Department of Neurology

Faint or seizure?

Q: I've been searching for basic information that describes epilepsy-related seizures and have not been able to find it. I'd like to know what the symptoms are of the mildest seizures.

I was in a car accident May 22, 1995, and since have experienced presyncope episodes that began with a sense of passing out but grew to include dizziness, nausea, muscle fatigue, mental disorientation, difficulty forming speech, etc. Recently, an episode occured in a physiatrist's office and, monitoring my blood pressure every minute over five minutes, she watched as my blood pressure fell from 118/82 to 92/50. After these episodes, I am weak, nauseous and fatigued for a period of 24 hours to nine days. I'm not looking for a diagnosis--just information that will help me ask intelligent questions of my doctors. I live in a rural area of the Pacific Northwest.

Thank you for your help.

A: Your workup will first begin with a careful history of your spells. Your physicians need to sort out whether these represent seizures (i.e., spells due to abnormal brain electrical activity) or near-faint episodes. Thus, they will need to get all of the information about how you feel and appear prior to losing consciousness, during the loss of consciousness (or near loss of consciousness) and after the episodes. It is crucial for you to bring witnesses, if there were any. Additional workup may include EEG, EKG, brain scanning, and/or videomonitoring of the spells.

"Mild seizures," as you put it, may have a wide variety of manifestations including staring, altered consciousness and odd behavior. Unfortunately, fainting episodes (loss of consciousness due primarily to loss of blood pressure) may often look like seizures, and even cause shaking and jerking of arms and legs. Distinguishing faints from seizures is very important, since they have different therapies.

This type of diagnostic problem is common for neurologists and epileptologists to see. There are many fine centers in the Pacific Northwest, including at the University of Washington (Seattle) and the University of Oregon (Portland).

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