Is this epilepsy?

[Cricket45]

My daughter (15) has had "fainting" spells. It started with one week where she felt ill and fainted in school.  She was out for a good 20 minutes, and her eyes where rolled back - fluttering. She was still "out" when the ambulance arrived. During that week she fainted a number of times (quick breathing and fuzzy periferal vision) and didn't feel like herself. Very bad headache over her right eye.  It didn't happen for a few weeks so we thought it was a virus.  Now it has happened a number of times, both while physically active and while just sitting in class.  There are two differences now though - she has started having "tonnic" cramps (according to the paramedics) and she can "faint" up to 8 - 10 times in a row. She never remembers anything besides telling her teacher she feels dizzy.  She is extreemly tired after these attacks. She can "faint" with her eyes open as well.

She is on a waiting list for an EEG, but that will take 2 months before she can get the test taken.  We have planned a trip that require one 9 hr.flight plus a couple shorter ones. This trip will take place before we can get the EEG done.  I am concerned that she will have a series of "attacks" that won't stop while we are on this long flight.

I would like to know if you are as conviced that this is epilepsy as I am. And what the chances are that her 8 - 10 "attacks" will become continuous. Is there anything I can so to prevent this?

I thank you for assistance.

[Lee9709]

There are other disorders that cause fainting.  I would recommend a Cardiac work-up.  Search out disorders like Neurocardiogenic syncope, heart arrthymia, long QT syndrome.  Especially with no signs of tongue biting, or urinary incontinence.  With Neurocardiogenic syncope, the fainting occurs due to a vaso response, an inbalance between the parasympathetic and sympathetic nervous system, which causes a pooling of blood in the lower extremities----a decrease in bp, cardiac output, which results in low oxygen to the brain.

[Cricket45]

Thank you for your suggestion of looking into conversion disorder. I have read what I can find on line and I will take this information along to her next consultation.

[Abhijeet Deshmukh, MD]

Hello.

Please do not think that I have ruled out a seizure. This forum helps us discuss the various possibilities so that when we go to the respective doctors' clinics, we are more informed. The material posted here is not to be taken as a medical advice!

In my view, her symptoms do not "fit" in the typical seizure manifestation. But it remains to be confirmed by the EEG. Even a small fainting has to have a reason. I believe the reason is something beyond seizures. Another possibility to mention here is pseudo seizures. Her symptoms are typical of conversion disorder, even with the choking sensation in the throat. I would suggest you read about conversion disorder.

The necessary things on travel include a dextrose / glucose vial, in case she has a fainting due to hypoglycemia. Carry some of her important medical documents. May come in handy.

Regards

[Cricket45]

Regarding as to where my daughter faints - it has either been in school or at home.

There has not been any head injury, tongue bite or urinary incontinence.  She can always feel the episodes coming so we are able to lay her down before she falls. She is totally out when she faints. The paramedics shook her slightly and yelled her name to see if they could get in contact with her with out any response.  She awoke shortly after.  She then soon "fainted" again and this is when the paramedic stated that she was having a tonic cramp. Her left arm was straight down by her side and her left hand was clenched extremely tight. All circulation was gone from that arm. It happened once more on the way to the hospital. Could this have any thing to do with the pain over her right eye? She has had a normal MRI scanning. Once while she was conscious between "faints" I asked her if she had any pain and she said it felt like there was a string around her throat. She could hardly breathe. I could hear her wheezing slightly as well.  She does have asthma - but we had that check recently with everything being as it should be.  The paramedics had monitors on her while she was having the episode on the way to the hospital and they said her heart was fine.

You say you believe she is just fainting. What is causing her to do this?

In regards to our trip - you mentioned that we should have the "necessary things” with us. I am uncertain as to what these would be. Please explain.

Thank you for your help.

[Abhijeet Deshmukh, MD]

Hello.

There are certain markers for seizures. Apart from the EEG, there are some hints which help you differentiate seizures form something else.

Seizure is an episode of central nervous system dysfunction. From your description, it appears that she faints. Fainting comes close to being absence or atonic seizures. These are usually seen in younger children. Her age is a bit unusual for these.

During a seizure, there may be a head injury, tongue bite or urinary incontinence. Did she have some of these?

I do not think the diagnosis should entirely depend on the EEG. The clinical features are important.

Have all the fainting episodes occurred in school? Overall, the diagnosis of seizures is questionable, but you can always wait for the EEG to reveal something. Do not worry about the travel. Make sure you have the necessary things and inform one of the crew about her possible episodes.

Regards

[spastic]

Hi, I'm a friend of the forum and I would definately see if you can be put on the cancellation list for the EEG.  I would also see if your Dr can request an emergency neuro consult.  I can understand your concern with your trip and everything.  See if you can get bumped up on the cancellation list.  I hope everything goes well.  Please keep me posted.

Spastic Ada