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What Causes Anxiety, Restlessness, Weakness And Rapid Heart Beat?
Question: Hi doc. Which condition could be causing the following symptoms to appear ONLY around evening time? (I have no symptoms at all in the morning)
-Generalized bodily malaise
- Anxiety and restlessness
- Decreased vigor/vitality
- Increased impulsiveness
- Downheartedness, more dramatic thinking/life-views
I have an abnormal EEG but no seizures. PET: Reduced blood flow to fronto temporal left lobe . Normal blood and urine tests taken in the morning including thyroids sugar level cortisol etc.
Had asthma and allergies in the past but not anymore. History of high eosinophils count, chronic dhiarreah, folliculitis.
28 years old. Family history of Alzheimer's, Parkinson.
Thank you very much
-Generalized bodily malaise
- Anxiety and restlessness
- Decreased vigor/vitality
- Increased impulsiveness
- Downheartedness, more dramatic thinking/life-views
I have an abnormal EEG but no seizures. PET: Reduced blood flow to fronto temporal left lobe . Normal blood and urine tests taken in the morning including thyroids sugar level cortisol etc.
Had asthma and allergies in the past but not anymore. History of high eosinophils count, chronic dhiarreah, folliculitis.
28 years old. Family history of Alzheimer's, Parkinson.
Thank you very much
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at the list of symptoms you provide they all seem to be part of a mood disorder, manifesting with anxiety and mild depressive episodes. While you describe yourself the anxiety and negative view on life, mood disorders commonly include reduced energy, fatigue and malaise.
As to why they appear around evening time, that is a feature in some patients. It is thought to occur due to the fact that daytime is often busy with activities leaving less time to think. Also another hypothesis for them not being present during the day is because the activity of sleep in itself has an antianxiety effect allowing for feeling better in the morning.
Of course at times there are hormonal causes or brain lesions but you have rendered my job easy in that regard as you have already done the necessary test to exclude them.
Regarding the PET scan, the only exam showing something, while that at times may support a diagnosis of dementia, it is not a diagnostic test only a supportive one. Only if there is also diminishing of cognitive functions on neuropsychological tests can one suspect dementia (which is highly unlikely at your age unless the family members you mention with Alzheimer's and Parkinson's developed the condition at a very young age).
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at the list of symptoms you provide they all seem to be part of a mood disorder, manifesting with anxiety and mild depressive episodes. While you describe yourself the anxiety and negative view on life, mood disorders commonly include reduced energy, fatigue and malaise.
As to why they appear around evening time, that is a feature in some patients. It is thought to occur due to the fact that daytime is often busy with activities leaving less time to think. Also another hypothesis for them not being present during the day is because the activity of sleep in itself has an antianxiety effect allowing for feeling better in the morning.
Of course at times there are hormonal causes or brain lesions but you have rendered my job easy in that regard as you have already done the necessary test to exclude them.
Regarding the PET scan, the only exam showing something, while that at times may support a diagnosis of dementia, it is not a diagnostic test only a supportive one. Only if there is also diminishing of cognitive functions on neuropsychological tests can one suspect dementia (which is highly unlikely at your age unless the family members you mention with Alzheimer's and Parkinson's developed the condition at a very young age).
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your detailed answer. I am in fact taking psychiatric medication as I had a psychotic episode 2 years ago. Prior to that I had depersonalisation and derealisation for 6 years. I wonder if there could be an underlying physical cause for these symptoms. Which condition/s would yield an abnormal EEG (I think it was fronto temporal as well, alpha?) plus the abnormal PET while having normal MRI /CT, and causing these kinds of psychiatric symptoms?
I know I have mild cognitive impairments for example in excecutive functions as shown in an extensive test I took at the clinic (time administration in tasks was quite below average). I'm also self aware of problems in attention, medium term memory, spatial orientation. And, since are 13 I begun to "phase out" like looking into nothing, classmates would call me autistic as a joke. And at age 16 I begun to lose personal objects too often like forgetting my backpack after having sit down somewhere and then leaving.
At are 12 I started with asthma-like attacks. At age 16 started taking Accutane for acne. Are 18 after I stopped taking this med I started having chronic diarrhea and folliculitis. Maybe everything is interconnected.
I know I have mild cognitive impairments for example in excecutive functions as shown in an extensive test I took at the clinic (time administration in tasks was quite below average). I'm also self aware of problems in attention, medium term memory, spatial orientation. And, since are 13 I begun to "phase out" like looking into nothing, classmates would call me autistic as a joke. And at age 16 I begun to lose personal objects too often like forgetting my backpack after having sit down somewhere and then leaving.
