Seizure versus syncope

Abstract

A 21-year-old right-handed female presented to clinic with a diagnosis of "seizure disorder". Birth, labor, delivery, and development were normal. At 14 years of age she experienced her first "blackout". She was taken to the local Emergency Department (ED) and was diagnosed with syncope. She injured her elbow and was admitted with a normal neurological examination. Following admission, a brain MRI and laboratory testing was normal. Following her discharge, she continued to experience infrequent breakthrough events several times a year usually during stress or missed meals. She was seen by the Epilepsy service and underwent a brain MRI which was normal. An EEG demonstrated "bifrontal polyspikes that are potentially epileptogenic discharges and that are suspicious for a seizure disorder". Clinical correlation was "strongly advised". She subsequently was placed on phenytoin (PHT). A recent episode had witnessed "jerking". Higher doses of PHT titrated to 400 mg nightly resulted in mild intermittent dizziness, blurry vision, and incoordination. She eventually graduated high school with difficulty, though was unable to find employment due to transportation limitations since she did not drive. She became pregnant despite using the birth control pills and had her pregnancy terminated due to the fear of birth defects from her PHT. She was subsequently seen for another opinion.