Dear Dr. Archer,
I have a 17-year-old daughter who I am very concerned about and I don't know where else to turn.She is a junior in high school, a straight A student, very involved, very popular, a beauty queen title holder - I could go on and on. Last September she began having episodes of passing out.She was diagnosed as having neurocardiogenic syncope.She is tall and thin, which fits the profile.Her episodes of passing out became so frequent that she ended up missing two and a half months of school. She returned to school the latter part of November and still continued to pass out. The spells she had sometimes resembled seizures to me.She did begin showing signs of depression. Being homebound, she had been removed from all social activities, no school, no sports, etc. In December, the passing out episodes stopped.She has appeared to be doing much better, until the last week or so. I have noticed that she has seemed very down. Today at school she had another "fainting" spell. Her teacher said she was with them in class, and all of a sudden her head hit the desk and she began to jerk- not like a grand mal seizure, but quick jerky movements. When the teacher laid her down, her jaw appeared clinched.After she slapped her face a couple of times, her eyes opened and she began to cry. I brought her home and she slept a couple of hour. When she woke up, you would not know anything had ever happened. I have noticed she sleeps a lot.She falls asleep as soon as she gets home and sleeps a couple of hours or until I wake her up, sleeps all night, and will sleep anytime we are riding in the car. She has had EEG's in the last few months that always come back normal.I am beginning to worry about severe depression, bipolar disorder (she does have definite mood swings) etc. She is in the prime of her life and I feel like her high school years are being stolen from her. I believe these episodes are starting all over again, and so does she.She describes the feeling she has right before she passes out as feeling very tired, and exhausted, kind of in a "haze". I don't know what I expect you to tell me, I'm just at a loss as to what to do, but I know she needs help. I appreciate any help you can give me.Ifeel I cannot waste any more time. Thank you for your time.
Everything you describe sounds like a seizure disorder and repeated normal EEGs really don't disprove this unless they are done during an episode. I suggest that you see a neurologist for a complete work up as soon as possible. A psychiatric appointment would only be indicated if all else is negative and as a last resort. Interestingly one possible cause for bipolar disorder (manic-depression) is mini seizures in the limbic system which is the emotional center of the brain. These often have mood swings as their only symptom. Also many medications that treat seizure disorders are also effective for bipolar disorder. However in this case the 'fainting spells' which come out of the blue, are preceded by an aura (a sensation that something is about to happen) and followed by fatigue and sleep are absolutely classic for a seizure. And this is typically easy to treat. One final note is that sometimes even after the seizure disorder is under control there still needs to be further treatment for a residual psychiatric condition. Good luck.