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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I've had a TBI and notice my temper is shorter and I have gh

Customer Question

I've had a TBI and notice my temper is shorter and I have high anxiety levels.
Submitted: 11 months ago.
Category: Neurology
Expert:  Dr. Frank replied 11 months ago.

Hello, welcome to JA. How can I help? Have you had brain imaging (MRI) and an EEG? any changes? Were you knocked out and for how long? Were you started on Depakote for the mood change, headaches, or seizures? (or any combination thereof). Please ask a question and I can reply. Dr Frank

Customer: replied 11 months ago.
Had many MRI's while in intensive care, was very close to needing intervention for about a week. Was told I had two I(bilateral I think) "acute" subdural hematomas, broken jaw smash sinuses, broken tooth, extreme inner ear damage on right side of head, and was "out" for most of two months (my existence was abou5 brief flashes of about 5 seconds to a minute.
Customer: replied 11 months ago.
Had many MRI's while in intensive care about two weeks.....
Customer: replied 11 months ago.
Broken jaw. Surgeries to repair sinuses and ear about 2 to 4 months later.
Expert:  Dr. Frank replied 11 months ago.

How can I help your situation? do you have a question? Dr Frank

Customer: replied 11 months ago.
Had many MRI's while in intensive care about two weeks, was very close to needing intervention for about a week. Was told I had two I(bilateral I think) "acute" subdural hematomas, broken jaw smash sinuses, broken tooth, extreme inner ear damage on right side of head, and was "out" for most of two months (my existence was abou5 brief flashes of about 5 seconds to a minute. Broken jaw. Surgeries to repair sinuses and ear about 2 to 4 months later.
Customer: replied 11 months ago.
I was on Depakote for a time, and had serious repercussions and side effects to it. With assistance from a family MD, I got Depakote listed as an allergen. It was inducing a psychosis. Through the process, I have had Bi-polar listed as a diagnosis, and have been being treated as such. The problem is that when I'm on the medications, I am sleeping 22 hrs. a day give or take. I go off them, I get anxious, easy to anger, and have trouble sleeping at all, or at least regularly. I'm at square one treating the TBI. Recently I found the advertisement regarding PBA, and it seems to be a better / more accurate explanation. I'm hoping to see what direction I could take towards that consideration. I need to have medicine help, but not to the extent of my current meds. Basically, instead of sleeping all day, I'd like to have a functioning healthy life.
Expert:  Dr. Frank replied 11 months ago.

so do you have questions about PBA? This can be a result of brain injury, previous subcortical stroke, or from bilateral subdural hematomas that compress the frontal lobes. It can be a result of typical neuroleptics like chlorpromazine/stelazine coupled with anticholinergics. Any disorder that effects deep white matter connections in the frontal lobe including demyelinating diseases, or subcortical dementias like Binswangers'. There are new medications that are FDA approved . But the hallmark of the disorder is "emotional incontinence" as it is called, an inability to control emotional outbursts, that are not event driven. Please get back to me if you wish to discuss this aspect of your issue. Dr Frank

Customer: replied 11 months ago.
Should I speak to my Primary care Doctor about PBA?
Expert:  Dr. Frank replied 11 months ago.

HI. If you have incontrollable laughing or crying jags, then yes, you should discuss this as a possiblitity. there is neudextra, a combination of two medications, dextromethorphan, and quinidine, which effect dopamine secreting neurons that are damaged from these broken connections in the frontal lobe. It is indicated for diseases like ALS, or huntington's disease as well as MS or stroke patients. There are some side effects, you have to establish a test dose, and then work your way up.

Expert:  Dr. Frank replied 11 months ago.

One thing I might bring up after reading your statement, is to question if you could have a frontal disinhibition syndrome, which is where compression of the frontal lobes, especially when bilateral, can cause problem of regulation of emotion, leading to outbursts of anger or disinhibition (lack of control) of motivation, craving, sexual desires can be effected, etc. You can become obsessive about certain daily functions, eating, sleeping, etc. Would you say that more closely follows your day to day? If that is the case, a functional study (PET fdg) would look at frontal lobe functional activity in terms of metabolism. It might suggest medications like modafinil might work if you have continuous sleeping periods, etc. Please get back to me to discuss this further, or remember to rate my services by clicking on the rating stars if satisfied. Dr Frank

Expert:  Dr. Frank replied 11 months ago.

I hope you find a way to control the anxiety and emotionality, get back to me anytime if I can help. Dr Frank

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