DEAR DR. GOTT: Although I am seeing a neurologist, I want to run my situation by you because I love your column and trust your expertise.
I am a woman in my 20s in good health, not overweight. I try to work out three to five times a week, if not more. I don’t smoke or do drugs, but I occasionally drink. I am taking medication for birth control, anxiety and stress. I have what I would describe as occasional panic attacks. I have a high-stress job and other stresses in my life.
Recently, I felt nauseated and slightly dizzy at work. I also had a mild headache. Since a lot of people in my office were sick at the time, I figured maybe I was getting the flu or a cold. I left to get checked out by a doctor, as the symptoms didn’t improve. By the time I made the five-minute drive, I was sure I was going to throw up. I checked in at the office and quickly went to the bathroom and sat on the floor. After five minutes, I had not thrown up. That was when I realized I could not stand solidly on my own.
Someone came, got me in a wheelchair and to an examining room. That’s when my motor skills were affected. My right arm would not stop moving up and down, and my right leg was also shaking. My speech was affected, reduced to stuttering. They took my vitals, and as I waited for the doctor, my back arched and my body started jerking. I had no control and could not talk. Instead, I mumbled loudly so someone would help me. They thought I was having some panic episode, but it would not stop. This continued for hours. During all of this, my mind was OK. I knew what was going on and could answer questions. I just didn’t have control of the stuttering or of my body movements. I had an EEG and MRI and will get the results soon. Could it have been a form of a partial seizure or severe migraine that many women get around this age?
DEAR READER: Yes, it could. Let’s discuss seizures first. They are caused by abnormal electrical brain activity that may be provoked by high fever, low blood sodium or magnesium, low oxygen levels in the brain, hypoglycemia (low blood sugar), alcohol, medication withdrawal or may have no identifiable reason. A solitary seizure doesn’t imply epilepsy, but even mild forms of a seizure might require treatment because they can occur at inappropriate times, such as when driving an automobile. You may have experienced a partial seizure or a pseudoseizure (pyschogenic nonepileptic seizure) that didn’t result in a loss of consciousness but manifested in confusion and jerking.
Most migraine types in adults, and there are many, are associated with headache; however, a vertiginous migraine associated with recurrent episodes of vertigo with or without nausea, vomiting, photophobia or headache in a setting of positive family history of migraine or previous personal history might support the diagnosis.
Other possibilities include a nervous-system abnormality that resulted in seizure-like activity. Infection (specifically meningitis), hormonal changes of the menstrual cycle or medication may be the culprit. Overdose or abrupt withdrawal of many medications can trigger symptoms such as those experienced.
Whatever the cause, you need the results of your EEG and MRI so your neurologist can pinpoint why you experienced such symptoms and the best way to prevent them from happening again in the future.