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    Are unconsciousness, convulsions and muscle rigidity symptoms of seizure?

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Posted on Mon, 16 Nov 2015 in Brain and Spine
Question: Hi Doctor,

To begin with, I am totally confused. For a long time, I've had seizures or extra pyramidal symptoms or whatever name it is called the next morning after a heavy drinking session. My face muscles become numb around my mouth, my breathing stops and becomes erratic, my neck turns to one side and my spine arches back almost choking my wind pipe. Sometimes, on rare occasions these attacks occur even while I am drinking. If such an attack occurs, I am taken to a local ER where they administer Phenergan and the condition subsides. All the doctors consulted so far say that is a case of EPS. However, recently, when I was driving my car, and I have been off alcohol for a long time, I had a recurrence of this attack. I was administered phenergan and all was well. And since this is the first time this occurred without any connection to alcohol, I decided to consult a neurologist who told me that this was not EPS and it was some sort of epileptic seizure. He asked me to take a Brain Scan and EEG, and both turned out to be normal. This has confused the neurologist but he has put me on Petril Beta for a month, and suggests using Midazolam instead of Phenergan next time an attack occurs. Now I am super confused than before. Can somebody please help?
doctor
Answered by Dr. Ajay Panwar 2 hours later
Brief Answer:
History is suggestive of seizures.

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through your clinical history meticulously and I must say that it indeed appears to be a history of seizures.
First of all,EPS is not supposed to be episodic disorder.What you are telling appears to be marked by distinct clinical episodes of the symptoms you have mentioned and these symptoms(breating stops--neck turns--spine arches--wind pipe choking) are very likely suggestive of seizures only.

I agree with the neurologist's opinion.You should be on a trial of antiepileptic drugs even if Brain scan and EEG are normal.I suggest you to carry on with his Petril Beta and Midazolam advice for now,and observe for the response in next one month.

If you have some further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar 41 minutes later
Dear Dr. Panwar,

Thank you for responding and for your clear answer.

I, however, have a few doubts, chiefly due to my ignorance based confusion. I apologize in advance if this comes across as questioning your professional competence. I will list them below.

1)These incidences first occurred only in my early thirties--I am 44 now -- after numerous deaddiction treatments for my alcohol dependence. Maybe I was administered Disulfiram during my treatments, I am not sure. And all through up until now till the recent attack I have never had a seizure unless I drank alcohol. The attack usually happens the next day of drinking too much alcohol. If I drank moderate amounts of alcohol, nothing happens the next day.

2) I had quit alcohol totally from 2004 to 2012 and I did not have a single attack The recent attack on Saturday 17th October was the ONLY instance of attack which was non related to alcohol. I have not drank since 3 weeks. So if this was seizure, shouldn't it also happen whether I drank alcohol the previous day or not?

3) Aren't the symptoms (breathing stops--neck turns--spine arches--wind pipe choking) also indicative of EPS?

4) If it is not, then how does Phenergan, a drug used to treat allergy related symptoms, work every time?

5) The neurologist has suggested Midazolam injection as SOS as a substitute for Phenergan when an attack occurs. I am concerned about this as I read up that Midazolam can also cause respiratory problems which can also be fatal sometimes. So I am worried, should an attack arise administering this instead of Phenergan will endanger my life. Even during my one and only non-alcohol related attack last week, Phenergan was the drug that worked and immediately controlled my symptoms.

6) Will Petril Beta totally stop my symptoms even on the next day of drinking alcohol or while drinking it.

Thank you in advance!

XXXX
doctor
Answered by Dr. Ajay Panwar 16 hours later
Brief Answer:
Antiepileptic drug trial.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing further details.

