Q. Can seizures be related to chronic sinusitis?
Hello doctor,
I am writing to get a second opinion for my relative. He is a 19 year old male. He had a seizure last year and the second seizure was on last week. His electroencephalogram (EEG) was normal and also had an magnetic resonance imaging (MRI). The doctors said that he has chronic sinusitis with thickened mucosa and they started giving him antibiotics. I want to know whether the seizure is related to the sinusitis. If yes, does that mean he might have a brain complication? I want a medical advice whether there is a need to start with Tegretol. My blood test showed high levels of white blood cells (WBCs). Currently, the doctor has given Keppra. Should he start it? Please guide.
Hi,
Welcome to icliniq.com. We usually recommend antiepileptic if someone has two seizures within 24 hours. In approximately 70% cases, we may not be able to identify any specific cause for seizures, for example - infection, stroke, focal cortical dysplasia (FCD) and tumor, as in your case. Sinusitis is an incidental finding and at present it seems to beunrelated to epilepsy. You should complete antibiotic course as prescribed for its coverage. For epilepsy, he will need antiepileptic drugs (AED). There are many AED to choose from, but once you have been given Keppra (Levetiracetam) you can continue the same, as it is a new generation drug with minimal side effects and drug interaction. With the limited information I have, I would recommend starting it to prevent future seizures. Your neurologist can provide you with its optimal dosing. High white blood cell (WBC) could be related to sinusitis or as a transient rise from seizure itself. It should come down by itself. It would be good to know how long his seizure was and what he did during his seizure. Did he passed urine, stool or bite his tongue during the episode?
Hello doctor,
Thank you for your answer. The seizure lasted for around 90 sec and he did not pass urine or stool. He had bitten his tongue and got bleeding gargles from it. Also, when he recovered he did not remember what had happened. He also felt a deep chest pain for about two to three days after the seizure. I remember that the night before seizure, he was awake till late night as he was preparing for school exams. Also, he was highly stressed at that time. I have also included some magnetic resonance imaging (MRI) pictures. You take a look and let me know if anything more is needed. I also would like to know is this a case of epilepsy or something else and is it curable. Thanks for your medical advice.
Hi,
Welcome back to icliniq.com. Thank you for this update. Seizure is defined as a single episode of convulsion whereas epilepsy is defined as two or more episodes of seizure. Since he had two seizures, he hasepilepsy. Antiepileptic drugs (AEDs) are used to prevent future seizure episode. It is not a cure. It will allow the brain to remodulate itself with a hope of outgrowing of seizure tendency. Most of the patients do outgrow it in few years of onset. Seizure threshold is usually lowered by lack of sleep, sleep deprivation, fever, illness, stress or lack of food. In his situation, lack of sleep could be a trigger. Magnetic resonance imaging (MRI) images (attachment removed to protect patient identity) were reviewed and they look better. No further workup is needed at this point, unless his epilepsy gets out of control while on AEDs.
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