At are 12 I started with asthma-like attacks. At age 16 started taking Accutane for acne. Are 18 after I stopped taking this med I started having chronic diarrhea and folliculitis. Maybe everything is interconnected.
Brief Answer:
Read below
Detailed Answer:
Thank you for the additional info.
I would be careful before saying you have an abnormal EEG as EEG may have normal variants among individuals, it may also be influenced by many factors, such as by medication the patient is under. If there is only alpha rhythm as you mention that doesn't mean much, alpha rhythm is the most common found on EEG tracings. What worries us usually is when there are epileptiform abnormalities such as spikes and sharp waves or slowing on EEG.
As for what other physical causes could be discussed, since the MRI and CT are normal (issues such as stroke, tumors, infections, inflammatory lesions of the nervous system are excluded by that) then the two conditions to consider would be epilepsy and early onset dementia.
I do not think it is likely judging by your account though. That is because you seem to have been well explored with thorough tests by your doctors and epilepsy would have provided some epileptiform changes on EEGs (as I said alpha rhythm does not indicate epilepsy). If you can upload an EEG report I would be happy to look at that to better judge.
As for the early onset dementia, the fact that the symptoms go so far back in time renders it unlikely as even in early onset forms it is not that early, it happens after the twenties. So such early changes make dementia less likely, it is much more possible for the changes on the tests to be due to difficulties in concentration due to anxiety and depression. However given the family history for dementia it is advisable to compare results by periodically repeating tests say once a year.
So to resume, while I would be more confident if you could upload some reports (the MRI and EEG reports, perhaps the PET scan as well) for me to read myself, I am much more inclined towards a primary psychiatric issue rather than an identifiable physical cause (one could argue that psychiatric conditions are just as physical, only that the abnormality is at a cellular neurotransmitter balance level which cannot be pinponted with the means of some diagnostic test).
Let me know if I can further assist you.
Read below
Detailed Answer:
Thank you for the additional info.
I would be careful before saying you have an abnormal EEG as EEG may have normal variants among individuals, it may also be influenced by many factors, such as by medication the patient is under. If there is only alpha rhythm as you mention that doesn't mean much, alpha rhythm is the most common found on EEG tracings. What worries us usually is when there are epileptiform abnormalities such as spikes and sharp waves or slowing on EEG.
As for what other physical causes could be discussed, since the MRI and CT are normal (issues such as stroke, tumors, infections, inflammatory lesions of the nervous system are excluded by that) then the two conditions to consider would be epilepsy and early onset dementia.
I do not think it is likely judging by your account though. That is because you seem to have been well explored with thorough tests by your doctors and epilepsy would have provided some epileptiform changes on EEGs (as I said alpha rhythm does not indicate epilepsy). If you can upload an EEG report I would be happy to look at that to better judge.
As for the early onset dementia, the fact that the symptoms go so far back in time renders it unlikely as even in early onset forms it is not that early, it happens after the twenties. So such early changes make dementia less likely, it is much more possible for the changes on the tests to be due to difficulties in concentration due to anxiety and depression. However given the family history for dementia it is advisable to compare results by periodically repeating tests say once a year.
So to resume, while I would be more confident if you could upload some reports (the MRI and EEG reports, perhaps the PET scan as well) for me to read myself, I am much more inclined towards a primary psychiatric issue rather than an identifiable physical cause (one could argue that psychiatric conditions are just as physical, only that the abnormality is at a cellular neurotransmitter balance level which cannot be pinponted with the means of some diagnostic test).
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello and thanks again.
Now that you have written it, I remember the report did in fact mention epileptiform activity. I was diagnosed with epilepsy and was prescribed with Valproic Acid. I took it for one year until I had another EEG at another hospital and the new neurologist said I didn't have epilepsy. So I stopped taking it. I don't remember any noteworthy improvement while under that medication.
My psychiatrist is prescribing calcium diphenyl hidantoinate for me, alongside the aripiprazole and the amoxapine. It's been a year now and I feel improvements but I still get there symptoms I mentioned on the first message.
If dementia is ruled out, could this be some kind of rare epilepsy with psychotic episodes? I don't have seizures nor absences as described on petit mal symptomatology though, unless they are so micro I don't notice them nor anyone around me... except when I "phase out". I retain consciousness though. Or would I not notice it if I didn't?
Another symptom worth mentioning is that for two years I was making symbolic connections between every event that happened to me, like if deciphering messages. Maybe some part of the brain that deals with allegories/metaphors was overactive.
If this is in fact some kind of epilepsy, which anti-epileptic would best work for this specific case?
