QUESTION:

I have a four year old who can be fine one moment and the next moment will become extremely violent. He head butts, hits, kicks, bites, and verbally abuses our family and occasionally outsiders. He recently had an EEG done which had abnormal spikes indicating possible seizure activity. My question is if a seizure only lasts 1-2 minutes why do these outbursts of violence last up to an hour? He is now on 600 mg of Neurontin twice daily; he may still have at least one episode during the course of the day and the outburst does not last as long. But he is extremely manipulative and controlling. Does this sound like seizures or a personality disorder? Can a child this young have bipolar disorder? Does a person with bipolar disorder usually have an abnormal EEG? He and our family have had a traumatic year.

DR. HELLER'S ANSWER:

I was so saddened reading your story. I hope my information is of help.

Not all seizures last only 1-2 minutes. Seizures in the temporal lobes and deeper structures of the brain (which are not seen on an EEG) can last significantly longer. I've had patients stare into space unarousable for 5-10 minutes, "awakening" into a profound rage and self-destructive behaviors.

It's very difficult to tell what's going on, but the likelihood of a personality disorder is low.

Bipolar can indeed be present at this age, and is being diagnosed with increasing frequency. It's a very difficult diagnosis to make. The bipolar disorder is not usually associated with an abnormal EEG.

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