DEAR DR. GOTT: I am writing about someone I know. He is 40 years old and has had the following symptoms for at least the past 10 years: fits of rage, seizure-like episodes (unconscious, body goes rigid, convulses, wets self, confusion, weakness and vomiting), hand tremors, neck and shoulder pain, and self-confessed fainting spells (although these may have been seizures). Two times following seizures, tests gave no indication of having had a seizure.
Do you have any suggestions about what this may be?
DEAR READER: This individual has most of the symptoms of grand-mal seizures. This type of seizure is dramatic and is what most people picture when they hear the word “seizure.” His symptoms of fits of rage, hand tremors and neck and shoulder pain may be related brain damage caused by the seizures or the result of head trauma caused by falling or flailing around during the seizure. Another type of seizure, known as a frontal-lobe seizure, can cause emotional symptoms, such as rage, depression and euphoria.
I strongly recommend that a neurologist see this gentleman for a complete examination and extensive testing. The specialist will need to know what testing he has had in the past, whether he is on any medication, how much alcohol he drinks, whether he uses illicit drugs, how often the seizures occur, when his first seizure occurred and whether it directly followed anything, such as head trauma, and more.
Your brief note doesn’t say whether he is under the care of a neurologist. If he is, why isn’t he on medication (which I assume is the case, since you don’t mention it) to help control the seizures? Untreated seizure disorders can be life-threatening, not only to the sufferer but to others. For instance, if he has a seizure while driving, he will lose control of his car, and if others are also on the road with him (or in the car), they are in danger as well.
As for the normal testing, many people with seizure disorders can have normal MRIs, so this may not be indicative of anything.
Unless he is ignoring the condition and refusing medical treatment, there is no good reason for him to have gone undiagnosed and untreated for 10-plus years. He needs to get to a doctor before he does permanent/further damage to himself or harms those around him.
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