My psychiatrist is kind and open minded and works with a neurologist, if you suggest anything new he will definitely look into it.
About the results I seem to have lost the original reports, but if you think they could yield some light on this, I will retrieve them from the hospitals. I also have all sorts of blood and urine tests, ranging from blood copper, to DHEA or DMT in urine. Any specific test that might be of interest? I can take new ones as well.
Kind regards,
XXXX
Now that you have written it, I remember the report did in fact mention epileptiform activity. I was diagnosed with epilepsy and was prescribed with Valproic Acid. I took it for one year until I had another EEG at another hospital and the new neurologist said I didn't have epilepsy. So I stopped taking it. I don't remember any noteworthy improvement while under that medication.
My psychiatrist is prescribing calcium diphenyl hidantoinate for me, alongside the aripiprazole and the amoxapine. It's been a year now and I feel improvements but I still get there symptoms I mentioned on the first message.
If dementia is ruled out, could this be some kind of rare epilepsy with psychotic episodes? I don't have seizures nor absences as described on petit mal symptomatology though, unless they are so micro I don't notice them nor anyone around me... except when I "phase out". I retain consciousness though. Or would I not notice it if I didn't?
Another symptom worth mentioning is that for two years I was making symbolic connections between every event that happened to me, like if deciphering messages. Maybe some part of the brain that deals with allegories/metaphors was overactive.
If this is in fact some kind of epilepsy, which anti-epileptic would best work for this specific case?
My psychiatrist is kind and open minded and works with a neurologist, if you suggest anything new he will definitely look into it.
About the results I seem to have lost the original reports, but if you think they could yield some light on this, I will retrieve them from the hospitals. I also have all sorts of blood and urine tests, ranging from blood copper, to DHEA or DMT in urine. Any specific test that might be of interest? I can take new ones as well.
Kind regards,
XXXX
Brief Answer:
Read below.
Detailed Answer:
Hello again!
The thing with seizures is that they can present in many different forms. They can be easily recognizable like in grand mal seizures where the diagnosis is certain already before the EEG. But there are rare seizure presentations like those "phasing out" episodes you describe which are difficult to divide from psychogenic episodes. Actually often a patient can have a mixture of the two, both true epileptic as well as psychogenic seizures.
So in these cases the only thing able to differentiate is EEG recordings during episodes. That is the only test which I would be interested in. Outside the episodes EEGs can be inconclusive (as the fact you have been told differently by two different doctors suggests) so in uncertain cases it is prolonged EEGs which may be accompanied by video recordings in hospital setting which may make the diagnoses. If there is no seizure on EEG recording while patient is having symptoms than epilepsy can be excluded. That is what you can ask your doctors or check your records if it has been done, I do not believe there is the need to dig out the other blood tests you've had.
Whether I would have high hopes for it to be epilepsy....not that much really, at least not as the sole cause it would be a rare type and still wouldn't explain all your symptoms, there would still be a contributing psychiatric condition to explain your initial symptoms you mention in your query. The fact that valproic acid hasn't had any effect is not that encouraging really, because it is among the antiepileptics the one which is used on almost all types of seizures. As for other antiepileptics before suggesting one depends on the seizure type on the EEG which I mentioned.
Wishing you good health.
Read below.
Detailed Answer:
Hello again!
The thing with seizures is that they can present in many different forms. They can be easily recognizable like in grand mal seizures where the diagnosis is certain already before the EEG. But there are rare seizure presentations like those "phasing out" episodes you describe which are difficult to divide from psychogenic episodes. Actually often a patient can have a mixture of the two, both true epileptic as well as psychogenic seizures.
So in these cases the only thing able to differentiate is EEG recordings during episodes. That is the only test which I would be interested in. Outside the episodes EEGs can be inconclusive (as the fact you have been told differently by two different doctors suggests) so in uncertain cases it is prolonged EEGs which may be accompanied by video recordings in hospital setting which may make the diagnoses. If there is no seizure on EEG recording while patient is having symptoms than epilepsy can be excluded. That is what you can ask your doctors or check your records if it has been done, I do not believe there is the need to dig out the other blood tests you've had.
Whether I would have high hopes for it to be epilepsy....not that much really, at least not as the sole cause it would be a rare type and still wouldn't explain all your symptoms, there would still be a contributing psychiatric condition to explain your initial symptoms you mention in your query. The fact that valproic acid hasn't had any effect is not that encouraging really, because it is among the antiepileptics the one which is used on almost all types of seizures. As for other antiepileptics before suggesting one depends on the seizure type on the EEG which I mentioned.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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