Navigating the Challenges of Unexplained Neurological Symptoms in Teens

Perplexed parents

Dear Dr.
Lan,
I have a 17-year-old daughter who experienced a sudden fainting episode last April.
It was a hot day, and she left home without breakfast because she was in a hurry to meet her teacher.
Shortly after leaving, she called to inform me that she was feeling unwell.
When I arrived to pick her up, she fainted again but regained consciousness after about 3 to 4 minutes.
We went to the hospital that day, where an electrocardiogram was performed.
The doctor suspected it might be a transient issue and advised me to keep an eye on her.
This marked the beginning of her suffering.
About a month and a half later, she suddenly couldn't get out of bed, stating that the floor felt like pudding and unstable beneath her feet.
She began to experience sensations of earthquakes at times, along with dizziness, blurred vision, and moments of darkness.
During this phase, she suffered from vertigo, nausea, and tinnitus.
We underwent a series of tests, including echocardiograms, CT scans of the brain, and balance assessments, consulting specialists in cardiology, otolaryngology, and neurology, but no issues were identified.
A neurologist at the Veterans General Hospital even suggested that her symptoms might be psychological, which left her feeling very frustrated and reluctant to seek further treatment.
However, as her condition did not improve, we sought help at another hospital.
She was seen by a neurologist at National Taiwan University, and initially, the medication seemed effective.
She would sleep a lot, but when she felt better, she could get out of bed.
If she felt dizzy, she would rest at home.
This cycle continued for nearly six months.
By October of last year, she thought she could manage her dizziness and live a normal life, but within a week, she began to experience shortness of breath, involuntary muscle spasms in her limbs, and headaches.
The long-term use of medication led to stomach pain, prompting the doctor to change her prescriptions, which only provided temporary relief.
One day at school, she nearly fainted again, and the school urgently took her to Chang Gung Memorial Hospital.
The otolaryngologist and neurologist there could not find any issues either.
Her medications were adjusted multiple times, providing only short-term relief.
Eventually, the doctors suggested that she might have to live with these symptoms for life, as the medical community has yet to identify a cause.
This has left my daughter feeling very discouraged, and since the beginning of this year, her immune system has been weak, making her prone to colds and gastroenteritis.
Interestingly, when she has a cold or gastroenteritis, her dizziness seems to disappear, but once she recovers, the dizziness returns.
Since March, she has developed new symptoms, including severe pain in the back of her head, which does not respond to painkillers.
Recently, she has been telling me that her whole body hurts, to the point where she cannot find a comfortable position in bed.
She can no longer distinguish between sharp and dull pain; she just knows that she is in significant pain.
This nearly year-long ordeal has severely affected her concentration, disrupted her school life, and made her irritable and prone to crying.
Last week, she began to feel depressed, and many negative emotions surfaced.
This morning, she was in so much pain that she couldn't get out of bed, experiencing headaches and dizziness, although her complexion seemed fine and her lips had color.
Seeing my daughter's suffering as a mother, I truly feel helpless.
I sincerely ask for your assistance, Dr.
Lan.

Dabby, 30~39 year old female. Ask Date: 2016/04/11

Dr. Lan Shengxing reply Neurology

Dear Dabby, I didn't see anyone, but generally, at this time, we believe that parents should patiently accompany their children in receiving treatment, rather than constantly seeking different tests and treatments.
I would like to recommend Dr.
Li Jiayan to you; I believe Dr.
Li can provide you with good advice.

Reply Date: 2016/04/11

More Info

Navigating the challenges of unexplained neurological symptoms in adolescents can be a daunting task for both the affected individual and their family. Your daughter's situation, characterized by a series of distressing symptoms including fainting, dizziness, and persistent pain, is understandably concerning. It is crucial to approach this matter with a comprehensive understanding of potential underlying causes and the importance of a multidisciplinary approach to diagnosis and treatment.

Firstly, it is important to acknowledge that unexplained neurological symptoms can stem from a variety of sources, including physiological, psychological, and environmental factors. In your daughter's case, the initial fainting episode could have been triggered by dehydration or low blood sugar, especially since she had not eaten breakfast that day. However, the subsequent symptoms she experienced, such as persistent dizziness, a sensation of the ground being unstable, and episodes of faintness, suggest that there may be a more complex interplay of factors at work.

The fact that extensive medical evaluations—including cardiac assessments, brain imaging, and consultations with various specialists—have not yielded a definitive diagnosis can be frustrating. It is not uncommon for patients with neurological symptoms to be misdiagnosed or to receive a diagnosis of a psychological nature when no clear physiological cause is found. This can lead to feelings of invalidation and frustration for both the patient and their family, as you have described.

Given the chronic nature of your daughter's symptoms, it may be beneficial to consider the possibility of a functional neurological disorder (FND). FND is characterized by neurological symptoms that cannot be explained by traditional neurological diseases. These symptoms can include motor dysfunction, sensory disturbances, and episodes of altered consciousness. Importantly, FND is not a psychological disorder per se, but rather a condition where psychological factors may contribute to the manifestation of neurological symptoms. This does not mean that the symptoms are "not real"; rather, they represent a complex interaction between the brain and the body.

In addition to exploring the possibility of FND, it is essential to address the psychological impact of your daughter's condition. Chronic pain and debilitating symptoms can lead to anxiety, depression, and a sense of hopelessness. It is crucial to provide her with emotional support and to consider involving a mental health professional who specializes in chronic illness. Cognitive-behavioral therapy (CBT) can be particularly effective in helping patients manage their symptoms and improve their quality of life.

Furthermore, the observation that her symptoms seem to improve during episodes of illness, such as when she has a cold or gastrointestinal issues, may indicate a psychosomatic component to her condition. Stress and anxiety can exacerbate physical symptoms, and addressing these emotional factors may lead to an improvement in her overall well-being.

As a parent, it is natural to feel helpless in the face of your child's suffering. However, advocating for her needs and seeking out specialists who are experienced in managing complex cases can make a significant difference. Consider seeking a referral to a specialized clinic that focuses on functional neurological disorders or a multidisciplinary pain management center. These facilities often employ a team of healthcare providers, including neurologists, psychologists, physical therapists, and occupational therapists, to create a comprehensive treatment plan tailored to the patient's needs.

In summary, navigating the challenges of unexplained neurological symptoms in adolescents requires a multifaceted approach. It is essential to consider both physiological and psychological factors, seek out specialized care, and provide emotional support to your daughter. With the right resources and a supportive environment, it is possible to improve her quality of life and help her regain a sense of normalcy.

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