I still have questions...

[Guest guest]

How common is seizures for those with LBD? I was so shocked by the

whole seizure episode of my mom's -- don't recall reading about that.

TIAs I've read about -- but this was no TIA -- definitely seizures.

And mom never had them before -- her first was on the last day...

Do you think it was LBD related or something else? She also had COPD.

Her death certificate reads:

* Respiratory failure

* Aspiration seizure

* Lewy body dementia

What triggered the seizure? -- everything, as far as I know, was

normal -- and then out of the blue it came on... According to the NH

she got back to baseline and was only going for observation (I don't

believe that that could be true b/c there was no comment by the EMTs

that she had another seizure in the ambulance) - and when I got there

she was unconcious / unresponsive and curling up in a fetal

position...

The other main things were:

* High white blood cell count = infection somewhere

* Very little urine = kidney failure = could my observation of 1/2

and 1/2 nails weeks before been a hint? I emailed the nurse, but got

no response...

* And difficulty in breathing - rattling in her lungs - could she

have swallowed saliva or something else into her lungs during the

seizure?

* And throwing up blood - too much for it to mean that she bit her

tongue

I know my questions make no difference - I can't turn back the clock.

But I wish I knew why...

Yesterday was my first tough day -- as I usually visit mom all day on

Sundays... I'm saddened that mom's last day on Earth was with so much

pain and discomfort and there was nothing I could do for her...

I did find this:

Seizures in elderly patients with dementia: epidemiology and

management.

Mendez M, Lim G.

Department of Neurology, The University of California at Los Angeles,

Los Angeles, California 90073, USA.

Epileptic seizures occur in patients with dementia at a higher

prevalence than among healthy elderly individuals. The incidence of

seizures among patients with dementia varies with the aetiology of

the dementing illness. In patients with Alzheimer's disease (the most

common form of dementia), approximately 10-22% have at least one

unprovoked seizure. Seizures usually occur in later stages of

Alzheimer's disease, on average, > or =6 years into the course of the

disease. Seizures in Alzheimer's disease are more likely to occur

with early-onset disease, particularly if there is a familial

presenilin I mutation. The incidence of seizures in other dementing

diseases is less clear. There are special considerations regarding

the management of seizures in the elderly with dementia. First, the

presence of cognitive impairment may impede an accurate diagnosis of

seizures. Clinicians may also mistake seizure manifestations for

symptoms of the underlying dementia. Second, since most dementia

patients are elderly, there are pharmacokinetic changes with aging

that affect the use of antiepileptic drugs. Third, antiepileptic

drugs have potential cognitive adverse effects that may worsen

dementia. Although few studies are available, extrapolations from

research in young people and elderly patients without dementia

provide several recommendations for the management of seizures in

patients with dementia: exclude symptomatic causes of seizures before

committing to antiepileptic drug therapy; treat after a first seizure

if there is evidence of focal neurological involvement or a risk of

recurrent seizures; use antiepileptic drugs with minimal cognitive

adverse effects, such as carbamazepine, valproic acid, gabapentin and

lamotrigine; and use the lowest possible dosage and monitor

antiepileptic drug levels, where possible.

(not that it answers my questions...)

And this:

Diseases such as Alzheimer's, or other diseases that change the

internal structure of the brain, may cause seizures. Kidney disease,

liver disease, alcoholism and even diabetes may increase

susceptibility to seizures in later life.

---

Although -- it could have been the amyloid angiopathy (a disease of

small blood vessels in the brain) she had that brought on the

seizures:

Since CAA (cerebral amyloid angiopathy) is associated with

progressive blood vessel degeneration, and since there is no

effective treatment, most patients have a poor prognosis. Aggressive

neurosurgical management allows increased survival following lobar

hemorrhage, but as of 1998, 20-90% of patients die from the first

hemorrhage or its complications, which include progression of

hemorrhage, brain edema (swelling) with herniation (downward pressure

on vital brain structures), seizures, and infections such as

pneumonia. Many survivors have persistent neurologic deficits related

to the brain lobe affected by hemorrhage, and are at risk for

additional hemorrhages, seizures, and dementia. Prognosis is worse in

patients who are older, or who have larger hemorrhages or recurrent

hemorrhages within a short time.

(although I recall them saying at the ER that they didn't see blood

in the brain...)

I guess I'll never know for sure... mom's neurologist wants to talk

w/ me when things settle down... he's probably curious too...

PS - As I contacted friends of mom's I did hear that my old ballet

teacher (and mom's old colleague) will be moving into an assisted

living facility soon, now she's in a skilled nursing facility after

after having a stroke -- close to my neighborhood, no less -- she

never married and has no children -- I foresee my helping her now b/c

she is going to need help with the move... and maybe with visits...

if she'll have me... I'll be calling her today - or visiting - can't

decide which would be easier for her or me when I break the news.