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What Causes Seizures After Working Out In An Elderly Woman?
Question: I am 10 years post op anterior cervical fusion. I now, for the last 5 years have had presence seizures after working out (strenuous) especially when doing upper body, including surfing and swimming. MRI of brain within normal limits. EEG normal. This only occurs with exercise, not lower body or running.
As an example, I did 30 minutes of lap swimming today and had an episode.
As an example, I did 30 minutes of lap swimming today and had an episode.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern and perplexity.
Seizures related to physical activity are part of what are called reflex epilepsy, where seizures are related to certain stimuli. It is very rare for them to be due to physical activity, usually due to other stimuli. However even though rare they are described in the literature. The fact that they are related to certain activities and not others has also been described in other patients.
Being so rare unfortunately their mechanism is not that well known. In many of the patients described EEG studies have shown the originating brain area to be in the temporal lobe. One hypothesis for their development is that exercise is related to increased electrical activity of the responsible brain areas and therefore leads to increased propensity for seizures. Another hypothesis is genetic mutations leading to alterations in the transportation of glucose into nerve cells and hence low glucose levels more pronounced during exercise. However it is a question only of the hypothesis, a satisfactory mechanism has not been elucidated.
Regarding other tests which could be done, MRI and EEG are fine, but if it has been only a common EEG it detects epileptiform activity when done outside of the episodes only in half of the patients. For that reason I would recommend more prolonged EEG recording during everyday activity and during the triggering exercises. It can be accompanied in epilepsy clinics with video EEG to study relation of epileptiform changes with type of seizure.
Other tests would be heart rhythm study and some blood tests to look for other causes such as electrolyte abnormalities, but I suspect they’ve already been done.
From a practical point of view if you want to stay medication free I am afraid that the only alternative is reducing exercise or stopping it altogether. If you are open to try other antiepileptics which may not have side effects, the above mentioned EEG studies may allow a more appropriate therapy selection for your seizure type and electrical activity.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern and perplexity.
Seizures related to physical activity are part of what are called reflex epilepsy, where seizures are related to certain stimuli. It is very rare for them to be due to physical activity, usually due to other stimuli. However even though rare they are described in the literature. The fact that they are related to certain activities and not others has also been described in other patients.
Being so rare unfortunately their mechanism is not that well known. In many of the patients described EEG studies have shown the originating brain area to be in the temporal lobe. One hypothesis for their development is that exercise is related to increased electrical activity of the responsible brain areas and therefore leads to increased propensity for seizures. Another hypothesis is genetic mutations leading to alterations in the transportation of glucose into nerve cells and hence low glucose levels more pronounced during exercise. However it is a question only of the hypothesis, a satisfactory mechanism has not been elucidated.
Regarding other tests which could be done, MRI and EEG are fine, but if it has been only a common EEG it detects epileptiform activity when done outside of the episodes only in half of the patients. For that reason I would recommend more prolonged EEG recording during everyday activity and during the triggering exercises. It can be accompanied in epilepsy clinics with video EEG to study relation of epileptiform changes with type of seizure.
Other tests would be heart rhythm study and some blood tests to look for other causes such as electrolyte abnormalities, but I suspect they’ve already been done.
From a practical point of view if you want to stay medication free I am afraid that the only alternative is reducing exercise or stopping it altogether. If you are open to try other antiepileptics which may not have side effects, the above mentioned EEG studies may allow a more appropriate therapy selection for your seizure type and electrical activity.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Since it is upper body exercises only or activities that are mostly, is there any possibility that there is some mechanical aberration created by my fusion? I do have disc disease above and below the plate. If I run, scull or bike I have no issues, I would think sculling might be problematic but it is obviously more leg...I am very careful to have eaten and to be hydrated...might be related to oxygen intake? Holding breath? Not exercising is not an option. Altering my methods has been helpful. I was surprised the swimming caused a problem. Thank you.
I already submitted this question but without reply. Is there any chance that the disc disease above and below my plate is causing some issue. Nerve compression? It seems odd that it is with only upper body exercise!
I already submitted this question but without reply. Is there any chance that the disc disease above and below my plate is causing some issue. Nerve compression? It seems odd that it is with only upper body exercise!
Brief Answer:
Read below.
Detailed Answer:
I did think of the possibility of the cervical issues playing a role when I gave my previous answer. In theory arthritic changes, with disc disease and osteophyte formation may lead to compression of the vertebral arteries, the arteries which supply with blood the posterior part of the brain which pass through the vertebral arcs during their course. Hence there could be insufficient blood supply, more likely so during physical activity when more blood is pulled in the muscles.
However that does not explain why it happens only with certain activities and not with others, that remains unclear. Actually should be more pronounced during running when in a vertical position and blood flow to the brain has gravity against it.
