Urinary Incontinence Naturopathic Treatment
Urinary incontinence can be seen in frontal lobe seizures if the frontal cortical representation of the bladder is involved in seizure activity. This can occur without secondary generalization, but does not have a definite localizing value, because this may also be seen in temporal lobe seizures. Urinary incontinence is not a definite proof of an epileptic event, because 44 of patients with nonepileptic psychogenic seizure reported urinary incontinence with their events (43). Ictal urinary urge was also shown to localize to the nondominant hemisphere (44). Stool incontinence is exceedingly rare as a manifestation of epilepsy and could suggest other origins for the patient's episodes.
A 48-year-old man was brought to the emergency service after a convulsion 15 minutes earlier. During dinner he suddenly noticed twitching in both his arms. His eyes, he told us, were forced to look upwards and to the left. He felt a tight contraction of both arms and legs in extension. At that very movement he tried to overcome the involuntary contraction of the limbs, but he failed. There was no trismus, no tongue biting, no urinary incontinence and no clouding of consciousness. The attack was over within a few minutes. After this, he felt a general weakness without impaired consciousness or confusion.
The spectacle of a generalized event associated with frothing, tongue biting, and urinary incontinence has a tremendous impact on bystanders and relatives. The idea that someone may be suddenly seized by such a horrendous attack contributes to the stigma of epilepsy. Patients and relatives can be offered some assurance that such generalized attacks are often the easiest to bring under control with adequate antiepileptic drug management, provided compliance is also adequate. Furthermore, it should be emphasized during history taking that most seizures do not reach the stage of secondary generalization, and thus, minor features should also be identified and reported. The dread of a generalized tonic-clonic seizure is so culturally ingrained that minor ictal phenomena (for instance, the staring and automatisms of complex partial seizures) are often neglected or entirely missed. Because complex partial seizures may also result in injuries, their identification is...
Friends who witnessed the attacks reported that her face turned pale and she sweated profusely and fell to her right side while sitting. No jerks were noted and she recovered promptly after some 30 seconds of unconsciousness. Two of the attacks were associated with urinary incontinence. Two episodes occurred when she was standing upright, and two attacks came on while she was seated. All four occurred during menstruation but apart from that no particular precipitating factors could be identified. One distant relative had epilepsy but otherwise the family history was negative for epilepsy.
Felbamate was initiated in September 1993, at a time when she was having 50 seizures a day. It did not help, and she was referred to a pediatric epileptologist at a major university. Review of several EEGs in the past confirmed typical changes for absence epilepsy. A trial of methsuximide was initiated and decreased the seizures frequency from 30 a day to 10 a day. This was the best seizure control that had been achieved in some time. Her family moved to a small town and she adjusted to her new school setting. Her seizures increased to 100 per day, and methsuximide was discontinued. She began having trouble in school. A trial of lamotrigine was discussed, but her mother was understandably hesitant to try a ninth medication. J continued to worsen and was having hundreds of events a day, associated with regression in school and occasional urinary incontinence.
The patient is a 53-year-old woman with a history of seizures beginning at the age of 5 years. The seizures occurred several times daily when she was a young child. Witnesses described a sudden blank stare, sometimes accompanied by humming or picking at her clothes. Occasionally she walked around during the episodes but she never fell down. Urinary incontinence occurred with some of the seizures up until the age of 12. Although she never had a warning or an aura, she usually knew when she had a seizure because she recalled a sensation 'as if daydreaming'. She specifically described this as not merely a loss of time but as a definite feeling. She has had only four generalized tonic-clonic seizures in her life, each proceeded by an odd feeling of 'going down a tunnel.'
Typically, complex partial seizures of frontal lobe origin are frequent with a marked tendency to cluster. The attacks are brief, with a sudden onset and offset, without the gradual evolution of the temporal lobe seizure. Some types of frontal lobe seizure occur largely or exclusively during sleep, and in some patients the epilepsy comprises frequent short nocturnal attacks (sometimes known misleadingly as paroxysmal nocturnal dystonia). The tripartite pattern of aura absence automatism is seldom as well defined in frontal lobe as in mesial temporal lobe complex partial seizures. A brief non-specific 'cephalic aura' can occur, but not the rich range of auras of temporal lobe epilepsy. The absence (motor arrest) is usually short, and may be obscured by the prominent motor signs of the automatism. There are marked qualitative differences between frontal and temporal lobe automatisms, although these are often not specific enough to be reliably of diagnostic value. Frontal lobe...
