Locker-Room Consultation
Chelmowski was beginning to worry that he was never going to figure it out. Early one morning, at his usual spin class, he found himself on a bike next to an old friend, George Morris, who was a neurologist specializing in seizure disorders. Could these weird episodes be seizures? They weren’t like any seizures Chelmowski had ever heard of, but who knows? In the locker room, he approached Morris. “Have you ever heard of seizures characterized by profuse sweating?” he asked. He outlined the patient’s story. Morris nodded his head as he listened. Yes, he had several patients who sweated like this. Chelmowski should send the patient to his clinic to be tested.
A few weeks later the patient went to the epilepsy center at Aurora St. Luke’s Medical Center, where Morris was medical director. A 20-minute electroencephalogram was normal. If these were seizures, Morris told him, there was a good chance that they would show up on the EEG only when he was having one. They arranged for the patient to return before his next expected day of sweating. It took about an hour for the electrodes to be placed onto his head for the EEG. He could almost cover the whole array with a baseball cap. He didn’t usually wear one, but it was better than walking around with a head full of wires for all to see. Every morning a technician would come to his house to download the data. He was supposed to be hooked up for seven days, but when no sweating episodes happened, they gave him another weekend. And finally, his long-awaited day of sweating occurred.
A couple of days later he got a call. These were seizures. They originated on the left side of his brain, just behind the ear, in what is known as the temporal lobe. A seizure is an episode of abnormal brain activity, and the temporal lobe is in close communication with the autonomic nervous system, which can trigger sweating. Days later, he went back to the center to see Morris and start medications to stop the seizures. He asked the doctor why the episodes came every month. Morris just shook his head. Some seizures have this kind of rhythm. They can be any number of days apart, but a 20-to-30-day cycle is the most common. No one is sure why. It took a while for the patient to get on the right medications at the right dose, but once on it, his seizures stopped. He hasn’t had one in nearly five years.
The patient doesn’t know why he started getting seizures at age 58, although he wonders whether it’s linked to a car accident he was in when he was 10 or 11. He was riding in the front seat in the days before seatbelts and smashed his head on the steering wheel. Maybe, Morris told me. That kind of injury can cause seizures many years later. The injured neurons cause abnormalities in surrounding brain cells, which may, eventually, trigger the abnormal activity that results in a seizure. But epilepsy, as recurring seizures are called, often starts in late middle age. Morris attributes it to cerebrovascular disease — what others call ministrokes.
This patient isn’t buying it. He still traces it all back to a head-on collision resulting in a close encounter with a hard plastic steering wheel.
Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share, write her at Lisa.Sandersmdnyt@gmail.com.