Often, No Cause Found for Grand Mal Seizures

Q:  My daughter is 16 years old. She has had two grand mal seizures this year, three months apart. She is seeing a neurologist and is now on depakote, 1000 mg per day. All of her tests are negative except for her EEG, which shows seizure activity.

Why is this happening to her? She is very healthy and athletic as well as a ballet dancer. Going over her history with the doctor, we cannot find any reason for the onset of these seizures. Can you explain what is happening to her or anything we can do to help her? Will her brain ever heal itself or will she forever be on medication with the worry that this can happen again?

A:  I cannot imagine how frustrating it must be to look at your daughter, see this wonderfully healthy young woman, and yet know that there is something that is wrong that can’t be seen or touched.

You note that all tests with the exception of her EEG were normal. I assume that she also has had an MRI and/or a CT scan of her head as part of the evaluation along with a comprehensive panel of blood tests.

I spoke to David Walsh, MD, a neurologist, who shared several thoughts in response to your concerns. Of all people with a new onset of a seizure disorder, 70% have no recognizable cause. For reasons that are unclear, an area of electrical instability appears in the brain that acts as the trigger for a seizure. It would appear that the investigations undertaken with your daughter did not identify a cause.

Sometimes physicians don't communicate as effectivelyas possible, and they might leave unanswered questions for parents. Dr. Walsh suggested a meeting between you and your daughter’s doctor strictly to have your questions addressed. He also thought a second opinion might be reassuring and helpful. Although there are studies showing some success with brain surgery for intractable seizures, this is not appropriate or useful in a person for whom medication is sufficient. On the brighter side, as many as 50-60% of people will "outgrow" their seizures if they have remained seizure-free on medications for two to five years.

The vast majority of people with seizures live productive lives indistinguishable from those without this disorder. Short of consulting with the Department of Motor Vehicles regarding rules for drivers with seizures, I would encourage you to set no new limits on your daughter’s activity as a result of this and treat her just as you did before this condition came into your lives.

Dr. Russell Robertson is Associate Dean for Faculty Affairs and Associate Professor of Family and Community Medicine at the Medical College of Wisconsin. His biweekly column of medical advice also appears in the CNI Community Newspapers throughout metropolitan Milwaukee.