Seizure-like episodes pose epilepsy question

DEAR DR. ROACH >>

My husband experienced seizure-like episodes, without tonic/clonic body movements, in high altitude while traveling and being physically active in Colorado and skiing in France. Both episodes happened at least 12 hours after physical activity. Our general physician back home felt that these were not true seizures, but a reaction to possibly being dehydrated and in high altitude.

A vast amount of testing resulted in nothing unusual going on with his cardiovascular system or his brain. But, just recently, he had another episode two days after being active, hydrating at sea level and banging his head — with more body movement this time.

I have been researching online, and seizure-like reactions seem to occur due to electrolyte imbalances. It is very hard to get to a neurologist without an excessive wait time. Do you think anti-seizure medications are warranted?

DEAR READER >> It’s important to separate a seizure, which anyone can get if there is enough stress to the brain, from epilepsy, a condition where the person is susceptible to recurring seizures. For it to be considered epilepsy, a person generally needs at least two unprovoked seizures (with no unusual stress to the brain) at least 24 hours apart. Only epilepsy is treated with long-term anti-seizure medicines.

There is indeed a risk of developing seizures while at a high altitude. In addition, there are many other conditions that can provoke a seizure. You mentioned electrolyte imbalance, but sodium (too much or too little) as well as too little amounts of magnesium and calcium are among the most common. Low blood sugar is a frequent cause.

Some recreational drugs cause seizures, but withdrawal from drugs and especially alcohol is more common. Metabolic diseases of the kidney and thyroid are also common. Sleep deprivation, brain injury (especially stroke, but also trauma), brain tumors, and brain infections are all common triggers that your husband probably had an evaluation for.

Had it only been the first seizure, my advice likely would have been the same as your physician’s, although I probably would have offered a consulta- tion with an epileptologist (a neurologist with expertise in seizures). Now that he has had a second — and unprovoked — seizure, my suspicion that he has epilepsy is much higher. (Let me add that, in hindsight, it’s clear the first seizure actually was a seizure.) Most people experiencing their first seizure while at a high altitude were eventually found to have epilepsy after further testing, including an electroencephalogram. The high altitude doesn’t cause the seizure; it just increases the risk of a seizure in a person who has an underlying propensity for it.