Q. I am the foster parent of a 17 year old young woman who has been diagnosed with BPD. She has had epilepsy from the age of three and has been on a variety of medications since age eight. Two years ago, her specialists threw their hands up in the air claiming her seizures weren't epileptic seizures. Her family physician put her on Dilantin at that time. Eventually, she reached a dosage of 1500 mg of Depakote and 600 mg of Dilantin daily, to no effect. One year ago, her mother died and she came to live with us. (We have known her for three years.) When she came to live with us, we took her to another doctor who recognized that we were definitely dealing with seizure activity that seemed to take on a variety of forms. Sometimes it would simply be a blank stare that would last for a few seconds. Other times she would fall to the floor, jerking her head and limbs, curling into a fetal position and then going rigid. This could last for 15 minutes. When we took her to the hospital, they would say there was no indication of a seizure. Recently, we put her in the hospital because of a suicide attempt, emotional flatline for three days, and an apparent inability to distinguish the truth from a lie. At that time she had three days of heavy seizure activity-3-5 seizures a day, and they transferred her to the university where her neurologist is based. She was put on observation for four days and had no seizure activity whatsoever. Her neurologist took her off the Dilantin and wants to begin lowering the Depakote. At that time she was diagnosed with BPD and from what I have read, I agree. My question is, what is the connection between BPD and epilepsy? Also, can an individual learn to mimic seizure activity so closely that it appears to be genuine? I know that she has had two grand mal seizures in her life, one at age three and the other at age 8, but most of what we have seen in the past three years seems to be what the doctors have called pseudo-seizures. Apparently they don't show up on EEG's.
A. I think you're probably on to something. I have seen this exact same phenomenon. While some of the seizures may be fake, the ones where the mood and attention problems are there are likely associated with the BPD. The problem is the seizures are in very deep structures in the brain - and the EEG does not pick those up. Much like a submarine underwater can't be detected in calm seas.
She needs all her diagnoses made and treated. You might see a huge difference in her if she was placed on Prozac first, and a week later add the epilepsy medication Tegretol. Dilantin doesn't work for these type of seizures, and Depakote is inconsistent. Sometimes Tegretol needs to be combined with a second medication like Depakote or Lamictil.