[29F] With seizures and nocturnal choking episodes
Patient Description
A 29-year-old female has been experiencing seizures for the past two years, which started after a traumatic event involving the sudden death of her grandmother. The seizures initially began with shaking in specific body parts, such as the left leg, shoulder, and face, and have now progressed to the chest. These episodes occur both during the day and night, often waking the patient from sleep. During these episodes, she sometimes feels like her breathing stops, which is very frightening. The chest shaking lasts for less than 5 seconds, and she rates its severity as a 5 out of 10. She has not experienced any loss of consciousness or blackouts during these episodes but does feel confused and disoriented afterward. She also experiences memory loss and unusual sensations like tingling before or after a seizure. The patient has a history of using tramadol and methadone and is currently taking vitamins and supplements such as chromium, B3, B6, and E. She has not yet seen a neurologist or had any diagnostic tests like an EEG or MRI. There is a family history of heart disease and possible sleep apnea, but no known history of epilepsy or other neurological conditions.
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Arora's Assessment
What might be happening
Based on the information you've provided, here are some possible explanations for your symptoms:
Seizures/Epilepsy
- Focal Seizures: Your description of shaking in specific body parts that changes location over time suggests focal seizures, which originate in one area of the brain and can cause localized symptoms. The progression of symptoms from your leg to your shoulder, face, and now chest is consistent with this type of seizure.
- Sleep-Related Seizures: The episodes of waking up with shaking and feeling like you can't breathe could be nocturnal seizures, which occur during sleep. These can sometimes be mistaken for sleep apnea.
Anxiety and Stress
- Post-Traumatic Stress: The onset of your symptoms after a traumatic event (finding your grandmother's body) suggests that stress and anxiety could be contributing factors. Stress can exacerbate seizure activity and cause symptoms like shortness of breath and chest tightness.
Substance Use and Withdrawal
- Medication Effects: Your history of using tramadol and methadone, as well as your current use of supplements, could be influencing your symptoms. Both tramadol and methadone can affect the nervous system and potentially contribute to seizure activity, especially during withdrawal or dose changes.
Unifying Diagnoses
- Epilepsy: Given the recurrent nature of your symptoms and their progression, epilepsy is a strong possibility. This condition can cause a variety of seizure types and symptoms, including those you've described.
- Sleep Disorders: Conditions like sleep apnea or parasomnias (abnormal behaviors during sleep) could also be contributing to your symptoms, especially the choking sensation and nocturnal awakenings.
What you can do
Seizures/Epilepsy
- See a Neurologist: It's crucial to consult a neurologist for a thorough evaluation. They may recommend tests like an EEG (to measure brain activity) and an MRI (to look for structural abnormalities in the brain).
- Medication Management: If diagnosed with epilepsy, your neurologist may prescribe anti-seizure medications to help control your symptoms.
- Lifestyle Adjustments: Avoid known triggers like sleep deprivation, excessive stress, and certain foods or supplements that may exacerbate your symptoms.
Anxiety and Stress
- Mental Health Support: Consider speaking with a mental health professional to address any underlying anxiety or stress. Techniques like cognitive-behavioral therapy (CBT) can be very effective.
- Relaxation Techniques: Practices like deep breathing, meditation, and yoga can help manage stress and potentially reduce seizure frequency.
Substance Use and Withdrawal
- Medication Review: Discuss your current medications and supplements with your healthcare provider to ensure they are not contributing to your symptoms.
- Gradual Tapering: If you need to reduce or stop any medications, do so under medical supervision to minimize withdrawal effects.
General Tips
- Symptom Tracking: Use MDandMe to journal your symptoms, track progress, and get insights. This can help you and your healthcare provider identify patterns and triggers.
- Healthy Lifestyle: Maintain a balanced diet, regular exercise, and good sleep hygiene to support overall health and potentially reduce seizure activity.
What you should look out for
Given the severity and complexity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Increased Frequency or Severity of Seizures: If your seizures become more frequent or severe, seek immediate medical attention.
- Loss of Consciousness: If you experience any episodes of loss of consciousness or blackouts, this requires urgent evaluation.
- New or Worsening Symptoms: Any new or worsening symptoms, such as significant memory loss, confusion, or muscle weakness, should be promptly addressed by a healthcare provider.
Remember, while I can provide information and suggestions, it's essential to consult with real health professionals to receive a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.
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3 mo ago