First Seizure

Abstract

22-year-old man was referred to Neurology outpatient clinic for an isolated epileptic seizure. Seizure occurred in sleep. He was a keen athlete (footballer and rugby player) with no history of any previous illnesses. Seizure occurred in the morning hours on a Sunday. He admitted that the day before he had travelled to capital for an international football game (as a fan, not a player) and since noon had not eaten well and drank some beers (approx. 15 units) between 1 pm till approximately 8 pm. He arrived home around 11 pm and despite feeling hungry he did not eat. He went to bed at 2 am. Around 6 am his girlfriend felt that the “bed was shaking” and she heard a thud as patient fell from his bed. There was whole body jerking which settled after 2–3 minutes. There was convincing postictal phase lasting 15–20 minutes. He remembered paramedics being in his room (so amnesia was not longer than 20 minutes). There was no incontinence or bitten tongue. He was found to have low sugar (2.1 mmol/l). When questioned he did not mention any collateral family or personal medical history suggestive of epilepsy or genetic problems (no illnesses “running in the family”). His girlfriend mentioned that for last 6 months he had had intermittent left hand jerks he can not control but they were of no concern to him. These jerks were always on one side. Neurological exam was completely normal.