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Epilepsy

Suspected seizure

07/07/2009

Question:

I have multiple sclerosis and was diagnosed approx 7 years ago. I have no prior history of seizures or similar however last week I had an "episode" of something whilst driving which has had quite terrible consequences. I cannot account for a number of minutes whilst behind the wheel on the road and ended up driving on the wrong side of a highway and have no memory of getting there and had no reason to even be on that particular road. I did not convulse (that I can remember) and remained upright and holding the steering wheel however after the impact of the crash I still could not comprehend my surroundings or how I got there. To have lost this period of time is, at best, unsettling and of course now I am scared of it happening again. Prior to this loss of awareness I felt well and strong and remember everything else about the events of the morning prior to this happening. The period I cannot account for amounts to approximately 15 minutes (I think). I am awaiting an EEG and a follow up MRI to see if this indicates anything. As I have struggles with chronic insomnia for a number of years which has rarely been treated or taken seriously by the medical profession, I am wondering if this could be the root of the sizure issue(if in fact this could be classed as a seizure). Can you provide any advice or direction as to whether some immediate assistance with the insomnia would be beneficial and possibly arrest this problem before it happens again. My understanding is that it is not common for MS to lead to seizures but it can happen in a small number but my instinct is that being sleep deprived for so long may have contributed to a greater degree. Although I don`t need a lot of sleep generally and have pretty much gotten used to 2-3 hours a night (four to five hours is a great sleep for me)to lose periods of time and cause danger to myself and others is frightening. Needless to say I am not driving right now. Please advise if you can

Answer:

I understand your concern because an episode of loss of awareness can be terrifying. The first step is to determine if the event was a seizure. My suspicion is high based on the duration and features you mention. The EEG and MRI may provide some direction. You are correct that seizures may occur in a small number of people with MS. Sleep deprivation can trigger seizures, but almost only in susceptible individuals. It could be true that if your insomnia is controlled, you may not have another seizure, but you must work with your neurologist to assess the risk of a future seizure based on your history and workup, and that will determine if you need chronic antiepileptic treatment. A full evaluation of your insomnia seems indicated as well.

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Response by:

Michael   Privitera, MD Michael Privitera, MD
Professor of Neurology
College of Medicine
University of Cincinnati