Dr. Suzanne O'Sullivan
speaker
271 appearances
2 recordings
2 series
first heard Mar 2025
last heard Apr 2025
Dr. Suzanne O'Sullivan’s voice in public audio — every appearance, attributed to the second.
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That's fairly typical of how epilepsy behaves and seizures in sleep. But I think the important thing is that this is the conversation I would like people to have because very often the conversations I'm having with patients are they're saying, but it must be epilepsy, but it must be epilepsy because it feels so impossible to them that the brain could do this without a disease.
And what I would love... you know, it's much like if you're deciding, does someone have migraine or do they have something else? You just have a conversation about it could be this, it could be this. And people are fine with the alternatives. But most of the conversations I have are people are almost begging to have epilepsy because they know how stigmatized the alternative is.
So this is exactly what I would like to see happening is you've got two possibilities and both are equally respected so that either can be considered.
Exactly. Yeah.
We don't fully understand. You know, when I was studying training as a neurologist, so let's say in the 1990s, we didn't have a clue about this stuff, but we are beginning to develop evidence.
theories but they are only theories but an awful lot of it really is around the concept of what we call predictive coding so how your brain processes information it isn't absorbing information as if we were video recorders or something our bodies behave as we expect it to behave in the case of Matthew I'm going back a bit now with remembering the story 2015 I'm asking you to go back a decade yeah I can hardly remember what I had for my breakfast but
So Matthew had some tingling, I think, in his legs. I've forgotten exactly how it started, but it started with some disturbed sensation in his legs. And then he was reassured by his doctor who didn't find anything wrong with him, but he wasn't really reassured. And he felt that he had a more serious problem than that.
That tingling in his legs then progressed into a feeling that he wasn't coordinating or using his legs correctly. And that then progressed further until he got to the point where he wasn't able to walk and he was completely wheelchair bound.
Now, as a neurologist, when you examine someone who cannot move their legs at all, there is a big distinction between what you find when you examine someone who's got, say, a spinal cord disease or brain disease and something psychosomatic, because the nervous system is arranged in a very complex way. And when you can't move your legs because you've got a brain disease, it looks one way.
If it's a spinal disease, it looks another way. So when I saw Matthew, it was very obvious to me his reflexes were normal. Lots of things were normal, and yet he couldn't move his legs.
First of all, you can tell from the history how multiple sclerosis behaves. It's flitting symptoms that move around the body. And then basically you would be able to see certain signs in the legs, such as a particular kind of spasticity or stiffness in the muscles, reflexes that are very brisk, palpitations. patterns of sensory loss that fit with the brain.
And then when you do brain imaging, MRI, you can kind of see the result of the loss of myelin rather than the loss of myelin itself. In Matthew, none of these kind of abnormal signs when you examined him, apart from not being able to move his legs, everything was normal. And brain imaging, etc, was all normal. It was very obvious that this had a psychological cause.
So the question Matthew would have for me is, how could I not be able to move my legs? You're telling me my nervous system is healthy. Why can't I move my legs?
Well, I think it's very unbelievable for people.
There are kind of, again, analogies for this in life. If you think about your foot or your feet for even a moment, they feel different than if you're not thinking about them. Because our bodies are awash with all of these sensations at all times that we could feel instantly.
if we paid attention to them, but because our brains can only handle so much information, we just eradicate that white noise so we can pay attention to the conversation we're having or important things in the room. So first of all, it takes very, very little for your body to feel different. All you have to do is pay attention to it and you will notice stuff.
these things are supposed to be automatic you've been learning them your whole life but Matthew became aware there was something wrong with his feet so the minute he pays attention to his feet they feel strange and then what does that do it makes him pay even more attention to his feet it becomes a kind of a looping thing that gets out of control
So that's how you change the sensation in your body. But then think about motor activity. So I always give examples like sports people. So only some sports people can take penalty tries. You might be brilliant at something when no one's looking at you, but the scrutiny of the crowd completely affects your ability to coordinate your muscles.
Or I give examples like walking on a cliff path somewhere. Any other day you just walk, you don't think about it. But if you're walking somewhere where there's jeopardy,
Exactly. We can change the quality of both our movements and how our body feels by the scrutiny that we pay to our bodies. Very often these things happen because we are paying so much attention to the body and then we expect the body to behave in a certain way. way and therefore it does. So it's not actually that unusual for people to have problems a little bit like Matthew's.
Showing 81–100 of 271 · page 5 of 14
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