What investigations are needed after repeated seizures?

Question

Hello doctor,

I wanted to let you know what was going on with me and see what you think. I had another seizure yesterday at my daughter's soccer game and fainted in front of the audience. I am 42 years old, and this was my third seizure in the past two months, after being seizure free for several years.

My medicine dose has stayed the same, yet the incidents still happen. My wife videotaped the latest seizure, and it seemed that my arm movements were different from other incidents. I may share the video if it would aid your assessment.

I have also been under significant work-related stress and have been sleeping only about four hours per night due to a new project. Could sleep deprivation or stress be contributing factors?

In addition, I sometimes notice a strange metallic taste just before a seizure occurs. I am not sure whether this is relevant, but I wanted to mention it.

As a result of the recent seizures, my driver's license has been suspended again, which has made it difficult for me to transport my children and manage daily responsibilities.

I have a few questions:

Are there any other tests or assessments that you would suggest at this time?
Should I think about changing my present treatment or trying some of the newer anti-seizure medicines?
My brother told me to try CBD oil. Is there any legitimate proof for its use in managing seizures in my case?

Finally, my daughter's school recently informed me that she has been experiencing anxiety related to my condition.

Do you have any recommendations on how to discuss epilepsy and seizures with a 9-year-old in an age-appropriate and reassuring way?

Thank you for your time and guidance.

I look forward to your recommendations.

Answer 1

Hi,

Welcome to icliniq.com

I hope you are doing well.

A recurrence of seizures after a long period of seizure freedom should be a red flag for a full reassessment. There are a number of possibilities including sleep deprivation, increased stress, changes in the effectiveness of drugs or other underlying neurological changes.

Not getting enough sleep is a frequent trigger for seizures, particularly for those who have epilepsy. Definitely inconsistent lack of sleep (4 hrs per night) can lower the seizure threshold and increase the risk of breakthrough seizures. Even if your prescription dose hasn’t changed, lifestyle changes, stress levels, metabolism or the way you absorb medication can affect how well your treatment is working.

There are a few things you mentioned that are especially important:

The metallic taste you experience beforehand could be an aura that can be a focal seizure that occurs before a larger seizure.

This is important information to share with your neurologist, as the change in the pattern of arm movements during the seizure may be a sign of a change in seizure activity or seizure type. If possible, you might find it very helpful to bring the video recording to your appointment.

I suggest you discuss the following with your neurologist:

Detailed neurological examination including:

Repeat EEG, possibly with prolonged or video monitoring.
A brain MRI, especially if it hasn't been done recently.
Blood tests, including serum medication levels, to ensure your medication remains within the therapeutic range.
A sleep-deprivation EEG sometimes detects abnormalities that standard testing misses.
Review of your current anti-seizure medication plan.

Some people will need to make adjustments in the dosage, combination therapy or change of medication over time.

Your treating physician may consider newer medications such as Brivaracetam, Lacosamide or Cenobamate depending on your specific situation.

Questions about CBD therapy.

There is scientific evidence supporting the use of prescription cannabidiol for certain types of epilepsy.
The FDA-approved drug Epidiolex has shown benefit for certain epilepsy syndromes.
But the quality and consistency of over-the-counter CBD products varies widely, so any use should be discussed with your neurologist before starting.

As for your daughter, a simple, honest and reassuring talk will do the trick. You could say that:

Seizures can look frightening, but they're a medical condition doctors are helping you manage.

You are being treated, and you’re working closely with your healthcare team.

There are always adults to help if a seizure happens.

When she has a problem or gets confused, she can ask questions.

If she is still anxious, you may want to consider talking to a child counselor or psychologist for further support to help her feel more secure.

I know how frustrating it can be to have your driver's license suspended. Although these restrictions are generally necessary for safety reasons, many people are able to regain their driving privileges once their seizures are controlled and they meet the applicable medical criteria.

I hope this addresses your concerns.

Please feel free to follow up if you need any additional clarification.

Thank you.