Recurrent Neurological Episodes in Young Adult with Childhood Epilepsy History

Case at a Glance

A 23-year-old male with a family history of epilepsy and personal history of childhood seizures presents with a 6-month history of progressive neurological symptoms including lethargy, disorientation, staring episodes, and a recent seizure-like event at work.

Patient's Story

The patient reports having childhood epilepsy that was reportedly in remission for 13 years. He has a strong family history with both his father and grandmother having epilepsy. Currently prescribed baclofen 5mg twice daily for muscle spasms. Over the past 6 months, he has experienced worsening symptoms including extreme fatigue, confusion, staring spells, photophobia, and muscle twitching. He also reports frequent panic attacks with associated chest pain and dyspnea, along with emotional lability. Despite maintaining 8-10 hours of sleep nightly, fatigue persists. Recently experienced a significant episode at work characterized by an epigastric rising sensation and near-syncope lasting 5-10 minutes, followed by immediate sleep upon returning home. The patient lives independently and reports that symptoms are interfering with his ability to work and drive safely.

Initial Assessment

Emergency department evaluation focused primarily on chest pain symptoms, with limited attention to neurological concerns despite patient's reported history. Patient has contacted his neurologist for follow-up but faces scheduling delays. Current stressors include recent relocation and living alone.

The Diagnostic Journey

Neurologist has ordered a 24-hour EEG study, though availability is delayed until October. The patient has been working with a therapist for anxiety management and has tried multiple antidepressants over the past 5 years, though discontinued them several months ago due to lack of efficacy. Consulting physician suggests symptoms may be more consistent with panic attacks rather than seizure activity, recommending both neurological and psychiatric evaluation.

Final Diagnosis

Pending - differential diagnosis includes recurrent epilepsy versus anxiety/panic disorder with somatic manifestations. Further EEG monitoring required for definitive diagnosis.

Treatment Plan

Scheduled 24-hour EEG monitoring for October. Continue current therapy for anxiety management. Consider psychiatric re-evaluation for anxiety and mood symptoms. Patient counseled on seizure precautions including driving restrictions until diagnosis clarified.

Outcome and Follow-up

Patient awaiting EEG results and continued neurological monitoring. Ongoing therapeutic support for anxiety management. Patient educated on the importance of medication compliance if epilepsy diagnosis is confirmed and expressed concern that continued antiepileptic therapy might have prevented current symptoms.