Brief Answer:
I don't see where ophthalmology will be able to add anything

Detailed Answer:
Good afternoon. Thank you for your question. Despite what would appear to be a plethora or tests on your daughter-- in my opinion several things are not clear to me in terms what has been done to work this problem. First of all, I see no utility in having ophthalmology see her because nothing they find or don't find can explain the change in her mental status and blank stares.

Secondly, if you've been to a neurologist what that to someone specialized in either epilepsy or headaches? Either of those 2 subspecialists may be able to opine on this case a bit differently in terms of requested testing as opposed to a general neurologist. Obviously, the change in mental status, stares, and lack of blinking is suggestive of some lapse in her state of awareness. You say she goes 15-20 min. without blinking, however, I would ask that the next time something happens that you actually time the events from start to finish and if possible videotape her with your telephone for the entire duration of the event. You should also document the details ON PAPER as to what happened and be very observant for eye movements, limb movements, lip smacking, tongue movements, head turning, etc. Document her responses to you when she is in this type of state and you ask specific questions from her. Ask her to remember certain objects or colors and then, ask her to recall them after the episode is over.

Try and lift or alter the position of her head or a limb while she is in this state to see if she maintains the position or doesn't...does she resist movements or not?

Next, in this case I would opt for an MRI of the brain with what are referred to as FINE CUTS through the temporal lobes and use gadolinium contrast (after clearing her by laboratory testing for her kidney function to make sure she can tolerate the XXXXXXX ...get an EGFR and CREATININE in blood). This is referred to as a SEIZURE PROTOCOL where I practice and can show in some cases an entity called MESIAL TEMPORAL LOBE SCLEROSIS which can explain temporal lobe based behaviors and changes in status of awareness. If it is positive then, she will need more indepth analysis which would be best done at a Teaching Hospital or Academic Center. It appears that you are from Illinois and therefore you should be close to either Rush, Loyola, or Northwestern. All have excellent neurology departments that can do these tests (if appropriate clinically).

Another possible differential diagnosis from what you're describing is something referred to as MIGRAINE EQUIVALENT or ATYPICAL MIGRAINE attacks. This actually means something a bit different from what it sounds like and the best specialist to appreciate this as a possible diagnosis would be a HEADACHE SPECIALIST. I think it is less likely that she suffers from this given the information you've provided but nonetheless would not discount it as a possibility unless something else turns up that better explains the constellation of symptoms.

As far as EEG's are concerned- if she's only had 1 EEG and if it's only been a standard recording then, you should know that the actual sensitivity of a short 22 minute recording typically done with activation procedures is only about 30-35%. This means that 65-70% of the time a person could have real seizure disorder and not be captured on a single EEG. That is why at least 2 standard recordings are performed in my clinic when this sort of presentation occurs and usually I may even bypass the 2nd standard recording to do if the first is negative and head straight for either a SLEEP DEPRIVED recording with prolonged monitoring of 60 minutes.....OR, depending upon the frequency of her symptoms I may choose to do a 6-8 hr. standard recording (non-sleep deprived) or even hospitalize her for 3-5 days and perform VIDEO RECORDED monitoring. That would only be in the case where her episodes are occurring fairly frequently (2-3x/week) otherwise, the chance of capturing something will be low and she'll have spent her time as an inpatient without getting much important data.

BTW, SLEEP DEPRIVED studies are performed after patients are instructed to simply awaken from their normal night of sleep 2-3 hrs. EARLIER than usual before coming to the center for recording. They do not have to stay up for prolonged periods of time as we used to make them stay up....that was rough!

I may also perform a sleep study to be sure that some type of primary sleep disorder or parasomnia is not occurring that could be responsible for some of her symptoms. Again, this test would be done based upon the index of suspicion for a sleep disorder as per history and physical examination.

These are my additional suggestions as to how to approach your daughter in order to rule out as much as possible organic disease processes which could be either related to aberrant electrical activity in the brain, some form of atypical or unusual headache/migraine presentation, or some form of sleep behavior disorder.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact 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 25 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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