Epilepsy suspicion: diagnosis accuracy after the first seizure

Question

Accepted Answer

A 22-year-old female patient with a history of sudden loss of consciousness and a fall resulting in brain contusion. As a result of the injury, an episode of retrograde amnesia was noted.
Available data: clinical examination report, EEG, Dopplerography of the brain supplying vessels, MRI of the brain. All of them showed no pathology. EEG recorded several rhythm disturbances, which may indicate an epileptic seizure. Antiepileptic drugs were prescribed.

Problem statement

Can a single loss of consciousness followed by amnesia indicate the presence of epilepsy?

Selected Format

Video conference

Outcome

The videoconsultation was conducted by a leading European epileptologist. The professor expressed doubts about the diagnosis. Insufficiency of the volume of the performed MRI was also noted. The study was not aimed at identifying epileptogenic areas of the brain. The results of MRI of the brain made it possible to exclude signs of hemorrhage and foci of contusion. No pathology was found in this aspect.
Based on the study results, the professor was able to state with a high probability the following.
The patient received a significant skull injury with a fracture of the zygomatic bone as a result of the collapse. Retrograde amnesia is confirmed as a consequence of a concussion. There are no signs of an epileptic seizure. MRI does not reveal anomalies that could be assessed as potentially epileptogenic. EEG also did not reveal epileptic pathology.
Based on the data presented, it can be argued that the patient did not have epilepsy, but had syncope (a short-term loss of consciousness). This led to a fall, a skull injury, probably with a concussion. This explains retrograde amnesia. Therapy with antiepileptic drugs is not advisable.
General measures to stabilize blood circulation were discussed. These include, first of all, regular contrast showers on the principle of heat-cold. Drug therapy is not indicated. Since the patient had no more complaints, the professor considered the diagnosis and treatment completed.

Medconsonline Comment

The purpose of the consultation was to obtain a second opinion on the patient's diagnosis of epilepsy based on a single case of loss of consciousness and an episode of amnesia. The consultant reversed the diagnosis made by colleagues and informed the patient that she was healthy and did not need to take antiepileptic drugs. Thus, the patient gained confidence that she did not have serious health problems, and also avoided taking medications with strong side effects.

Consulting expert

Christian E. Elger

Professor, Dr. Med., One of the leading european neurologists and epileptologists

Neurology