Your doubts are rationale and need to be answered.Please find your pointwise answers:
1)Though alcohol intake may be followed by a seizure(well after a day or two),but if the event is everytime associated with alcohol intake only(except this last event)-then it becomes a slightly odd factor for the diagnosis of seizure.Despite that,I would say that your event phenotype(breathing stops--neck turns--spine arches--wind pipe choking),is close to a seizure phenotype and seizure still remains the probable diagnosis.Anti-seizure medications should be put on trial.
2)Symptoms are episodic and not in favor of EPS(even phenotypically).
3)Phenergan probably helped because of its sedative effect.Its also used as a potent sedative,besides being anti-allergic.
4)Lorazepam is a better alternative than midazolam.You are correct that injectable midazolam may have some concerns(respiratory depression)while using in outpatients on SOS basis.Intranasal midazolam is an alternative as well.Rather,I am in favor of putting you up on a conventional antiepileptic drug trial like phenytoin, valproate or levetiracetam.You should discuss this with your treating neurologist.
5)A first line antiepileptic may be a better choice than Petril Beta.However,Petril beta has both, anti-anxiety and antiepileptic action.It may prove to be helpful.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar 44 hours later
Good evening Doctor Panwar,

Thank you for your patience and guidance.

Today I met with a neurologist and she more or less confirmed the opinion of the first neurologist that it is some sort of seizure. An MRI Epilepsy protocol was taken and while the online report generated seems normal in all aspects, here are a few that worries me.

1) Few Small T2/Flair Hyperintense Foci in left Corona Radiata and Bilateral Frontal White Matter - Suggested Small Vessel Disease

2) Mild Diffuse Cerebral Atrophy.

Should I be worried about the above? The doctor has not seen the MRI yet.

Also, I was asked to stop Petril Beta and start on the following.

Levipil 250 mg initially and after two weeks 500 mg.

Cloba 10 mg

Clobazam 10 mg md (what is this for?)

Etilam .5 mg

Stillnoct 6.25 mg (night)

Am I on the right track? Since all these are based on the experience of the doctors and not on documentary evidence as none of the tests indicate 100 percent that I am epileptic, will all these medicines turn me into an epileptic dependent on these medicines for life? Also, I was treated and cured for Hepatitis C last year so will all these medicines affect me?

Thank you in advance.

Sincerely.
XXXX

doctor
Answered by Dr. Ajay Panwar 7 hours later
Brief Answer:
Please upload the MRI.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Though,the MRI changes you have mentioned can be due to your alcohol intake history.I would like to have a look at the MRI in order to make a better comment.Is it possible for you to upload the MRI CD as a .rar archived file on google drive and provide the google drive link here in the follow-up question?

Further,do you suffer from Hypertension or any other chronic disease?High blood pressure,Diabetes can further add up to cause such MRI changes.

Even I mentioned above that instead of Petril Beta,you should be on first line antiepileptics drug trial.So,this treatment approach is appropriate.You should start taking these medicines and observe for the response.

This is just a misconception that antiepileptic medicines make the patient dependent on them.These medicines can be tapered and stopped when the treating doctor feels so.
Even if you were treated for Hepatitic C,these are unlikely to cause any problem.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar 41 minutes later
Hello Doctor Panwar,

Thank you once again. I am afraid I don't have the MRI reports on hand and nor do I have the film. This hospital is very far away from where I live so I could not wait till the report was generated. Besides, the doctor left before they were generated, with the understanding that the reports will be given to her on Monday by the hospital staff and then she will study them.

I am not sure how I can upload to Google docs because the report is basically undownloadable. However, please feel free to use my log in details if you don't mind. Before that, I would like to ask one question. I am an avid gym goer and very fit body wise. I take L Carnitine Tartrate as a gym supplement. Can I continue with it? I read on the internet that it is good for epilepsy and in some pages that it is not. So just confused there too.

Also, I do not have BP, Diabetes, or cholesterol.

Here are the log in details for my reports.
XXXX
USER NAME : XXXX
PASSWORD; XXXX


Thank you in advance,

XXXX
0000



doctor
Answered by Dr. Ajay Panwar 12 hours later
Brief Answer:
Some reports say that it may increase seizure frequency.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

I logged in with your details.I could see the MRI-Epilepsy protocol listed there in your account but when I clicked,it just load empty pages.It seems that report has not been generated till yet.Paradoxically,report status shows completed.

Further,there is not enough literature on 'effects of carnitine tartrate on seizures'.Few case studies does mention that it may increase the seizure frequency but to be clear,there is no scientific evidence or large human studies to document this.So,I just can't say that Carnitine is absolutely contraindicated.

