During my stay in the NCCU, most of my neuro labs were normal. I still had some episodes but they were fewer, so it was harder to correlate them with my EEG (brain activity tracings). Dr. Toni Rosales (neuro hospitalist) and Justine Yu (neuro resident) were in charge of my case, and they had a sudden flash of inspiration that sent them back to the books when I insisted that I was aware of everything during my episodes. One of the key features of seizures is loss of consciousness, and my claim of awareness plus the lack of EEG abnormalities during episodes go against seizure as the diagnosis. They also reviewed the circumstances that triggered the episodes, which were emotional excitement and laughter.
Cataplexy is a neurologic condition associated with a sleep disorder called narcolepsy, where the normal mechanism for switching your body “off” during sleep (a protective function of the brain so that you don’t act out your dreams and end up hurting yourself) becomes dysfunctional. In a nutshell, my brain accidentally turns my body “off” at random times, even when I’m not asleep. It’s like the opposite of sleep walking, so I guess it’s walk-sleeping? 😛 When my overall condition became more stable over the next couple of days, we were able to notice that each episode was precipitated by certain triggers. In the first few hours after I got out of my diazepam daze, I was so hungry because I haven’t had anything to eat or drink ever since I was admitted (a day or two days ago?). I got so excited when my nurse brought in my food tray, that I slumped over the table the moment I was about to reach for my dinner and woke up with a feeding tube down my nose 😦 Bad trip!!! Pretty funny now that I look back on it, but seriously, I never knew that nasogastric tube insertion was such a pain in the a*…um…nasopharynx. >.<
Doc Toni and Justine tested their cataplexy hypothesis when my friends, Gem and Kaye, (surgical residents) dropped by. Doc Toni instructed them to make me laugh while the EEG leads were on, so they can monitor my brain waves in case they triggered an episode. Their scheme was a success. They made me laugh so hard (and it still kind of gives me the giggles even now) when they told me that it was too bad I was already awake, because they originally planned to pull a prank on me by putting all sorts of surgical devices on me like a colostomy bag (used to drain poop in intestinal bypass surgeries), surgical drains and whatnot so I’d completely freak out when I woke up. Thanks a lot, true friends forever talaga kayo!
So by that time, the Neuro team was leaning more towards a diagnosis of narcolepsy and cataplexy instead of complex partial seizure.