Why did I collapse suddenly and become unconscious?

Question

Hello doctor,

I had a terrifying episode six days ago where I suddenly collapsed without any warning and started violently shaking all over, and witnesses said I was completely unconscious for five to six minutes. I bit my tongue severely during the episode, causing significant bleeding, woke up profoundly confused and disoriented for over an hour, had severe muscle soreness throughout my entire body, and had an intense headache for three days. I have absolutely no memory of the episode, which is extremely frightening, and I am now terrified this will happen again while driving, at work, cooking with a hot stove, or caring for my young children. I have never had anything remotely like this before, though I have been under tremendous stress at work and home, and I have only been sleeping two to three hours nightly for the past four months.

I have the following questions:

Was this definitely a seizure, or could it be something else (such as syncope or psychogenic episode)?
What is the difference between provoked and unprovoked seizures?
What causes seizures in adults (such as epilepsy, brain tumor, stroke, infection, or metabolic conditions)?
What tests are needed (such as electroencephalogram, video-electroencephalogram monitoring, brain MRI, CT, and blood work, including electrolytes and glucose)?
Will I definitely have more seizures, or could this be a one-time event?
Do I need anti-seizure medication after the first seizure?
What medications exist, and how do I choose between them?
What are the side effects, and how long is the treatment?
When can I legally drive again, and what are state driving laws?
What activities are unsafe now?
What is the risk of sudden unexpected death in epilepsy (sudden unexpected death in epilepsy)?
Could this be epilepsy?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

What you described, sudden collapse, violent body shaking, tongue bite, complete loss of consciousness, and prolonged confusion, is very typical of a generalized tonic-clonic seizure. The severe body soreness and headache afterward also support this. Syncope or fainting usually lasts only a few seconds, and recovery is rapid without confusion or tongue biting.

Sometimes seizures can be provoked by a specific temporary factor like sleep deprivation, infection, low blood sugar, alcohol, or severe stress. When no such cause is found, it is called an unprovoked seizure. If unprovoked seizures repeat, the condition is called epilepsy.

In adults, seizures can be caused by many things, including epilepsy, head injury, stroke, brain tumor, infection, metabolic problems (like low sodium or blood sugar), or medication withdrawal. Identifying the cause helps determine whether this was a one-time event or the beginning of epilepsy. Identifying the cause helps decide if this is a one-time event or the beginning of epilepsy. The essential tests include:

An electroencephalogram (EEG) is used to record brain electrical activity.
Brain magnetic resonance imaging (MRI) is used to look for structural causes.
Blood tests for glucose and electrolytes.
In some cases, video-electroencephalogram monitoring is used to capture and analyze an event.

Not everyone needs lifelong medication after a single seizure. If tests are normal and there is a clear trigger (like severe sleep loss), sometimes doctors only monitor. But if the electroencephalogram or magnetic resonance imaging is abnormal, or there is a high risk of recurrence, anti-seizure medicine is started.

Common medicines are:

Levetiracetam.
Lamotrigine.
Valproate.
Carbamazepine.
Oxcarbazepine.

The choice depends on seizure type, side effects, other health issues, and pregnancy plans. Common side effects may include tiredness, mood change, dizziness, or rash, but most patients tolerate them well. Treatment usually continues for two to five years seizure-free before considering stopping, under medical supervision. Never stop medicines suddenly.

For safety, you should avoid driving, swimming alone, cooking on open flames, climbing heights, and bathing unattended until you are medically cleared.

Until cleared by your neurologist. Most states require six months seizure-free before driving again. The risk of sudden unexpected death in epilepsy (sudden unexpected death in epilepsy) is very low, about 1 in 1000 per year, and mainly occurs in people with uncontrolled frequent seizures. Taking medicines regularly and ensuring good sleep greatly reduces this risk.

In your case, severe sleep deprivation could have triggered the seizure. But since it was prolonged and severe, you should have an electroencephalogram, magnetic resonance imaging, and full blood work soon. With proper evaluation and good sleep hygiene, the outlook is very positive.

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

Thank you.