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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes sudden seizures while experiencing vertigo and anxiety?

Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Thu, 1 Sep 2016 in Brain and Spine
Question: I would be so grateful if you could help me. I had my first tonic clonic (grand mal) seizure 7 days ago at work. It lasted 1 minute 30 seconds, I bit my tongue badly but did not have any incontinence. Beforehand, I was shaking, had a loud beating heart and had a feeling of vertigo and anxiety (aura). Afterwards, I was confused for approx. 15 minutes.

I was being very active at the time and was bending down and rising several times to tidy up a room which may have contributed to feeling faint or having a ‘head rush’.

I am 27, a larger woman (5'6, 266lbs) with untreated bulimia that comes and goes in phases since the age of 15. For the previous 3 months before my seizure, I alternated between low carb days (the days I accept as 'good days') and bad days where I may binge and purge (vomiting only) up to twice a day, 3-5 days a week.

I binged and purged 13 hours before my seizure and did not eat or drink anything after purging. I then had 5 hours sleep, woke, then drove an hour to work.

After my seizure, my employer (who happens to be a Doctor) gave me lots of water and tea and sent me to a GP, after ambulance services refused to come to my aid. An hour later, I had a blood test and the results came back all normal but borderline low potassium. My ECG scan is normal, nothing wrong with my reflexes or balance, and I do not have diabetes.

I have not told my GP or my neurologist about my bulimia, as I find it highly embarassing to talk about. My MRI and EEG scans are pending, but my neurologist said they will most likely come back clear. I have never before or since my seizure felt an aura, had headaches or had any family history of epilepsy. I have also stopped my bulimic pattern for now which is a positive!

Unfortunately I have lost my job, my driver’s licence, a paid for holiday with my family and possibly my entire career (as a children’s nanny) over this seizure but I may be able to save some of this if it turns out that the seizure was provoked. I realise I am probably clutching at straws or in denial that I may have adult onset epilepsy.

My neurologist has put the seizure down as 'isolated & unprovoked', but I have internet researched and strongly believe my seizure was brought on by a combination of non-diabetic hypoglycaemia, lack of sleep, dehydration and disturbed electrolytes. My question is; in your experience and knowledge, how likely is it that my seizure was provoked by my bulimia, rather than a potential diagnosis of epilepsy, and is there any way to prove that this is the case days after the seizure itself?

Thanks in advance.
doctor
Answered by Dr. Olsi Taka 40 minutes later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

Regarding the likelihood of your seizure being provoked by bulimia I would say that it is pretty high. I too am pretty confident that the MRI will not evidence any real issue. Of course as you seem to have understood by the research when you say bulimia that doesn't mean alone, it means by the hydration and electrolytic changes caused by the bulimia coupled with possible other factors such as lack of sleep. Neither in isolation may be enough to cause a seizure, but each lowers seizure threshold and when together they increase the likelyhood of a seizure happening.

Now regulations as to what is called a provoked seizure and when one is allowed to drive are not the same, they change from one country to the other. In the UK it seems the regulations on what is called a provoked seizure are pretty strict, it is only when you have been given by the doctor a drug which causes seizures, or if seizure happens in the first 24 hours of a stroke. Other factors such as lack of sleep, alcohol use for example are not qualified as provoked. I would say that the same would apply to bulimia related changes.

Even if we were to say that the argument that your seizure was provoked was accepted (I do not think it will), I don't think that would qualify you to retake the licence so soon. A period of 6 months without a seizure AND a neurologist stating you are unlikely to have other seizures is needed. Frustrating as it may sound to you it is understandable as you can't prove that it won't happen again, that your bulimia is cured suddenly in the course of a week so that this situation of dehydration and lack of sleep won't repeat itself.

While it is not what you wanted to hear I guess, I hope you understand. I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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