What causes a seizure in a healthy 35-year-old adult?

Question

Hello doctor,

I am 35 years old and was at work when I suddenly lost consciousness and started convulsing, according to my coworkers. I do not remember anything except waking up confused and disoriented in the ambulance. I had my first seizure three weeks ago, and I am terrified that it might happen again without warning.

The emergency room doctors performed several tests, including CT scans and blood tests, but everything came back normal. I have been referred to a neurologist, but my appointment is not for another month.

Since the seizure, I have been experiencing strange sensations, such as hallucinations, unusual smells, and moments when I feel detached from reality. I am afraid to drive, work with machinery, or even take a shower alone because I do not know if another seizure is coming.

My employer has placed me on medical leave until I am cleared by a neurologist, which is causing financial stress. I have never experienced anything like this before and am otherwise healthy. My family keeps asking whether I have been using drugs or drinking excessively, which is hurtful because I rarely drink alcohol.

What could cause a seizure in someone with no previous history?
Will I need to take medication for the rest of my life?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

A first seizure in an otherwise healthy adult can have several possible causes. These include structural abnormalities of the brain, such as an old injury or scar tissue, blood vessel abnormalities, infections, autoimmune disorders, metabolic disturbances (such as abnormal blood sugar or electrolyte levels), genetic predisposition, or, in some cases, no identifiable cause despite a thorough evaluation.

The episodes of déjà vu, unusual smells, and brief feelings of detachment from reality that you describe may represent focal aware seizures, which can occur before or after a generalized tonic-clonic seizure. These symptoms suggest that there may still be ongoing seizure activity and warrant prompt evaluation by a neurologist.

Further investigations, including an electroencephalogram (EEG) and a magnetic resonance imaging (MRI) scan of the brain, are usually recommended after a first unprovoked seizure, even if the computed tomography (CT) scan and blood tests are normal. These tests help identify the underlying cause and estimate the risk of future seizures.

The decision to start an anti-seizure medication (ASM) depends on the likelihood of seizure recurrence. Factors such as abnormal EEG findings, abnormalities on MRI, or recurrent focal seizures increase the risk of another seizure and may make treatment advisable.

Commonly prescribed anti-seizure medications include Levetiracetam, Lamotrigine, and Sodium valproate, although the choice depends on the seizure type, medical history, age, and other individual factors. Lifelong treatment is not always necessary.

If seizures remain well controlled for several years, a neurologist may consider gradually reducing and discontinuing the medication in appropriate cases.

Until you have been fully evaluated, it is important to avoid driving, swimming alone, bathing without someone nearby, working at heights, or operating heavy machinery to reduce the risk of injury. Driving restrictions after a first seizure vary depending on local laws and medical recommendations.

Because you are continuing to experience possible seizure symptoms, it would be advisable to contact your neurologist's office to determine whether your appointment can be moved to an earlier date. If you experience another seizure, prolonged confusion, repeated seizures, or a seizure lasting more than five minutes, seek emergency medical attention immediately.

I hope this information is helpful. Please feel free to ask if you have any further questions.

Thank you.