24 DISCOVERMAGAZINE.COM
KELLIE^JAEGER/DISCOVERIn temporal
lobe
epilepsy,
the
religious,
sexual and
writing
behaviors
can be part
of the
patient’s
personality,
but the
symptoms
are often
amplified
after a
seizure.
hadn’t had any fevers, though, and she
said she’d never had seizures.
Nevertheless, we began testing for
encephalitis, starting with an MRI of the
brain. Unfortunately, the radiologist found
no evidence of the condition, though it
doesn’t completely rule out the possibility.
Another way to diagnose the disease
is through a lumbar puncture, or spinal
tap. The procedure uses a needle to drain
a sample of cerebrospinal fluid (CSF)
from the lower back, the same fluid that
coats the brain. If the brain is inflamed,
the evidence would show up in the CSF. We ran the
test, but once again, all the tests came back normal.
I called the psychiatrists, apologetically, with the
results. They said the news of normal results was
simultaneously wonderful and confusing: Without
any medical treatment, Melissa had suddenly, and
mysteriously, gotten better. She was completely back
to normal, they said, but they had no idea why. I was
happy to hear she’d recovered — but what did she
recover from?
FINDING THE LIGHT
Finding the diagnosis now felt more like finding a
constellation in the night sky: There were more dots
than I knew what to do with, and most were not part
of the picture. My job was to look out upon the end-
less array of bright lights and not simply draw a line,
but by connecting a few of the shiniest beacons, find
the Big Dipper.
Hoping to locate one such star, I visited Melissa
again. I asked her a long list of questions about
whether anything like this had happened to her
before. She said this was the weirdest experience of
her life, and she’d never had another like it.
“And you’ve never had a seizure before?” I asked
again.
“Never.”
“What about short periods of time that you don’tremember, or staring spells where you lose track of
what you’re doing or talking about? Has that ever
happened to you?”
“Sometimes that happens, yes. I stare off some-
times, but that’s probably just my ADD.”
This was news to me. “You were diagnosed with
attention deficit disorder?”
“No. I just have it. It’s not a big deal. It’s just been
acting up recently.”
Before I could reply, the nurse walked in to tell
Melissa that if she wanted to order dinner, she would
have to do it soon, before the kitchen closed. Melissa
thanked her and quickly grabbed the
menu, lifting it in front of her face.
On the back of the menu, scrawled
around the dessert selection and in
between the entries on the drink list,
were meticulous notes about each menu
item. I couldn’t help but comment, ask-
ing Melissa if she typically put so much
thought into dessert.
She laughed. “Yeah, I take a lot of notes.
You should see my Bible.” She showed me
it; almost all the white space, every gap or
margin, was covered in blue cursive.
That’s when it struck me. The religious behavior,
the overt sexuality, the waxing and waning symptoms,
the “ADD” self-diagnosis, the excessive note-taking.
I knew how to connect them. There’s a condition
known as Geschwind syndrome, which presents
with a constellation of symptoms including hyper-
religiosity, atypical sexual behavior and hypergraphia
(excessive and abnormal writing behavior). The syn-
drome is seen in people with temporal lobe epilepsy,
meaning they also have seizures. Episodes of “spacing
out” that occur in adulthood can be brief seizures,
though they are frequently waved off as normal or
incorrectly called attention deficit disorder.
In temporal lobe epilepsy, the religious, sexual
and writing behaviors can be part of the patient’s
personality, but the symptoms are often amplified
after a seizure. Once the seizure passes, the symptoms
gradually fade as well, until the patient returns to her
former self, as Melissa did.
An electroencephalogram, or EEG, confirmed the
diagnosis by finding abnormal brain waves arising
from Melissa’s left temporal lobe. Even though she’d
already returned to normal, we started seizure medi-
cation to prevent future staring spells or odd behavior
at work. But I still wanted to check one more thing.
On an MRI, patients with temporal lobe epilepsy
sometimes have a white dot emanating from the
temporal lobe. The speck of brightness is often so
subtle that radiologists may miss it unless they are
deliberately seeking it out. I opened Melissa’s MRI file
and scrolled to her temporal lobe. Sure enough, hid-
den amid the shades of gray matter, was a faint glow,
like that of a dying star, the last bright dot missing
from the constellation.^ DEliezer J. Sternberg is a neurologist at Massachusetts
General Hospital and the author of NeuroLogic: The Brain’s
Hidden Rationale Behind Our Irrational Behavior. The cases
described in Vital Signs are real, but names and certain
details have been changed.VITAL SIGNS