[wittyreference]

Does anyone remember that Reddit post where a guy thought his landlord was sneaking into his apartment and leaving him notes? He insisted the handwriting was completely different. Then a poster suggested he get tested for CO poisoning, which it was, and the “different handwriting” was actually a part of his delusion.

“Burning out all of the glucose and dopamine in your brain” isn’t a thing. “Functional Neurological Disorder” is another name for Conversion Disorder - a condition of apparently neurological symptoms inconsistent with neurological anatomy or mechanisms, triggered (most often) by significant stressors, often suffering a longer duration in patients who strongly believe “this is definitely a physical disease!”

[codeulike]

Also odd is that OP uses the term 'seizure' but I think he means 'seized-up', like an engine that wont run. He explictly mentions at one point that the EEG didnt show anything like epilepsy.

But then he says things like "I'd work for 30 minutes, seize, sleep for 2 hours, then work, then seize, then sleep, ad nauseum."

If he was actually having siezures (absence seziures or focal seizures or myoclonic seizures or tonic clonic seizures) then presumably the EEG would have picked that up and he would have been diagnosed with and treated for epilepsy. At least I hope so because Tonic Clonic seizures (for example) can be extremely dangerous if they are uncontrolled.

Anyway I'm glad he has been able to get back to doing things in a way that feels sustainable and enjoyable.

[vegardx]

It could be like you said, but poor choice of word if that is the case.

But are you even able to see that someone had a seizure from looking at an EEG after it happened? I was under the impression that it sort of have to be happening while you're measuring.

I've been through multiple rounds of both MRI and EEG, mostly to be able to rule out things like brain damage as a precaution. I'm a little fuzzy on the details as this was done so long ago.

[phaedrus441]

You're correct. Routine EEG (~30 minutes) can capture active seizures and sometimes patterns that might lead you to think someone is predisposed for a seizure. Often patients need long-term monitoring ("LTM") where they are connected to an EEG for several days to tease out the source of their problems.

[codeulike]

Yes that's it. But if op was seizing every time he worked for a few hours it would be fairly easy to capture that on an EEG

[dreamcompiler]

> Burning out all of the glucose and dopamine in your brain” isn’t a thing

You may be right that it can't happen from overwork--I've never heard of it--but glucose starvation of the brain is very much a thing. That's what hypoglycemia causes. Type 1 diabetic patients get brain fog when they take too much insulin (which causes hypoglycemia). When it's mild, they can tell it's happening and they seek sugar, which fixes the problem very quickly, if temporarily. When it's severe, they lapse into a coma and sometimes die.

If this person's diagnosis was accurate, sucking on a sugar cube would fix it instantly. If that didn't work then the diagnosis is suspect.

[Trasmatta]

Yeah, I'm a type 1 diabetic and nothing about this person's post made sense. It's just not how blood glucose works. There's not a store of glucose in the brain that can just suddenly be depleted because you worked too much. Glucose travels in the blood and its uptake is regulated by insulin. If he was suffering from hypoglycemia he would feel effects in his entire body, and it would be at least temporarily resolved by eating sugar.

[GordonS]

AFAIK, when it's mild your brain is not actually starved of glucose at all, and hypoglycemic symptoms (e.g. brain fog) are caused by your endocrine system changing hormone levels (such as cortisol) to "signal" your body that it needs glucose to increase blood sugar levels. If it gets severe enough, then the brain can run out of glucose and the person can die - but AFAIK the body prioritises the brain for fuel above all else, so it really is the last thing to go.

[garganzol]

Glucose can be present in blood but the brain can be still unable to consume it due to diabetes (insulin absence) or some form of a mitochondrial disease (inability to transfer glucose to ATP via oxidation).

In both cases this is a panic situation from brain's point of view which is compensated by a spontaneous "stop" (seizure as OP seems to call it) and by injecting adrenaline with a corresponding response from endocrinal system (more glucose + more insulin).

[wittyreference]

Neuronal glucose uptake is via transporter GLUT1, which is insulin independent. Insulin-dependent glucose uptake is primarily GLUT4. Even in insulin absence, the brain gets its sugar.

[sneak]

> “Burning out all of the glucose and dopamine in your brain” isn’t a thing.

This sort of narrative-based grandstanding is something the author is previously known for.

His "lol oops I hacked too much" doesn't hold up to scrutiny, otherwise this would be an extremely common thing in overworked knowledge workers. It's not.

[Robotbeat]

I’ve had similar things happen. It’s not uncommon.

It is a physical thing. I’m not sure it’s caused by burning out all the glucose or whatever (as that is short term addressable). Dopamine, that’s possible.

