Epileptic Falls

Epileptic Falls

The case
A 35 years-old woman with a history of convulsions from 2 years of age was presented. Due to the history of recurrent febrile convulsions, she was started on mephobarbital at the age of 4 years.

History

her past medical history was significant for an occipital hemorrhage secondary to a seizure-related head injury at the age of 26, ovarian cysts and a transiently positive antinuclear antibody that was thought to be secondary to phenytoin. Family history was negative for epilepsy. Her father died from a myocardial infarction.

She reported of first menstrual period at the age of 13 and also her first febrile seizure. Over the ensuing years, she experienced two different types of seizures at an average frequency of times a month. The first type consisted of the feelings that she is forced or pushed down.

The second type began without a warning- she lost consciousness and the then was observed to stare for up to 330 seconds and to fall abruptly to the ground, usually with no apparent rhythmic or tonic motor movements.Positionally, she was tired, hungry and frustrated.

Previous evaluation consisted of an EEG(which showed left temporal interact epilepsy form discharges) and a normal routine magnetic resonance imaging scan.

Examination and Investigations
The patient was examined on three basis and the investigations attained as per these examinations were as follows:
1. General Health-Normal
2. Cardiologist examinations-Normal
3. Neurological examinations- Remarkable

Her anti epileptic medications were tapered and several seizures of the second type ascribed above were recorded while she was in bed. The ital EEG recordings demonstrated electrocardiograph seizure activity confined to the left anterior to mid-temporal region in addition, electrocardiography (ECG) monitoring showed progressive bradycardia leading to complete a systole for up to 14 seconds before a normal heart rate was resumed. The change in cardiac rhythm began after the initial clinical manifestations of the seizures(starting and unresponsiveness). The ECG finding prompted a consultation.