There is actually a syndrome called the bow hunter’s syndrome, where there is no compression in a neutral position, but when there is head rotation the symptoms aggravate because the vertebral artery is pressed on some fibrous band in the neck. However while that would explain the lack of oxygen during actions like swimming there is also the type of manifestation which doesn’t fit. What I mean is that lack of blood flow to the posterior areas of the brain mostly leads to dizziness and loss of consciousness, not typical convulsive seizures which is the other reason I didn’t mention it. You do not provide much information on what happens during your seizures, seizures can manifest in different ways. If by seizure you mean simply altered consciousness then this hypothesis may actually be explored (would need an angiography, an exam where it is entered through a catheter in your vessels and contrast is injected). If in doubt though I would do first the prolonged EEG I mentioned which is a non invasive test and leave this hypothesis as a last option because angiography is an invasive test which is done only when really necessary.
Let me know if I can further assist you.
Read below.
Detailed Answer:
I did think of the possibility of the cervical issues playing a role when I gave my previous answer. In theory arthritic changes, with disc disease and osteophyte formation may lead to compression of the vertebral arteries, the arteries which supply with blood the posterior part of the brain which pass through the vertebral arcs during their course. Hence there could be insufficient blood supply, more likely so during physical activity when more blood is pulled in the muscles.
However that does not explain why it happens only with certain activities and not with others, that remains unclear. Actually should be more pronounced during running when in a vertical position and blood flow to the brain has gravity against it.
There is actually a syndrome called the bow hunter’s syndrome, where there is no compression in a neutral position, but when there is head rotation the symptoms aggravate because the vertebral artery is pressed on some fibrous band in the neck. However while that would explain the lack of oxygen during actions like swimming there is also the type of manifestation which doesn’t fit. What I mean is that lack of blood flow to the posterior areas of the brain mostly leads to dizziness and loss of consciousness, not typical convulsive seizures which is the other reason I didn’t mention it. You do not provide much information on what happens during your seizures, seizures can manifest in different ways. If by seizure you mean simply altered consciousness then this hypothesis may actually be explored (would need an angiography, an exam where it is entered through a catheter in your vessels and contrast is injected). If in doubt though I would do first the prolonged EEG I mentioned which is a non invasive test and leave this hypothesis as a last option because angiography is an invasive test which is done only when really necessary.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The seizure is a presence seizure. Sense of XXXXXXX vue, abnormal smells, memory loss i.e.Would not remember driving home. Looking at me, I appear fine. I have been a migraineur with aura since 13, had an episode of transient global amnesia with hospitalization, complete vascular work up. Episode occurred during extreme exercise, the seizures then began to occur. I was treated with Lamictal for the seizures but it created mania, then topamax, agitation, memory loss etc. at that point I found that reducing my level of exercise to be the best course. To some people, exercise is an important aspect of their life as it should if they wish to maintain their health!
Thank you for your very thorough answer and I will persue having my testing done under the conditions that cause my difficulties and perhaps with neurologists that deal specifically with epilepsy. My current neurologist believes they may be some form of migraine variant and she has taken my lead in the degree of testing that has been done. To some the solution seems simple, to limit the exercise. As an athlete, and someone wishing to know the cause I think I will explore your suggestions. Thank you.
Thank you for your very thorough answer and I will persue having my testing done under the conditions that cause my difficulties and perhaps with neurologists that deal specifically with epilepsy. My current neurologist believes they may be some form of migraine variant and she has taken my lead in the degree of testing that has been done. To some the solution seems simple, to limit the exercise. As an athlete, and someone wishing to know the cause I think I will explore your suggestions. Thank you.
Brief Answer:
Read below.
Detailed Answer:
Thank you for the additional info. I must say that moves suspicion away from a lack of blood flow, that does look like a temporal seizure (if you go back to our exchange actually most of the case reports on exercise related seizures locate them in the temporal lobe).
I too believe that you should find a neurologist with epilepsy as a subspecialty as it is not a common case.
Regarding exercise (I wish I was as motivated as you :), you should be able to learn patterns which trigger seizures with time, and be able to modify the type of exercise without having to interrupt it hopefully.
Wishing you good health.
Read below.
Detailed Answer:
Thank you for the additional info. I must say that moves suspicion away from a lack of blood flow, that does look like a temporal seizure (if you go back to our exchange actually most of the case reports on exercise related seizures locate them in the temporal lobe).
I too believe that you should find a neurologist with epilepsy as a subspecialty as it is not a common case.
Regarding exercise (I wish I was as motivated as you :), you should be able to learn patterns which trigger seizures with time, and be able to modify the type of exercise without having to interrupt it hopefully.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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