RSD Puzzle #138

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #138

Electrical Injury and Sympathetic Dysfunction

In electrical injury patients at least 30% also suffer from severe sympathetic dysfunction.

A high percentage of electrical injury patients (over 40%) develop subcortical seizures which cannot be recorded with standard EEG recording on scalp. Some of these seizures are due to brain stem dysfunction because of electrical current damage. Most originate from spinal cord, resulting in so called myelogenic seizures.

The tests that show such abnormalities in such patients are BAER for brain stem and STEP for spinal cord recordings.

Regardless, the patient needs to be treated as soon as possible before further damages occur. Treatments of choice are Klonopin (non-generic) in doses of 4 to 12 mg and the dosage adjusted not to cause severe drowsiness. Non-generic Tegretol is also effective but can cause complications in 2% of patients. On the other hand, Trileptal 150 mg., twice a day usually is excellent for the kind of seizures your husband suffers from. Generic Clonazepam is poorly tolerated. It has a tendency to cause allergic reactions and be ineffective for treatment of seizures. Consult your attending physician on these matters.

The circulatory problems he has are due to bouts of sudden sympathetic system dysfunction involving spinal cord (called spinal cord sensitization) resulting in myoclonic seizures. For these seizures the patient also needs to take alpha blockers such as Hytrin and also to receive epidural nerve blocks containing Depo - Medrol®.

This disease has a poor prognosis unless it is treated aggressively.

H. Hooshmand, M.D.

Copyright © 1997-2012 H. Hooshmand, M.D. No part of this publication may be reproduced, transmitted, stored in a retrieval system other than this specific media, transcribed, or translated into any language without the expressed written permission from the author; H. Hooshmand, M.D. and Eric Phillips and CMNE. This material is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician.

Send e-mail to Eric Phillips: EricmP9512@aol.com with questions or comments about this media and content.

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2012 H. Hooshmand, M.D.