Dear Dr. Roach: At 69, I still 鈥渮one out鈥� briefly, losing time and location. In grade school, I was told that I daydreamed too much, and at one point was deemed 鈥渞ather slow鈥� on my report card. I repeated sixth grade. I once missed a flight when my name was called, as I was zoned out. There are too many examples to note, but I鈥檓 wondering if I am a victim of absence seizures. 聽
J.S.
It is possible for children with partial complex seizures (there are several types of seizures that can cause staring spells, not just child absence epilepsy) to be misdiagnosed with inattention, but to get the diagnosis at age 69 is outside of my experience 鈥� 90 per cent of children diagnosed with CAE are seizure-free 15 years after diagnosis, so you would be a remarkable case for several reasons.
Zoning out does not require a pathologic diagnosis. There may be no abnormalities in your brain at all, anatomically or physiologically. Still, people with epilepsy range across all levels of function, from very low to very high.
I would recommend that you talk to your primary doctor about it. He or she might recommend an evaluation with a neurologist.
Dear Dr. Roach: I recently had gastroparesis diagnosed. I am concerned that gastroparesis might affect the absorption of medicines. I take Nexium, but I want to know whether there is anything I can do to prevent the condition from worsening.
J.M.
Gastroparesis is a condition in which the stomach does not contract normally, slowing down absorption of food and usually causing symptoms of bloating and distention, and often nausea, vomiting and pain.
Causes of gastroparesis can include diabetes, viral infections, medication and surgery. Some neurological diseases, such as multiple sclerosis, also can cause gastroparesis.
It stems from an inadequate nerve supply to and in the stomach, rather than a mechanical problem. Some of these are irreversible, but most of the idiopathic and post-viral cases will improve by themselves, although it may take months.
Dietary treatment, including eating several smaller meals and avoiding insoluble fibre and excess fat helps. Avoiding alcohol and nicotine helps as well.
Absorption of food and medication happens largely in the small intestine, so medication absorption usually is complete, although it may be delayed.
Medication treatment is limited by the side effects of the available medications.
Metoclopramide is effective, but can cause a severe movement disorder, tardive dyskinesia, so it is recommended for only 12 weeks.
Erythromycin, an antibiotic that causes many people stomach upset and diarrhea, is useful because those side effects are caused by an increase in stomach and intestinal movement, which is exactly the goal in people with gastroparesis. It, too, is recommended only for short-term use (four weeks), as the body tends to become accustomed to the medication and its effectiveness wanes.
The most effective drug, cisapride, can cause a potentially fatal arrhythmia, so it can be used only through a special program through the manufacturer.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