If you have further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar 1 hour later
Hi Dr. Panwar,

I just recharged my account, and I'd like to keep this active till such time my initial apprehensions are cleared. Thank you for clearing up on carnitine.

As for the reports, http://111.93.30.209/His/Public/View/Patientlogin.aspx.

You need to log in there and choose XXXXXXX Wise and then click on the report number and then Ok on the Pop Up. For this, you need to disable pop up blocker.

I have further questions for you. I got the first few attacks between 2001 and 2005 the next day after a bout of binge drinking, usually when I am in hangover, and when the alcohol is withdrawing from the body. Not during drinking but the next day. Then I stopped alcohol completely from 2005 to 2014, and I did not have a single attack. Then after I started drinking I got attack the next day, but I only got attacks if I drank heavily the previous day. Then the latest incident that happened even without drinking which is when I consulted a neurologist. So my questions are:

1) Am I really epileptic because I get attacks the next day only after I binge drink and not when I am off alcohol barring the latest incident when the attack happened even without drinking? Also, my EEG, Brain Scan and MRI do not show I am epileptic.

2) If your answer is that I am not an epileptic, then how will being on these medications help me?

3) How does Clobazam 10 mg md work? (what is this for?) Will it immediately subside my attack just as the way Phenergan subsides it immediately?

4) If I am not epileptic, shall I stop the medication and just keep Clobazam 10 mg md with me so I can use it when I have an attack?

5) Can I drink alcohol in moderate limits as the following links indicate I can?

Here in this link XXXX. It says this and this is exactly what has been happening to me except the latest instance "Can alcohol cause epilepsy?
‘Binge’ drinking can cause a seizure, even in people who do not have epilepsy. Such seizures can be due to alcohol withdrawal, toxic effects of alcohol, too much fluid, and metabolic changes in the body.Withdrawal seizures may begin within seven to 72 hours of stopping drinking."

The above is what is happening to me except the one, latest non-alcohol related instance, so can I just stop epilepsy medication and just keep Clobozam 10mg MD with me?

Some more links:
XXXX
XXXX

Thank you in advance!
doctor
Answered by Dr. Ajay Panwar 17 hours later
Brief Answer:
At present,you should continue the antiepileptic medicines.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Here are answers to your queries pointwise-
1)Though the seizures used to follow binge alcohol intake,but you had a last seizure without it.So,at this point,We can't brush aside the possibility of epilepsy.As,MRI and EEG are normal(which may come normal in many epileptic patients),we don't have an evidence,in sense of investigations.But,of course,clinical sense carries more value than investigations,and considering clinical history,this appears to be Epilepsy.Once you are on antiepileptic medicines,if the frequency of episodes decrease,that will prove the diagnosis.
2)So,as I mentioned above,I can't say that you are not epileptic,as if now.So,antiepileptic medicines should be continued to observe-if they help you or not.
3)No,clobazam acts differently than phenergan.This is not to be taken on SOS basis but on regular basis as advised.
4)As said above,you should continue medicines for now and take clobazam on regular basis.
5)Of course,even I mentioned in the discussion,that alcohol can cause seizures.In fact,it appears to be triggering your seizures.I just can't say whether even the moderate amount may trigger your seizures.So,its better to avoid,if you can.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar 3 hours later
Hi Dr. Panwar,

Thank you for your detailed answers. Just a couple things.

1) The SOS medicine i have been prescribed is Clobozam MD, and she told me to keep it under the tongue and that it will stop the seizure immediately pretty much like Phenergan. So what I am asking is that is that is true as the agony of undergoing the seizure is too much.

2) Also today, I took a liver function test and it shows SGPT 193 and SGOT 94. Is there a connection between the meds prescribed and should i be worried?

Thanks in advance!
doctor
Answered by Dr. Ajay Panwar 11 hours later
Brief Answer:
SGPT and SGOT may be deranged due to alcohol intake.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Clobazam MD is likely to help during the event as advised.If it does not help,Inj.Lorazepam SOS will be a better choice.

Deranged SGOT and SGPT are likely due to effects of alcohol in Liver.You should get a Ultrasound abdomen done to see the echotexture of Liver.Also,viral markers for Hepatitis B and C should be done.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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