New-Onset Seizures at High Altitude: Potential Sign of Epilepsy?
Seizure-like episodes occurring at high altitudes have raised concerns about the possibility of underlying epilepsy. A reader, S.S., shared her husband’s experience of experiencing seizure-like episodes during physical activities in Colorado and while skiing in France. These episodes occurred at least 12 hours after physical exertion and lacked the typical tonic/clonic body movements associated with seizures.
Their general physician suspected that these episodes may have been a reaction to dehydration and the high altitude, rather than true seizures. Extensive testing, including assessments of the cardiovascular system and brain, revealed no unusual findings. However, a recent incident involving head trauma and increased body movement during an episode has sparked further questions.
Research conducted by S.S. suggests that electrolyte imbalances could be a potential cause for these seizure-like reactions. However, obtaining a prompt consultation with a neurologist has proven challenging due to lengthy waiting periods. S.S. wonders whether anti-seizure medications might be necessary.
To provide clarification, it is essential to differentiate between seizures and epilepsy. Seizures can occur in anyone when the brain is subjected to sufficient stress. On the other hand, epilepsy is a condition characterized by a susceptibility to recurring seizures. For a diagnosis of epilepsy, a person typically needs at least two unprovoked seizures occurring more than 24 hours apart, without any unusual stress to the brain. Only in cases of epilepsy are long-term anti-seizure medications prescribed.
Indeed, there is a known risk of seizures at high altitudes. Additionally, numerous other factors can trigger seizures, such as electrolyte imbalances, including abnormal levels of sodium, magnesium, and calcium. Low blood sugar is another common cause. Certain recreational drugs are associated with seizures, as are withdrawal symptoms from drugs and alcohol. Metabolic disorders involving the kidneys and thyroid can also provoke seizures. Sleep deprivation, brain injuries like strokes or trauma, brain tumors, and infections can all act as triggers.
Given the occurrence of a second unprovoked seizure, the likelihood of epilepsy in S.S.’s husband has increased. It becomes evident, in retrospect, that the initial episode was indeed a seizure. Previous cases have shown that individuals experiencing their first seizure at high altitudes are subsequently diagnosed with epilepsy after comprehensive testing, including an electroencephalogram (EEG). It is important to note that high altitudes do not cause seizures but rather elevate the risk for those with preexisting susceptibility. This heightened risk may also apply to certain medications, particularly those used for depression.
Prompt consultation with an epileptologist, a neurologist specialized in seizures, is highly advisable for S.S.’s husband. The expertise of an epileptologist is crucial, as anti-seizure medication should not be prescribed by nonexperts unless it is a temporary measure until the patient can be seen by an expert.
Instances where nonexperts prescribe anti-seizure drugs have often resulted in improper treatment, according to the expert opinions of subsequently consulted specialists. To ensure a timely and comprehensive evaluation, it is crucial for S.S.’s husband to be reevaluated by an epileptologist. Specialists in epilepsy recognize the need for swift appointments when dealing with new-onset seizures in adults.
In conclusion, the possibility of epilepsy should be carefully considered in cases of new-onset seizures at high altitudes. While the initial concern was that these episodes were a reaction to the combination of altitude and dehydration, further incidents suggest a more complex underlying condition. Seeking the expertise of an epileptologist for a comprehensive evaluation and appropriate treatment is strongly advised.
