Possible Seizures: A Guide for Epilepsy Patients and Caregivers

Seizure (suspected absence seizure?)

Hello Doctor: A family member has developed acquired epilepsy (around 30 years old) and has been on antiepileptic medication for a long time.
The medication has been reasonably effective, and there have been no major seizures for nearly two years.
However, in the past six months, there have been episodes of suspected absence seizures and repetitive unconscious movements (lasting only a short time), along with excessive sweating, nausea, and increased heart rate.
The patient believes that these symptoms may not be related to minor seizures.
Based on my observations, I still think it is very likely that these are focal seizures.
I would like to ask the doctor if these symptoms can be classified as seizure activity.
Since the patient is due for a follow-up appointment soon, they will evaluate the feasibility of reducing medication (the last attempt to reduce medication two years ago was unsuccessful).
Should I advise the patient to inform the doctor about the suspected symptoms that have occurred in the past six months during the follow-up? The patient prefers not to mention any symptoms if there have been no seizures, but I believe it is important to inform the doctor for proper assessment.
How can I persuade the patient to communicate this to the doctor? This is a distressing situation for me as a caregiver.

Qinren, 30~39 year old female. Ask Date: 2021/05/10

Dr. Cai Zongzhang reply Neurology

Hello, dear! There are various types of symptoms associated with seizures.
Based on the symptoms described above, it is possible that a seizure may occur.
It is advisable to inform a physician to facilitate making the most beneficial decision.

Reply Date: 2021/05/10

More Info

Understanding the complexities of epilepsy and its management is crucial for both patients and caregivers. Your family member's experience with epilepsy, particularly the recent symptoms you've described, raises important questions about the nature of their condition and the potential need for adjustments in their treatment plan.

Firstly, it’s essential to recognize that epilepsy can manifest in various forms, including generalized seizures and focal (or partial) seizures. The symptoms you've observed—such as episodes of "spacing out," repetitive movements, excessive sweating, nausea, and increased heart rate—could indeed suggest the possibility of focal seizures, which may not always be recognized as typical seizure activity by the patient. Focal seizures can sometimes present with altered awareness or consciousness, and they can be brief, making them easy to overlook or misinterpret.

Given that your family member has been seizure-free for nearly two years, it is understandable that they might feel hesitant to report any new symptoms, fearing that it could jeopardize their progress or lead to medication changes. However, it is crucial for their healthcare provider to have a complete picture of their condition to make informed decisions about their treatment. This includes any new symptoms that may indicate changes in seizure activity.

When preparing for the upcoming appointment, it would be beneficial to encourage your family member to discuss these symptoms with their doctor. Here are some strategies you might consider to help persuade them:
1. Emphasize the Importance of Communication: Explain that open communication with their healthcare provider is vital for effective management of their condition. The doctor needs to know about any changes, even if they seem minor, to adjust treatment appropriately.

2. Discuss the Potential Risks of Not Reporting Symptoms: Highlight that failing to report these symptoms could lead to a misunderstanding of their condition, which might result in inappropriate medication adjustments or a lack of necessary interventions.

3. Reassure Them About the Doctor's Role: Remind them that doctors are there to help and that discussing symptoms does not necessarily mean they will face negative consequences. Instead, it can lead to better management of their epilepsy.

4. Offer to Accompany Them: Sometimes, having a supportive person present can make it easier for patients to express their concerns. Offer to accompany them to the appointment and help facilitate the conversation.

5. Provide Documentation: Suggest keeping a symptom diary leading up to the appointment. Documenting the frequency, duration, and nature of the episodes can provide valuable information for the doctor and may help your family member feel more comfortable discussing their experiences.

In conclusion, while your family member may feel uncertain about reporting their symptoms, it is crucial for their health and well-being that they do so. Encouraging them to be open with their healthcare provider will not only help in assessing the current situation but also in determining the appropriateness of any potential medication adjustments. Epilepsy management is a collaborative process, and your support as a caregiver is invaluable in navigating these discussions.

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