Mother Goes Blank and Talks Out of Her Head…What Is This?

Reader’s Question

My mother has a sickness where out of nowhere she will just blank out and start “talking out of her head.” What I mean is she will just start speaking words, but they won’t make sense, almost like someone who is disoriented. It’s almost like she is trying to carry on a conversation with someone. Then she will come to, and sometimes she’ll cry, or just struggle to try and be alone. I asked her what it’s like when she has an “episode,” and she generally won’t talk about it, but she did say that she blanks out and can’t remember saying or doing anything during the “episode.” And it seems to me that it is beyond her control. Her doctor says she has vertigo, but looking up vertigo, that’s not the same thing at all.

Our Consulting Clinical Psychologist’s Reply

There are so many questions I’d like to ask in this situation such as her age, her neurological history, medications, prior psychiatric treatment, etc. You didn’t mention a strong psychiatric history so I’m going to assume that her history in that area is insignificant. The situation you describe sounds more medical and neurological than mental health. In the Ask the Psychologist feature we recently had a woman describe a similar situation with her husband. I’m going to paraphrase parts of that reply:

Most likely, your mother is experiencing “complex partial” epileptic seizures. This type of seizure can be triggered by many events, including mild excitement, strobe lights, smells — just about anything. Once triggered, the individual fades out of consciousness — then begins about two minutes of what we call “automatisms,” or purposeless physical movements. These movements often involve picking at clothing or face or hair, hand waving, grabbing, etc. Some people begin walking or wandering. Once the seizure is over, the individual has no memory of the event and may be mildly confused and sleepy. A key to the diagnosis is that the behavior associated with the “seizure” will be almost exactly the same each time — as though the brain is running through a program of do this, rub that, turn the head, say something, and so on. If you mother’s “spells” are almost identical each time, that would support a diagnosis of seizure.

If this behavior is just starting, this is very serious business. A seizure is a type of electrical storm in the brain. We get a variety of unusual physical behaviors in “complex partial” seizures because the electrical discharge can take place in many different parts of the brain — even on one side and not the other. Complex partial seizures originating in the speech and language areas of the left cerebral hemisphere can often produce temporary expressive aphasia (talking gibberish) or receptive aphasia (inability to understand language).

This situation is very serious because seizures tell us that something is happening in the brain. Complex Partial Seizures are often accompanied by smaller, partial seizures. Does your mother have small “staring spells”? Does she wet the bed at night (suggesting nighttime seizures)? Does she drop things or run off the side of the road when driving?

Seizures can be the early-warning signs of a variety of neurological problems. It is very important that your mother be seen by a neurologist or a physician at a minimum. She will likely need an EEG and other neurology studies. Prior to the consultation with the physician, try to keep a record of the frequency of the events — separating them according to whether they are “off in space” episodes or those with physcial movements. I’d move on this very quickly. As an aside: she shouldn’t be driving or operating machines until this is medically investigated.

While there are a few psychiatric conditions that produce bizarre spells, I sense from your email that this situation is relatively recent, adding more support to the impression that the spells are medical/neurological in nature.