Dr. Hive - passing out? seizure? TIA?

[AngieW in Texas]

I'm not really sure what's going on with my 22yo.

 

She had a febrile seizure when she was 8yo as her only symptom of coxsackie virus (hand, foot, and mouth). Her temperature when the paramedics arrived was 105.

 

She had another seizure at 17yo when she had a heat stroke at Schlitterbahn (water park). She had neglected to sunscreen herself when the rest of us did and ended up with major burns that took a while to heal.

 

Both times she was evaluated by a doctor and put through an EEG and strobe lighting and they did not find any signs of a seizure disorder.

 

She is on medication - lithium, fluoxetine, and concerta.

 

During the Christmas rush, she passed out twice at work. She was working 8 hour shifts and both times were 5-6 hours into the shift. Immediately before passing out, she started hyperventilating, her eyes went really wide, and she had hot&cold flashes for 30-60 seconds. She rested for about an hour each time in the break room and then continued working without any issues. The episodes occurred about 2 weeks apart and I didn't know about them until after she was home.

 

Tonight I saw one of these episodes myself because it happened at home. She had been home from work for about 3 hours and had been playing on her computer since she had gotten home. She came downstairs to the kitchen to eat some leftovers. While she was getting her water, she suddenly started hyperventilating, her eyes started bugging out (very weird looking), and she said she was really hot and really cold. Within 60 seconds, she was on the floor.  I didn't know that this was exactly what had happened the previous times. Immediately after making her nose-dive to the floor, she opened her eyes and talked to me. She was aware of what had happened and knew exactly where she was. She felt (internally) very hot and asked for ice packs, so I gave her two ice packs. After a few minutes, she got up into a chair and drank a cup of apple juice and ate.

 

She did call her psychiatrist (she sees her monthly and is due to see her again next week) to let her know what happened. It's definitely possible that her medications are causing some issues, although she has been taking fluoxetine for several years and lithium for several months.

 

I'm just not sure what's going on.

 

Apparently she has some warning when this is going to happen, but not much. It isn't something that has happened frequently.

 

My 17yo has Ehlers-Danlos and has POTS and dysautonomia, so it is pretty typical for her to be on the verge of passing out if she gets up too quickly or if it's too warm. My 22yo hasn't been diagnosed with these issues, although she is definitely double-jointed, so it's possible that she also has Ehlers-Danlos, just a much milder version.

 

Any ideas?

[gardenmom5]

no ideas - but I'd bet against TIAs (aka: mini-strokes).  doesn't sound like that at all. 

good luck.

[Jean in Newcastle]

Whatever it is sounds like it's escalating  in the sense that she's had three reported times in the last 4 months.  I would get her to a neurologist.  Honestly, if it was my dd I would have her at the ER even. 

[Debbi in Texas]

My mother has had seizures since she was 17. She does not have any warning, but she does certain things she does during her petit mal seizures, like hand grasping and sniffing. I can always tell when she is having a seizure if I am on the phone with her. She does not have the cold/hot sensations. But everyone is different. I hope you can get her to a neurologist soon.

[lailasmum]

My son has reflex anoxic seizures which is the extreme versions of syncope and sounds like your other daughter. We're in a biggish support group and I've never heard it described like the ones your 22 yr old has but I do know of some people who have anoxic epilepsy triggered by syncope. That could be what's going on and why nothing is showing up to her doctors the rest of the time. Have you tried videoing the episodes?

Edited March 26, 2016 by lailasmum

[Tiramisu]

My first thought that it was EDS related. Maybe autonomic dysfuction and neurogenic syncope, closely related to POTS. 

 

I think certain meds or combos of meds can trigger issues. My dd was on zoloft and never had any problems but then a rheumatologist added plaquenil and the two together caused her to have dizzy episodes. Once her blood pressure was so low last summer that they had to keep taking it to get it. It seems both the meds can cause orthostatic hypotension. Combine that with dehydration and you can have a problem.

 

I'd try to make sure your dd is well hydrated. The other thing that might help is to have her move her legs and feet and not just standing still.

 

I would get it checked out to be on the safe side. 

[Sandragood1]

Coming at it from a POTS perspective, has she had any life changes that are making her sweat more, drink less, or exercise less?

 

Thinking of a friend with diet-controlled seizures, has she upped her intake of simple carbs or dropped her fat intake compared to previous levels?

 

I'd see a neurologist ASAP. Does she drive? She needs to stop until this is figured out.