the seizures started. You didn't say much about that....in other words, how do you or your neurologist know exactly when these seizures started if they were never diagnosed until some later time? Was there a specific injury event to the head which can be shown by MRI or CT scan as having a residual effect such as the presence of a scar of tissue (encephalomalacia, areas of hemosiderin deposits, areas of gliosis)? If not, was there a memorable point of time in the past when your behavior suddenly changed or something else happened where your personality suddenly became changed or different for no apparent reason? And so, the initiation event or time should be defined a bit more.

Secondly, HOW do you you or your neurologist KNOW FOR SURE that seizures have completely stopped? In other words, it is possible for a patient to suffer from a seizure disorder that causes what appears to be a mental problem or illness of some sort. Then, at some later time the epilepsy is diagnosed and then, treated and while the manifestations of those seizures may be brought under control (suggestive of seizure cure) the patient still doesn't feel quite right. In your scenario, your interpretation is that you're suffering from brain damage to a certain area of the temporal lobe that had been seizing. And while that may be true....it may be just as true that the reason the patient is not feeling "right" is not necessarily due to DAMAGE of the brain following extinction of the seizures as much as the former seizures simply metamorphosizing into another set of seizure activity that may be in another location of the brain...perhaps, even the same temporal lobe or perhaps there could be movement of the seizure focus from one temporal lobe to the opposite side. This is referred to as a mirror focus and can occur as a result of treating one area of abnormality either by surgical resection or even medication but then, having an area pop up in the same location but on the opposite side of the brain. The fact, that is on the opposite side of the brain is enough for you to feel differently than before...but all the same not normal.

Bottom line...treating a seizure "successfully" with a medication or by other means and extinguishing the symptoms of the seizure but still being left with feelings of "not feeling right" could be a sign of a mirror focus phenomenon or simply another seizure area becoming unmasked causing these feelings of "unwellness" as opposed to actual DAMAGE to any part of the brain.

So here is what you need to ascertain. How was it determined from a neurological perspective that your seizures had in fact, been extinguished and that the current feelings you're having are not due to another set of seizures within the same or opposite temporal lobe?

Now, assuming that in fact, you are no longer suffering from seizures and assuming further that the unwell/different feelings you have are definitely due to "brain damage" then, the way we would go about trying to localize that area of damage is actually quite straight forward.

1. Detailed history and physical with respect to the feelings you now have to try and determine some localization in the brain based upon clinical criteria. For example, predominant symptoms or signs of forgetful or inability to recall short term memory could point to mesial temporal or hippocampal involvement. Extreme outbursts of rage or anger could point to damage to the amygdala. Odd changes to person's personality..for example going from a GO GO GO type of person to someone who is rather lethargic or apathetic compared to before could indicate some sort of THALAMIC or THALAMIC CIRCUIT problem.

2. MRI of the brain WITH gadolinium contrast and FINE CUTS through the temporal lobe. This type of MRI imaging is sometimes referred to as a SEIZURE PROTOCOL and not obtained nearly as often as one of imagine it should be obtained...even if being worked up by a neurologist....unless the neurologist is an epileptologist in which case I would expect all of them to properly ask for this type of study if a person were having issues.

3. NEUROPSYCHOLOGICAL evaluation....NOT neuroPSYCHIATRIC evaluation......but rather neuroPSYCHOLOGICAL evaluation with proper psychometrics done by experienced testers and clinicians. This type of battery of tests (especially when tailored according to a patient's symptoms) can be extremely useful in narrowing down the area or areas of abnormality in the brain and specify whether it is right or left side. Funnily enough, there are times when neuropsych testing has been show to be MORE accurate than EEG recording data simply because the sensitivity and specificity of an entire battery of tests performed in the right environment and done by skilled clinicians can "see" virtually EVERY part of the brain and EVERY domain of cognition whereas an EEG can ONLY see surface electrical activity closest to an electrode and therefore, is very INSENSITIVE to what may going on in the deeper regions of the organ especially the brainstem, the thalamic regions, and deep visual pathways.

Also PROLONGED surface EEGS can be done under different conditions with and without video monitoring.

4. PET scans or FUNCTIONAL MRI's can localize areas or points of activity in the brain either between seizures or during seizures missed by surface EEG's for the exact reasons I enumerated in #3.

5. Brain mapping where a mesh grid is place upon the brain...but this is an open surgical procedure that I would not recommend doing for someone unless they were having intractable motor seizures and were at risk for serious physical damage if the seizures cannot be stopped.

---

Brief Answer:
If testing was done to verify LACK of seizure activity then, OK

Detailed Answer:
If you clearly had appropriate and adequate testing to establish a "seizure-free" state of being then, very well and so far so good. My steps to establishing the location of any potentially "damaged" brain still remains the same as I previously explained and outlined.

The actual inciting event that you believe precipitated the seizure state is not of consequence if it's been confirmed that no seizure activity is currently occurring.

If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?

Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 65 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
Temporal lobe damage

Detailed Answer:
If there is neuronal damage as in "electrically FRIED" from continuous uncontrolled seizure activity for years....and let's be clear and this point...my opinion is that having unchecked and undetected seizures for so many years with the overall description you've given is LESS LIKELY than not....but under the assumption that damage has occurred then, strictly speaking....NO...there's no known way to effectively reverse any scar formation and neuronal destruction that would've occurred.

I would never use Lithium for CNS problems ( i used to) but the toxicity factor of that heavy metal is simply too high for my taste. TMS (Transmagnetic Stimulation) is the best chance (in my opinion) of getting these "fried circuits" potentially rejuvenated though I think that's still a ways off from prime time release. Certainly nothing wrong with cardiovascular rehab but I don't see that as being an effective repair modality. What may have more of a positive effect than anything else could (definitely medications/drugs will not) be first optimize all metabolic processes (i.e. Vit. B12, folate, Vit. D, thyroids, cortisol, electrolytes, etc) and chemistries and then, engage in activities (cognitive gaming) that utilize whichever area you can prove was damaged so as to try and recruit that zone again...or if not THAT area....some surrounding NONdamaged areas.

Again, neuropsychological testing will be important to strictly localize any abnormalities which can then, be verified with PET/SPECT scans.

If I've satisfactorily addressed your questions could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback on your opinion as to our transaction?

Many thanks for posing your question to our attention on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 82 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---