In my case, it was caused I think by not getting enough sleep combined with cognitive load, perhaps exasperated by high sodium, and poor nutrition. Stimulants (such as caffeine, but also Ritalin, adderall, etc) if not carefully moderated both cause you to continue to work beyond the point your brain physically needs rest while also causing a kind of dopamine resistance where you need more stimulant for the same effect.

And you get migraines. In my case, optical migraines (expanding noise/patterns... in your visual cortex, not in your eyeball... that is me with somewhat foggy thinking and a bit of a head ache). A little like seizures but limited to certain parts of the brain. A little like micro-strokes as well as there’s evidence that migraines like that are somewhat vascular in nature in that similar damage is seen (in folks with lots of migraines) as in small strokes. And they seem to happen when combined with high sodium, low water intake, combined with lack of sleep and high cognitive load.

But I wouldn’t be too certain about the causes. It’s hard to tell with these things.

I suspect it has something to do with the glymphatic system (as drinking enough water seems to help as does getting enough sleep).

I’m more careful with my sleep schedule and generally don’t push myself overly hard like in grad school and try not to have too much sodium (eating Ramen—with the packet—triggered one of my episodes) and I really have them only extremely rarely—less than once a year—instead of multiple times a week like in grad school.

Recognizing limits on yourself is important. I think hard work is really wonderful and feels amazing, but you should be careful to sleep enough (7-8, maybe more if you’re recovering from something... I aggressively try to get at least 7 hours every single night), drink enough water, don’t over do it on stimulants, and make sure to eat enough.

[PragmaticPulp]

Burnout and stress related disorders are very real, but trying to explain them away as purely physical illnesses isn’t accurate, nor does it help with finding a resolution.

> It is a physical thing. I’m not sure it’s caused by burning out all the glucose or whatever (as that is short term addressable). Dopamine, that’s possible.

No, you don’t simply run out of dopamine, nor can you use it up by thinking too hard. The body is extremely good at keeping the brain fed and stocked with neurotransmitters, even between meals.

This pop-science concept of running out of dopamine isn’t real.

The real problem here is that mental illness still carries too much stigma. Some people are so resistant to accepting a mental health diagnosis and treatment that they will go to great lengths to reframe their problems in physical terms, thereby dodging what they feel (incorrectly) would be an admission of mental weakness.

Even this Tweet author’s doctor diagnosed him with a mental illness, and he even cites the diagnosis from the DSM. However, for some reason he still tries to reframe it as what he calls a “physical” thing.

[csnover]

> The real problem here is that mental illness still carries too much stigma. Some people are so resistant to accepting a mental health diagnosis and treatment that they will go to great lengths to reframe their problems in physical terms, thereby dodging what they feel (incorrectly) would be an admission of mental weakness.

I feel like suggesting that someone would try to ‘reframe’ their condition to avoid stigma inadvertently perpetuates stigmas by reinforcing the false dichotomy of mental vs physical illness.

Cognition is an extremely complex and poorly understood physical system, but a physical system nonetheless. There’s no separate ethereal plane where consciousness lives, no great uniqueness to its dysfunction. It’s not surprising to me that some people would introduce their own worse pseudoscience when physicians claim their problems are not physical problems, and I think that can happen regardless of stigma.

I believe we would do well to stop cleaving ‘mental illness’ (and, you know, ‘dentistry’) into a separate category from any other physical health problem. These conditions are physical conditions, just with such complexity that we’re not currently able to measure, understand, or treat them with the same level of precision as others. This sucks, but at least it’s honest.

[posthiatal1]

I don't agree with the OP's interpretation of the organic causes, but:

The PTSD seems quite plausible, as either a consequence of the original phenomenon or, yes, even a factor in it.

For an organic component, if any, I prefer hypoperfusion & ischemia.

I wonder if circulation can be impaired by chronic high levels of stress (and the inflammation caused by stress).

If so, I wonder if this can happen selectively, affecting most strongly the areas used most intensively during stressful times (and receiving the most exposure to high-cortisol blood).

I wonder if narcolepsy and/or something like this may work to protect the brain (from whatever mechanisms) during periods of high stress.

If ketogenic diet helps with narcolepsy, I wonder if one mechanism is that burning glucose is a source of oxidative stress...

[sneak]

There's nothing in your comment to suggest that your constellation of symptoms is in any way related to the constellation of symptoms (or purported underlying cause(s)) in TFA.

[Robotbeat]

He mentions seizures and micro stroke. This isn’t too far off. Qualitatively different effects, so the underlying physical cause could be different, but I wasn’t intending to imply that mine and his effects were identical.

[LargoLasskhyfv]

But https://en.wikipedia.org/wiki/Hypoglycemia is a thing.