How to manage my daughter's frequent fainting episodes?

Question

Hello doctor,

I have a girl who is twenty-three years old. Five years ago, she began experiencing episodes of faintness that sometimes caused her to fall to the ground. While lying on the ground, she may loudly repeat a word. These episodes last for about one to two minutes, after which she returns to normal.

If asked whether she repeated a certain word during the episode, she says that she cannot control it. Sometimes she feels short of breath during exertion, and at other times she does not. These episodes may not occur for several months, but at times they can recur as frequently as twice a week. She does not experience convulsions during these events.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand the concern.

Based on the description, these episodes do not appear to be simple fainting. The fact that she falls, loudly repeats a word without being able to control it, and then does not fully remember or control what happened suggests that her awareness is briefly altered during these events.

Even though she does not have shaking movements or convulsions, seizures do not always present with full-body jerking. Some seizures, especially focal seizures with impaired awareness (previously called complex partial seizures), can present in this manner, with brief collapse, automatic speech, and recovery within a couple of minutes.

Since this has been occurring for five years and varies in frequency, sometimes absent for months, and sometimes occurring twice a week, it should not be ignored. Other possible causes must also be considered, such as heart rhythm abnormalities that can lead to sudden loss of consciousness, or certain fainting conditions related to blood pressure changes.

The occasional shortness of breath with exertion makes cardiac evaluation important as well. A proper medical assessment is necessary. A neurologist should evaluate her, and investigations such as an electroencephalogram (EEG) and magnetic resonance imaging (MRI) of the brain may be required to assess for seizure activity or structural causes.

A cardiac evaluation with an electrocardiogram (ECG) and possibly extended heart rhythm monitoring, such as a Holter monitor, is also advisable to rule out cardiac causes. If a seizure disorder is diagnosed, treatment is often effective.

Commonly used antiepileptic medicines include Levetiracetam, Sodium valproate, or Lamotrigine, depending on the specific diagnosis and patient profile. Proper diagnosis is essential before starting any medication. Early evaluation can help identify the exact cause and guide appropriate treatment.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.