Autonomic phenomena associated with absence seizures include pupil dilatation, pallor, flushing, sweating, salivation, piloerection, and even urinary incontinence (21, 24). Neither the autonomic changes nor the automatisms allow one to distinguish absence seizures from other seizure types.
Diagnosis of epilepsy is fundamentally a clinical judgment. Clinical history should elicit details of seizure semiology, seizure provoking factors, and seizure frequency in the preceding five years.7 At times there can be discrepancy in the diagnosis of epilepsy when it is based only on a screening questionnaire. In a recent epidemiological survey in Togo of the 9,155 subjects screened by a screening questionnaire, 285 subjects (3.1 ) reported loss of consciousness, 263 (2.9 ) had seizures and 142 (1.5 ) had foaming and urinary incontinence during the seizure 74 (0.8 ) had absence seizures, 68 (0.7 ) had focal symptoms. During case ascertainment of the 304 subjects studied, diagnosis of epilepsy could be established in only 170 pa-tients.8 Documenting seizure provoking factors like sleep deprivation, photic stimulation, and hyperventilation, helps the clinician in the management of people with epilepsy.9
Few experiences match the drama of a convulsive seizure. A person having a severe seizure may cry out, fall to the floor unconscious, twitch or move uncontrollably, drool, or even lose bladder control. Within minutes, the attack is over, and the person regains consciousness but is exhausted and dazed. This is the image most people have when they hear the word epilepsy. However, this type of seizure a generalized tonic-clonic seizure* is only one kind of epilepsy. There are many other kinds, each with a different set of symptoms.
Parasomnias include a host of abnormal motor and behavioral manifestations occurring during sleep. Some of these may mimic epileptic seizures, such as sleep terrors, somnambulism, or REM-related agitated behavior. The difficulties in formatting a differential diagnosis are compounded by the fact that partial seizures in many epileptic syndromes can occur predominantly during sleep. Furthermore, witnesses often miss the initial elements of the episode. Clinical features that suggest epileptic seizures include the occurrence of oroalimentary or gestural automatisms, focal motor phenomena, tongue biting, urinary incontinence, and occasional attacks during wakefulness. In the absence of any of these features, a para-somnia is likely. When sleep EEG studies or monitoring are not available, a therapeutic trial with a medication for treating the most likely entity should be performed. Such a trial usually allows a clinical diagnosis.
Contralateral to a frontal source or spread pattern and can occur in isolation (47,48). Urinary incontinence is also common in generalized seizures, where it occurs due to the relaxation of the external sphincter (49). In absence seizures, it occurs (albeit infrequently) due to increased bladder pressure (50). Urinary incontinence is exceedingly rare in isolation, but one case is described in the text.
Sleep enuresis, defined as recurrent involuntary bedwetting that occurs beyond the age of expected nocturnal bladder control, is a common distressing disorder. The age at which continence is expected varies across cultures while the prevalence of continence is similar. In general, girls attain nocturnal continence earlier than boys. If continence has never been attained, the disorder is called primary sleep enuresis, while enuresis that recurs following a period of at least 3 months of bladder control is called secondary sleep enuresis. Primary sleep enuresis accounts for 75 of cases however, in older children, up to half have secondary enuresis. Because nocturnal seizures may be accompanied by incontinence, epilepsy is sometimes a part of the differential diagnosis. The majority of children achieve bladder control by age 4 with a 1-3 prevalence of enuresis at age 12 and a 1 prevalence in young adults (Schmitt, 1984 Klackenberg, 1987 Friman and Warzak, 1990). Daytime enuresis occurs...
Both the single- and the two-stage operation carry significant risks of neurological deficit. Hemiparesis can be due to traction per-operatively or to vascular infarction due to damage to the pericallosal arteries or venous thrombosis. A transient and highly distinctive disconnection syndrome with mutism, urinary incontinence and bilateral leg weakness is a not uncommon consequence of a single-stage complete callosal section. It is present in the immediate