Does my daughter really have seizures?
Dear
DrRich:
My
daughter’s first episode of syncope was a brief fainting spell during a
strenuous activity. She was unconscious for less than a minute, and vaguely
remembers fainting. It was
diagnosed as a result of a combination of her mitral valve prolapse and
hypoglycemia, and occurred three years ago.
Since then she has been careful to drink water and eat properly before
engaging in strenuous, physical activities.
Her
more recent episode, also during a strenuous activity, involved an
extended
period of unconsciousness (ten minutes) followed by another five minutes of
incoherence. She has no memory of
the event itself. This time a head
CT was ordered, which showed a "small abnormality" in the right
temporal area, likely a result of a former head trauma.
It was not a bleed, not a mass, nor free fluid.
Therefore, the medical staff believe that this episode was a seizure, and
have her on anti-seizure medicine.
However,
as I'm researching both seizures and syncope, her episode doesn't really seem to
fit a seizure profile, as she did not have any convulsions or muscle twitching.
She did say she felt weak after first recovering, and had
"sparkles" in her vision periphery for about five minutes after
returning to consciousness.
I
know you can’t make a diagnosis over the Internet.
But is it possible for a syncope episode caused by hypoglycemia and/or
MVP to last 15 minutes? That
doesn't seem to fit the syncope profile, either. (I’ve read your article on
syncope.)
Any
advice or resources that you can point me to would be appreciated.
Ms. X.
DrRich replies:
Dear Ms. X,
I
would be concerned, too, if I were you.
As
you note, I cannot make a diagnosis over the Internet, but I can make a couple
of general observations.
MVP
does not cause syncope. Some
cardiologists attribute an increased propensity for potentially lethal
arrhythmias to MVP, but this has never been convincingly shown.
The docs who blamed her syncope on MVP are likely misinformed.
Hypoglycemia
should not occur during strenuous activity in normal individuals, unless the
strenuous activity is maintained for several hours (as in marathon running).
Even then, the hypoglycemia associated with prolonged, strenuous activity
causes sudden weakness and loss of muscular tone, but usually not loss of
consciousness.
A
seizure is a possibility, but I would want to see a grossly abnormal EEG in
addition to a CT lesion.
Here’s
the real concern: When a person has syncope in the midst of a bout of strenuous
activity, the first thing the doc should think about is a ventricular arrhythmia
- a potentially fatal problem, that often causes sudden death.
Perhaps this has already been ruled out.
If not, she ought to strongly consider getting a consultation from a
cardiac electrophysiologist. And
she probably should not engage in strenuous activity until this possibility is
ruled out.
I
hasten to point out that I am referring to syncope in the midst of activity -
not just at the end of exercise. (Syncope occurring just as exercise has ended
is usually vasovagal syncope.)
Best
of luck,
DrRich
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